This examination is best carried out lying on the back with the knees well bent and held wide apart. With good light and a large hand mirror, the external vagina and its component parts can be visualized easily.
Fig. 111. Much of the female genital system, excluding the vagina, is within the abdomen. Only the vaginal entrance is visible externally, without the aid of instruments.
1. Examine the skin of the vulva, the labia majora and minora, surrounding and enfolding the entrance of the vaginal vault. Note any irritation, redness, ulceration, or sore on these skin structures, along with areas of drying, leathery whitening or skin cracking. These possibilities may mean leukoplakia or cancer of the vulva.
2. Feel the labia themselves, and note any one-sided ball-like enlargement under the skin, creating a bulge which may possibly be sore. An enlargement here may be a Bartholin cyst.
3. Look closely at the condition of the urinary exit, the dimpled-like opening just inside of the entrance into the deeper vagina. Observe any polyp-like reddened or bleeding growth about it. The possibility here is a urethral
polyp or caruncle.
4. Examine closely the entrance of the true, or deep vagina. An irritated blanched and cracking skin, covered possibly with a coating of pus or streaked with blood, is the appearance of vaginitis when it occurs.
LABIA MAJORA
CLITORIS
LABIA MINORA
ORIFICE OF VAGINA
URINARY OPENING
Fig. 112. External female genitalia include only the unimportant skin folds about the vaginal entrance. The urinary tract exit is visible recessed into this region. Most diseases of the external genitals are not serious.
5. With a hand separating the labia on each side, strain with great effort as in child birth or at stool, and note any balloon-like or other structure from the vagina coming into view. Such structures may be a fallen bladder, called a cystocele, a fallen uterus, called a prolapsed uterus, or a fallen rectum, called a rectocele.
6. After gentle soap and water cleaning of the vagina and hands, insert one finger into the vagina and feel the rounded cervix, high in the vaginal vault. Normally, the tissue here is soft and smooth, and any grossly rough, ir
regular or bleeding areas may include the possibilities of cancer or cervicitis.
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