Vaginal examination - examination by a gynecologist. Home birth through the eyes of an obstetrician-gynecologist

You can still hear stories about how “dangerous” it is to give birth, what terrible torments it is, what a threat a woman who decides to become a mother exposes herself to. Oddly enough, but these stories most often come from women who have one or two children. It is difficult to understand what is more in their stories: the desire to appear in the eyes of nulliparous women as a kind of "heroine" who does not care about anything, memories of the actual complications that accompanied their birth, or latent jealousy for those who also want to have children? Be that as it may, such “passions” do not contribute to an increase in the population, just as “warnings” like: “If you give birth to a child, consider that your youth is over. Why do you need to rush with a child? your pleasure!" And many women, having heard a lot of terrible stories and good "warnings", actually begin to live "for their own pleasure."

We adhere to the point of view that a young family "without a child is a flawed family that robs itself of the greatest pleasure - the happiness of raising a child. In addition, a childless family is, as a rule, a fragile family, spouses in such a family are not bound by common responsibility , a common concern for the child, and therefore easily part at the first encounter with difficulties.

In Czechoslovakia, there is another trend that does not contribute to the creation of harmonious families: an increasing number of marriages concluded not for love, but because the young showed negligence and the partner became pregnant. In such "forced" marriages, of course, the child is perceived as an unfortunate misunderstanding that has made life difficult for the young, and one cannot count on the fact that the child will receive from his parents everything that he can and should receive for normal development.

Both the fear of having a child and the view of the child as a burden ultimately turn against the child, against the young family, and against society as a whole. The child, of course, should be welcome in the family. And a child can become desirable only in a family where partners love each other, where both a man and a woman have determined their place in life, where, in addition to these two conditions, at least an elementary material base has been created. That is why we, while opposing marriages concluded for mercantile reasons, at the same time warn young people against too hasty marriages, concluded in a state of first blindness to each other.

The time most favorable for the birth of the first child is for a woman between twenty and twenty-eight years (deviations of one year in either direction are permissible); the second and subsequent children can be born without any health risk even after twenty-eight years. Here, however, exceptions are possible. Due to a number of reasons (for example, long-term infertility, for which a woman was treated), the first pregnancy can occur at the age of 35-40, and gynecologists know cases when pregnancy in middle-aged and older women proceeded and was resolved by quite normal childbirth. At this age, of course, there are certain complications that modern medicine successfully copes with, but at least we do not see good reasons why a woman who has crossed the twenty-eight-year mark would consider herself unable to give birth to a child. We only want to warn against the birth of a child women who have not reached twenty or at least nineteen years. The point here is not only that pregnancy at an early age can occur with complications; the fact is that a woman who is too young is not yet prepared physically, spiritually, or materially to become a mother.

We do not share the point of view of those psychologists who consider childbirth as a state of shock for a woman. In no doubt, pregnancy, like childbirth, leads to a restructuring of not only the woman's body, but also her psyche. Much here depends on the individual characteristics of the psyche of each woman. In an impulsive woman who does not adapt well to the environment, pregnancy can actually occur with certain complications, while in a woman who is balanced, with a normal state of mind, complications are extremely rare. It also depends a lot on the woman’s environment, on whether her husband is attentive or inattentive, whether she has friends, how her parents treat pregnancy, etc. In this sense, a woman, of course, must be prepared primarily psychologically, then and psychologists will have no reason to consider childbirth as a shock, and women themselves, properly prepared for childbirth, will not experience any shock conditions.

Fertilization

Pregnancy begins with the fertilization of a mature female reproductive ovum, or simply an egg, with a male reproductive cell, or sperm.

The very word fertilization, or syngamy (from the Greek syngamos - connected by marriage), means the fusion of male and female germ cells, resulting in the formation of the so-called zygote (from the Greek zygotos - connected together), capable of developing into a new independent organism. Fertilization is widespread in nature and is inherent in both plants and animals, as well as humans. It should be noted that fertilization underlies only sexual reproduction and ensures the transmission of hereditary traits from parents to offspring (we will talk about the transfer of hereditary traits from parents to children a little later).

Our task, of course, does not include consideration of the entire diversity of fertilization inherent in both the plant and animal worlds (those who wish to become more familiar with this issue, we refer to the special literature). We will consider only the process of fertilization in humans, and even then we will touch on this issue briefly, of necessity, so that our readers can imagine the essence of the process of fertilization and which organs are involved in it.

In the abdominal cavity of a woman, on both sides of the uterus, B are the ovaries. Once a month, in the middle of the menstrual cycle, only one egg matures in the ovaries, which separates from the ovary and enters the uterine, or fallopian, tube. Occurs, as gynecologists say, ovulation.

Here, a mature egg is located for no more than a day, slowly moving towards the uterine cavity. Fertilization occurs right here, in the fallopian tube, where male sex cells - spermatozoa - penetrate through the vagina and uterine cavity.

The nucleus of the egg, which can only connect with one sperm, is surrounded by a crown. If a mature egg retains vital activity for no more than a day, then spermatozoa have the ability to fertilize up to two to two and a half days.

From the moment of connection of the spermatozoon with the nucleus of the egg, a complex process begins, which has not yet been fully studied. The fertilized egg divides in two, each of the halves of the egg divides into new halves, the egg growing in this way begins to resemble a miniature raspberry in shape, which, continuing to grow, turns into a human embryo.

Start of pregnancy

A woman, of course, cannot know exactly when fertilization occurred and whether it happened. The absence of another menstruation indicates the beginning of pregnancy. If the delay or absence of menstruation is not caused by any other reasons, then a woman, subtracting 14 days from the day of the expected start of menstruation, can determine the onset of pregnancy with an accuracy of two to three days.

However, a delay in the onset or absence of menstruation does not necessarily serve as a "signal" of pregnancy. The menstrual cycle in a woman can also be associated with other reasons: a general deterioration in health (anemia, diabetes mellitus), mental disorders (depression, anxiety), extinction of the function of the reproductive system (menopause).

If menstruation does not occur within two weeks after the expected date, a woman should contact a gynecologist who will determine exactly whether pregnancy has occurred or not. (You should also see your gynecologist if you experience pain in your lower abdomen.)

Physical changes during pregnancy

The human embryo begins to live and develop at the expense of the mother's body, which in turn adapts to the changes that have taken place in it. The fetus receives oxygen and food along with the mother's blood and returns decay products to the mother's blood. So that the fetus does not experience any inconvenience during its development, it is surrounded by a liquid called amniotic fluid. These waters are expelled from the mother's body during childbirth.

A woman's first physical change during pregnancy is her growing belly. The size of the abdomen does not indicate, however, the height and weight of the fetus, and even more so that a woman may have twins or even triplets. Of course, the belly of a woman carrying twins is larger than the belly of a woman who is expecting one child, but the size of the belly as a whole depends on the individual characteristics of the structure of the body, and in different women in the same stage of pregnancy, bearing a fetus of the same height and weight, the size of the growing belly can be different.

The breast of a pregnant woman also increases in size due to the intensive growth of the mammary glands, the nipples swell and darken, from which a few drops of a thick translucent liquid may stand out already in the first weeks of pregnancy. A few months later, even before the onset of childbirth, this liquid will acquire a yellowish tint. This is not actually breast milk, but the secret of the mammary gland, known as colostrum. Compared to milk, colostrum contains more proteins, fats and mineral salts and is an indispensable nutritional food for newborns.

Another physical change occurs in a pregnant woman, which gives her a lot of grief: the skin turns dark in color on the abdomen in the navel and on the face. So-called pigment spots appear. They should not be frightened, they will disappear without a trace five to six weeks after birth.

More serious changes can affect the blood vessels of a pregnant woman: she may have hard-to-touch vein nodules on her legs, and hemorrhoidal bumps may appear in the anus. Such changes are usually observed in the last stage of pregnancy, and women at this time are advised to rest more often either lying down with pillows under their feet to reduce blood flow to them, or sitting with their feet on a bench.

Some young women who are about to become mothers may be intimidated by our story. However, we must reassure such expectant mothers: nothing unusual is happening to you, it’s just that your body adapts to new conditions for it, and after childbirth everything will return to normal and you will become even nicer and more beautiful than you were before pregnancy. It has long been noted that motherhood is beneficial to the appearance of the vast majority of women, and in this sense, of course, you will not be an exception.

Women's consultations

Having determined the time of pregnancy with the help of a gynecologist, the expectant mother should register at the antenatal clinic closest to her home and undergo regular examinations there. Experienced doctors will help you get rid of many of your possible fears; they will also monitor the normal course of your pregnancy. At the first warning signs, you will be hospitalized or given outpatient treatment, but in any case, you will be helped to carry the fetus until the time when you can have a normal healthy baby.

Your good health during pregnancy should not serve as a reason for you to stop visiting the antenatal clinic. You should visit this health facility throughout your pregnancy on days and times as determined by your healthcare provider.

Child's estimated birthday

Every pregnant woman begins to calculate the days when she will have a baby. Only a specialist doctor can determine the exact date of birth of a child. However, given your natural desire to know the expected birthday of the child, we will help you to do it yourself with a greater or lesser degree of accuracy.

Pregnancy lasts an average of 280 days, or ten lunar months. Usually European women living according to the Gregorian, or solar, calendar, are confused by this term - "lunar month" (it is also called "obstetric month"). But the female body does not live according to the solar calendar, as, however, strictly speaking, and not according to the lunar calendar. A woman's menstrual cycle takes an average of 28-30 days, that is, about one month, while the number of days in each of the months of the Gregorian calendar is not constant and ranges from 28-29 to 30-31 days. The lunar month is just over 29 days and thus is more applicable to the rhythm in which the female body lives, and therefore we are talking for greater accuracy not about nine months of the solar calendar, but ten months of the lunar calendar in relation to the average duration of pregnancy.

How to determine the date of birth of your child, "reconciling" the lunar calendar with the solar (or, as it is also called, tropical) calendar? Remember when you had your last period before pregnancy. Subtract three months from the first day of the last menstruation and add seven days to the resulting number - this will be the expected date of birth of your child. Suppose a woman's last menstrual period began on October 17th. October is the tenth month of the Gregorian calendar. We make a calculation: X-III \u003d VII. The seventh month in the Gregorian calendar is July. Now, by July 17, we add seven days and get 24. Therefore, the expected birthday of a child for a woman whose last menstruation began on October 17 of the past year will fall on July 24 of the next year. (In general, we strongly recommend that women who are about to become mothers keep an individual schedule of the menstrual cycle; after all, menstruation in different women happens not only once every 28-30 days, but can also occur according to the so-called shortened cycle and fall on days 21-24 or even exceed 30 days.)

If you haven't kept records and can't remember when your last period was, you can figure out your baby's expected birthday in a different way. When you feel the first movement of the fetus, add 20 weeks to this day (women who have given birth before can feel the movement of the fetus on average two weeks earlier than women who have become pregnant for the first time, so they must add 22 weeks to the first push of the fetus). However, this method of determining the probable birthday of a child, as you can see, is less accurate.

The course of pregnancy

Different women experience pregnancy differently. Everything depends on the general physical condition of the pregnant woman, on her character, mental balance, family situation and a host of other reasons, which at first glance may seem insignificant, but which, nevertheless, can have a very noticeable effect on a pregnant woman. It also matters how a woman herself relates to her pregnancy. It is clear that a woman living in a happy marriage and wanting to have a baby will treat her pregnancy differently than a woman who constantly quarrels with her husband or becomes pregnant out of wedlock.

In any case, we urge all pregnant women to inner peace, try to evoke positive emotions in themselves (it is not at all difficult to do if you listen to your favorite music recordings or reread your favorite books), not to succumb to mood swings that pregnant women really do not are stable.

Try to think more about your future child, about what name you will give him, how you will take care of him, what fairy tales you will tell - in a word, do not let anxiety or fear develop in yourself.

By the fourth month of pregnancy, some mental instability and internal anxiety usually give way to a calm balance, but in the last months there may again be a feeling of fear and anxiety before the upcoming birth, the expectation of pain that accompanies childbirth, other undesirable sensations. Share your concerns with your doctor - modern medicine knows many ways and means, including psychological ones, that will help you regain peace of mind.

Husband and other relatives of the expectant mother, as well as her friends, can do a lot to create a good mood for a woman who is in the last months of pregnancy. A woman should approach the birthday of her child calmly, confident in the happy outcome of her pregnancy, with the feeling that from now on she cannot imagine her future existence without a child whom she will love with all the strength of her soul and heart.

Nutrition of a pregnant woman

Of great importance for the normal course of pregnancy is the nutrition of a woman. It is noticed that pregnant women begin to feel the need for one dish, and from the sight of another dish that they used to love, they develop nausea. When compiling the menu of a pregnant woman, we advise you to adhere to the following simple rules:

a) food should be varied;

b) give preference to foods that are not too high in calories in order to avoid excess weight;

c) the menu should be dominated by fresh fruits and vegetables, especially those that contain vitamin C;

d) spicy spices should not be included in dishes;

e) try to avoid legumes that cause bloating;

f) eat boiled dishes more often, which are easier to digest;

g) be sure to include milk and dairy products (at least 1/2 liter) in your daily diet.

It should be avoided by a pregnant woman

Many modern women are accustomed to drinking strong natural coffee in the morning (some women do this several times during the day). Avoid this habit during pregnancy, as the caffeine in natural coffee increases blood pressure. For the same reason, give up strong tea, which dilates the vessels of the brain and heart. During pregnancy, rosehip decoction will benefit you the most.

In no case do not smoke! The nicotine contained in tobacco can act as a powerful poison on the fetus.

It is unnecessary to talk about this specifically, but in all seriousness it should be recalled that the strongest and extremely dangerous poison for the normal development of the fetus is alcohol, which should be completely excluded from the diet of a pregnant woman, even in microscopic doses.

Some pregnant women complain of poor sleep, irritability and other ailments, and therefore prescribe sleeping pills and sedatives on their own. Self-treatment is generally unacceptable, and especially during pregnancy. Take only those medicines and in such doses as your doctor has prescribed for you.

Chair

Literally two words about the chair of a pregnant woman. Empty your bowels at the same time every day. To avoid constipation, move more, eat fresh fruits with skins and vegetables. It is useful to drink a glass of water at room temperature on an empty stomach. If you have difficulty with stool, see your doctor.

Clothing and footwear

The clothes of a pregnant woman should be spacious, so as not to hamper movements, and correspond to the season. Avoid wearing clothes that are tight and uncomfortable, too warm or, conversely, unseasonably light. The shoulders of the bra should not cut into the body, and the cups should be chosen so that they do not compress the chest. You can find many models in fashion magazines, from which it is easy to choose the style that suits you best. However, stores always have a sufficient assortment of inexpensive dresses for pregnant women, which are suitable for both home and street.

The shoes of a pregnant woman should also be free and comfortable. We do not recommend wearing flat shoes during pregnancy, which can develop flat feet, but the heel should not be too high. Before going to bed, it is useful to stretch and massage the soles of your feet to relieve them of the tension that has accumulated during the day. You can do this with the help of your husband, or you can do it yourself, raising and lowering a handkerchief or pencil from the floor with your toes. A few minutes of such exercises will remove any fatigue from your legs.

Dental care

The fetus developing in the womb of a woman needs a large amount of phosphorus and calcium, which goes to the "building" of bones. It receives these components necessary for the embryo, naturally, from the mother's body. It is not surprising that a pregnant woman who does not watch her mouth may miss one or even several teeth by the end of her pregnancy.

That is why it is important to visit the dentist's office in the first weeks of pregnancy. Throughout pregnancy, do not forget to take good care of your teeth, eat more fresh fruits and vegetables, drink milk, include lemons and oranges in your diet, fish oil and other foods containing phosphorus and potassium are very useful.

At the first sign of tooth decay, contact your dentist.

Outdoors and body hygiene

Pregnant women should spend at least two hours a day outdoors. In summer, sunbathing is useful, which contributes to the production of vitamin D in the body. However, you should be aware of the danger of sunburn, so do not spend more than 5 minutes in the hot sun. In the following days, you can increase the time spent in the sun and gradually bring it up to 20 minutes, a longer stay is harmful to everyone, including pregnant women. Make sure that your head is covered with a scarf, and for women prone to freckles, wide-brimmed summer hats are suitable.

Pregnant women sweat easily. We recommend a cool shower in the morning and a warm shower in the evening, remembering to place a rubber mat on the bottom of the tub first to prevent slipping. Hot showers, like hot baths, are contraindicated for pregnant women. Women who do not have their own bath should wash over the basin with soap and a washcloth.

We are often asked if a pregnant woman can swim in open water in summer. If the water in the reservoir is clear and warm, you can swim, but only in the presence of a husband or people who can swim well. In closed reservoirs, devoid of natural channels, we do not recommend swimming either for pregnant women or for women who have recently given birth to a child, in order to avoid pathogenic microbes entering the internal genital organs.

The breasts of a pregnant woman require special attention. In addition to morning and evening washing, you should lubricate the nipples twice a week with baby cream, which can be purchased at any pharmacy or perfume department of stores. Flat or sunken nipples should be massaged more often to firm them up.

Pregnant woman cosmetics

A woman always remains a woman, even when she is expecting a child. There are no contraindications against the use of cosmetics during pregnancy.

However, we would like to draw your attention to the following circumstance. The skin during pregnancy releases an increased amount of oil, so we recommend washing your hair at least once every five days. When washing your hands, use a special brush or an ordinary toothbrush with soap and water so that your nails are always kept clean.

The rest depends on your tastes and habits.

Physical exercises

We have already talked about the colossal energy that a woman expends during childbirth. To prepare the body for these enormous loads, a pregnant woman should pay the most serious attention to physical exercises, aimed primarily at strengthening the muscles of the abdomen, legs and hip joint. A well-prepared woman's body will more easily endure the upcoming birth, and in some cases will significantly reduce the sensation of pain. The most effective set of physical exercises that are suitable for your body, you will be helped to make in the antenatal clinic, in which experienced doctors carefully monitor the course of your pregnancy. Some antenatal clinics have created special sports halls where pregnant women do physical exercises under the supervision of doctors or physical education instructors trained for this purpose.

Physical exercise is contraindicated only for women who are threatened with premature birth. In such cases, the supervising physician acts in accordance with the rules that exclude or minimize the risk of preterm birth.

When a woman has twins

The closer the day of the expected birth gets, the more often the woman looks anxiously at her stomach and asks the doctor who observes her, or her husband: "Is it possible that I will have twins?"

Of course it can. And now we will tell you in what cases twins are born.

In the chapter "Fertilization", which is part of the chapter "Motherhood through the eyes of a gynecologist", which you are now reading, you must have noticed one "inconsistency" that we did not specifically dwell on. There, we recall, it was about the fact that in the abdominal cavity of a woman there are two ovaries, and once a month, in the middle of the menstrual cycle, only one egg matures. Meanwhile, there is no "inconsistency" here, just nature once again showed its wisdom, taking care not only of the woman's health, but also of replenishing the human race.

Let's explain what is meant here. Under normal conditions, the egg matures once every four weeks in only one ovary - the right or left. In the next menstrual cycle, the ovary, which has already produced one egg, sort of rests, and the second ovary produces a new egg. So they function alternately throughout the entire period of a woman's maturity. However, there are cases when nature would definitely "feel" that the human race is threatened by a reduction, or boys began to be born more than girls, or, on the contrary, the number of girls began to outstrip the number of boys born, and then she "intervenes" in the woman's body, and the ovaries no longer alternately, but both at once produce one egg each, or one ovary produces two eggs, while the second ovary "rests", or one ovary produces one egg, and the second two at once, which happens much less often; the ovaries can produce even four or five, and in exceptional cases even more, mature eggs, and all of them will be fertilized (of course, you remember that each egg is fertilized by only one sperm, although each portion of sperm contains a huge number of vital spermatozoa). Then a woman can give life to two at once, and in exceptional cases to more children.

Twins born from different eggs are no more similar to each other than siblings born at different times are similar to each other, and at the same time they are of the same or different sexes. Such twins are sometimes called fraternal twins.

But that's not all. The ovary can produce an egg, which after fertilization will give not one, but two embryos. This happens in nature much less frequently than the birth of fraternal twins, but it still happens, and then twins are born, like two drops of water similar to each other and, moreover, endowed with the same character traits. At the same time, it is curious to note that twins in this case are always born same-sex - either only boys, or only girls. Such twins are also called identical twins.

Of course, you are interested in how often twins are born? Infrequently. On average, one twin accounts for 80-85 singleton births, triplets - already for 6-8 thousand births, but a greater number of twin children are born, as we have already said, in exceptionally rare cases.

It should be noted that the probability of giving birth to twins is higher in those women whose mothers or even more distant ancestors were themselves twins (the same applies to men who either themselves or their ancestors were twins).

Boy or girl?

And, of course, every pregnant woman wants to know: who will be born to her - a boy or a girl? We will try to answer this question, having figured out in which cases boys are born, and in which girls.

Each human body is made up of many billions of cells, and each of these billions of cells contains 46 chromosomes, connected two by two into 23 pairs of chromosomes, approximately the same in shape and size. In women, all 23 pairs of chromosomes are the same, and since these chromosomes resemble the Latin letter "X" at a very strong increase, they were called the X chromosome. In men, only 22 pairs of chromosomes are the same (i.e., only 44 X chromosomes), but the last, 23rd pair of chromosomes consists of one X chromosome and a second Y chromosome, so named because with a strong When enlarged, it resembles the Latin letter "Y".

Mature male and female germ cells consist of the same chromosomes as any other living cell of the human body, but it no longer contains paired, but single chromosomes, that is, a total of 23 chromosomes (in this sense, it would be more correct to call germ cells not actually cells, but half-cells, as if "sawed" in half along all 23 pairs of chromosomes, however, we will not confuse the established terminology). Moreover, if the female germ cell, having “taken” only one X chromosome from each pair of chromosomes, naturally “takes” the X chromosome from the last, 23rd cell, then in the male germ cell one of the two X- or The Y-chromosomes contained in the afterbirth, the 23rd pair, turns out to be "superfluous", and the spermatozoon "chooses" either the X-chromosome or the Y-chromosome as the last, 23rd chromosome.

When the female and male germ cells merge, a new living full-fledged cell is formed, containing in total the same 46 chromosomes as any other of the billions of cells in our body, connected by two into 23 pairs of chromosomes. Now, we believe, it will not be difficult for you to guess that if the spermatozoon contained the last, 23rd X chromosome, then the embryo of a girl arises, and if the Y chromosome, then the embryo of a boy arises.

From the figure we have presented, where the last, 23rd pair of chromosomes is depicted against each human figure, it is clearly seen how in one case a boy arises from the combination of X and Y chromosomes, and how a girl.

It remains to be added that all 23 single chromosomes contained in both female and male germ cells carry "information" about their owners, including even such information as the characteristics of their characters. It is not surprising, therefore, that a newly formed living fertilized cell, already containing 23 new pairs of chromosomes, inherits all the features of its parents: their appearance, character traits, and so on. A child can inherit both the strengths and weaknesses of the parents (the "strong" side does not necessarily become the father), and then he will look more like a father or a mother; if both parents are strong or weak, then the child is not like either the father or the mother, but represents something in between. Unfortunately, the child inherits not only the appearance of his parents and their character, but also some hereditary diseases that one or both of the parents suffer from and which they, in turn, inherited from their ancestors. That is why it is important for young people to undergo a medical examination before entering into marriage. We advise you to do this not in order to "humiliate" one of the partners: you will simply know in advance whether healthy children will be born to you or whether they will inherit some diseases that some people may not even know about. If one of the partners turns out to be a carrier of a hereditary disease, modern medical achievements will help him to recover (which is important for the health of the partner himself - the carrier of the hereditary disease), and then the children will be born healthy.

However, we, having explained in which case a boy is born, and in which a girl, did not answer your main question: who exactly will be born to you?

We must confess to you with all sincerity: we do not know.

The question of whether we will have a boy or a girl will worry people from time immemorial. In one of the Berlin museums, a papyrus from the time of Ramses II (end of the 14th - middle of the 13th century BC) is kept, in which it is assured that in order to find out the sex of an unborn child, one should pour grains of barley and wheat with the urine of a pregnant woman ; barley will sprout before - a boy will be born, wheat will be ahead of barley - to be a girl. The ancient Egyptians were naive people, don't you think? To prove this, in the forties of our century, an experiment was carried out in accordance with the "recipe" of papyrus. And what? In 80 percent of cases, the recommendation of the ancient Egyptians was confirmed!

In the past, in the 19th century, scientists came up with not one, but a round score of 250 ways to determine the sex of an unborn child. Unfortunately, none of them proved to be true in practice. In this century, careful studies of amniotic fluid and fluoroscopy have been applied, but, alas, they have not yielded any results.

Or maybe it's good that there are no reliable ways to determine the sex of an unborn child? Maybe Nature needs it so much that for every 100 girls 106 boys are born? Maybe, in fact, a person should not interfere in this secret of Nature, which she carefully guards from us in the belief that she will be able to save the human race better than we ourselves will be able to do it for her?

childbirth

Do not rush things, everything, as they say, has its time. So we have come to the consideration of the most complex physiological act of expulsion of the fetus and afterbirth from the uterine cavity, well known to everyone under the name of childbirth.

Indeed, childbirth is a most complex physiological act, which in turn consists of three periods: the opening of the cervix, the expulsion of the fetus and the birth of the placenta. It is in this sequence that we will consider the process of childbirth.

Opening of the cervix. This period begins with rhythmic contractions of the muscles of the uterus, sometimes called labor pains. With the advent of the first contractions, a pregnant woman, in fact, is no longer pregnant, but a woman in labor (after the end of childbirth, a woman in labor becomes a puerperal, but when she is discharged from the maternity hospital and she, happy, returns to her family, she is already a young mother. However, we are somewhat ahead of events). The first contractions are short - 20-30 seconds, no more - they seem to prepare the body of the woman in labor for the onset of childbirth. The time intervals between the first contractions are also significant - the body of the woman in labor must not only prepare for the upcoming birth, but also rest and gain new strength. Thus prepared, the body begins to experience new contractions - lasting up to 45 seconds, and the intervals between them are reduced from thirty to twenty, then to fifteen, ten, five, and, finally, are only two or three minutes. With the increase in contractions, the cervix opens more and more, preparing to release the fetus from the uterus.

Amniotic fluid rushes into the slightly opened cervix and pours out. At this time, the fetal head is pressed against the chest, which reduces pressure on the brain, and the fetus itself falls closer to the vagina: The first stage of labor lasts from 3-6 hours and can reach 11 or more hours. The first stage of labor ends with the full opening of the cervix.

It is important that throughout the first stage of labor, the woman in labor should try not to strain, breathe deeply and only through the nose (when breathing through the mouth, the lips, tongue and mucous membrane of the larynx dry out, which makes the woman in labor feel thirsty). You should not be afraid of anything, nature has foreseen everything in advance and gave you great strength, try to relax - a relaxed body will more easily cope with its duties when the second stage of childbirth begins.

Expulsion of the fetus. The second period, in fact, has already come after the full disclosure of the cervix. The regular contractions of the uterus in the first stage of labor in the second period are joined by the so-called attempts, or contractions of the muscles of the uterus with simultaneous contractions of the abdominal muscles and diaphragm. The fetus moves into the vagina and gradually comes out.

The second stage of labor is painless for the woman in labor and lasts no more than an hour, and for some women it takes only 15-20 minutes. Experienced doctors and obstetricians will constantly be near you, they will accept your child, slap him lightly on the ass, the child will startle from an unexpected slap, his lungs, which were in a "folded" state, will "open", air will rush into them, causing pain to the child , he, instinctively defending himself, will “compress” his lungs again, the child will scream in pain, and at that very time, as you might have guessed, his breathing will begin to function - inhalation, exhalation, a new inhalation and a new exhalation, which will henceforth accompany him throughout his life. The baby will be laid on a blanket, the umbilical cord will be bandaged, the excess will be cut off (don't worry about the baby - there are no nerves in the umbilical cord, so your baby will not feel any new pain) and a mark will be made on your child so as not to confuse him with another baby.

The birth of the afterbirth. Does this mean that in the second period, with the birth of a child, the process of childbirth ends? No, it does not mean that the woman in labor must also expel the afterbirth from herself.

What is the afterbirth and why should it be expelled from the uterus? The placenta consists of the placenta (i.e., the organ that carried out the connection between the mother's body and the embryo during fetal development), fetal membranes and the umbilical cord. They have fulfilled their function, intended for them by nature, and now they have become superfluous in the body of the woman in labor.

20-30 minutes after the birth of the child, the woman in labor will begin contractions again - contractions of the muscles of the uterus, abdominal muscles and diaphragm - and the afterbirth will be expelled outward without any pain.

The woman in labor is given the opportunity to rest for two hours, she, as a rule, falls asleep, and wakes up not as a woman in labor, but as a puerperal. That, in fact, is all that we wanted to tell you about childbirth.

Feet forward baby birth

In the vast majority of cases, the fetus in the mother's womb develops head down. However, there are times when the fetus develops head up.

In this case, during childbirth, the legs of the child appear earlier, and not the head. There is nothing unnatural in such a birth of a child. True, with this position of the fetus, the first stage of labor is somewhat lengthened, when the cervix opens, but otherwise, as in the case of the birth of a child head down, experienced doctors and obstetricians will help you. There is absolutely no reason to fear for the normal outcome of childbirth, when the fetus in the womb is head up.

Newborn weight and height

What mother does not want to have a healthy normal child! But if everything is more or less clear with the concept of healthy, then in the definition of the concept of normal there is a big disagreement of opinions.

It is quite normal when twins (not to mention triplets and more children born) are inferior in height and weight to singleton children, this is not surprising, and healthy twins quickly catch up in both height and weight of their peers.

Normal singleton newborns reach 50 centimeters in height and weigh 3300 grams. Deviations in one direction or another are acceptable.

postpartum period

It remains for us to say a few words about the postpartum period, when a woman returns from the maternity hospital to her family.

The greatest grief in the first postpartum period for women is delivered by an enlarged and limp belly. The abdominal muscles should be strengthened not only with special belts, but also with a set of physical exercises, which you will be introduced to in the maternity hospital. They will help you restore the previous shape of the abdomen and in the antenatal clinic, where you applied during pregnancy.

Colostrum, secreted from the mammary glands during pregnancy and so necessary for your child in the first days of life, will gradually be processed into regular breast milk, which contains all the necessary substances for the normal development of the child.

Six weeks after giving birth, a young mother should definitely visit a gynecologist. The doctor will carefully examine you to make sure that the postpartum period went well for you, and if necessary, will provide you with timely and effective medical care.

Protecting themselves from unwanted conception with a condom, 15 out of a hundred women become pregnant within a year. That is why the number of "fans" of this method of contraception is constantly decreasing. Unfortunately, condoms often break.

2. Coitus interruption: at its peak

According to a study conducted by Bayer in the fall of 2014, 6% of women still consider coitus interruptus to be the most effective method of contraception! And they are wrong.

The pre-semen fluid, which is released at the beginning of sex for lubrication, can contain from 10 to 20 million spermatozoa. Not a single man is able to “keep” the first portion, which means that the most agile sperm can get to the egg and fertilize it. In addition, this method of contraception violates the natural mechanism of sexual intercourse and has a bad effect on both partners. Regular intrusion into natural satisfaction over time leads to frigidity in women, impotence in men, or a sharp decrease in libido in both.

3. Douching with acidic solutions

For contraception, douching with acidic solutions (citric acid, herbs) is used, since they are detrimental to spermatozoa. But the action of such solutions can adversely affect the condition of the mucous membranes of the internal female organs, cause an allergic reaction, wash off the natural lubricant, provoking a change in the microflora and uncontrolled reproduction of harmful microorganisms.

4. We measure the degree of sexual life

Calendar, cervical and symptothermal methods of contraception are based on monitoring the temperature in the rectum, the condition of the cervix, the nature of vaginal discharge and other indicators. They, taken together and each separately, indicate the period most favorable for conception. So, in fact, they are rather methods of pregnancy planning, and not protection against it.

5. Contraceptive sponge: dubious effect

A contraceptive sponge is a small pad of polyurethane impregnated with substances that destroy spermatozoa (spermicides). In fact, it is a combination of mechanical and chemical methods. The sponge prevents the penetration of spermatozoa into the cervical canal and at the same time releases a composition that deprives spermatozoa of activity. Immediately before sexual intercourse, a woman should carefully insert a sponge previously moistened with water into the vagina and “wear” it for at least six hours after sex. The effectiveness of this method is rather low: 20-30 pregnancies occur annually in every 100 women using it.

6. Hormonal contraceptives

Now there are enough hormonal contraceptives on the market. They are divided into containing two types of hormones (progestins and estrogens), purely progestin and. The first and last are represented by several groups depending on the amount of estrogen - micro-, low- and high-dose.

Oral contraceptives reliably protect against pregnancy. The main thing is to choose the most suitable one with the help of a doctor and not violate his recommendations. Tablets should be taken daily, preferably at the same time. And passes for any reason - “husband left”, “forgot to buy”, etc. - have no right to exist. Hormonal contraceptives are compatible with most drugs, but not all. Some medicines can reduce the effectiveness of birth control pills. In order not to harm yourself, you should tell the specialist in time what exactly you are going to treat a cold, flu or some other disease.

To choose the best for yourself, reliable and safe contraceptive, you need to come for a consultation with a gynecologist. The doctor will determine relative or absolute contraindications, chronic diseases, allergies and bad habits, conduct a gynecological examination and, if necessary, prescribe additional tests. In particular, ultrasound, as well as consultations of narrow specialists, for example, an endocrinologist, if a woman has diabetes mellitus, and in case of varicose veins or hypertension, she will be referred to a cardiologist and a vascular surgeon. The independent choice of hormonal contraceptives is dangerous, because it can harm the body - the very side effects that it would be more correct to call the result of an inadequate choice of the drug.

In order not to experience discomfort during the examination, it is better to prepare for the visit in advance. Empty your bladder. The intestines, if possible, should also be empty. Otherwise, a gynecological examination, especially palpation

(examination of the state of the internal organs through the skin with your hands) will be difficult for the doctor, but painful for you. If you are sitting in line for a long time at the gynecologist, do not be too lazy to go to the ladies' room when your turn comes up to empty your bladder.

A woman going to see a gynecologist should remember the following:

• Before the examination, it is better to take a shower or bath and put on fresh clothes. At the same time, it is not worth rinsing especially carefully, since the doctor must see the vaginal microflora in a normal, “everyday” state. It is strictly forbidden to douche (to inject water, and even more so antiseptic substances into the vagina using a douche): firstly, douching will deprive the doctor of the opportunity to evaluate vaginal discharge, which is very informative for a specialist; secondly, a smear taken after douching will, to put it mildly, not be informative. It is not recommended to use special intimate deodorants or perfumes.
• The day before the visit to the doctor, exclude sexual intercourse, as a small amount of seminal fluid often remains in the vagina, which prevents a reliable analysis.
• The best period to visit a doctor is the first days after menstruation. During menstruation, it is not worth examining and further examinations, with the exception of extraordinary cases (for example, bleeding accompanied by severe pain).

Now in many modern clinics you will be offered a disposable diaper, but just in case, you can take at least disposable handkerchiefs with you, which will come in handy anyway, and they do not take up much space in your purse. From home, you can also grab socks so that, having prepared for the examination, you do not have to walk barefoot on the floor to the gynecological chair.

In addition, it is important to psychologically prepare yourself for a visit to the gynecologist, which is especially true for young girls. You need to understand that the doctor's questions about the intimate features and specifics of sexual life are due to medical necessity. At the same time, in order to successfully diagnose or treat, the answers should be as honest and detailed as possible. Remember that a specialist will never judge you for anything, but on the contrary, will try to help and explain any difficult points.

Survey progress

Gynecological examinations are carried out mainly in a horizontal position on a special gynecological chair that meets all modern requirements. The gynecological chair consists of the actual chair and footrests (slingshots). It is not difficult to sit on a gynecological chair. You lay a napkin on the surface on which you will sit, climb the steps onto the chair itself and lie down on it so that the buttocks are on the very edge of the gynecological chair (this position allows you to conduct an examination painlessly and get maximum information). Then you raise your legs one by one and place them on the stands so that the slingshots are in the popliteal fossa. Do not be shy or embarrassed to ask the gynecologist how to properly sit in the gynecological chair if this design is unfamiliar to you.

Before the examination, the doctor puts on disposable sterile rubber gloves, which are destroyed after pre-treatment in a special disinfectant solution.

Examination on a gynecological chair begins with an examination of the external genital organs. At the same time, the inner surfaces of the thighs are also examined, which makes it possible to identify varicose veins, abnormal pigmentation, the nature of hair growth, etc. Then - large and small labia, perineum. It is also important for a specialist to determine the condition of the walls of the vagina - whether they are lowered, whether there is pain when pressed. Be sure to examine the area of ​​the anus, which allows you to immediately identify the presence of hemorrhoids, cracks and some other disorders.

After the preliminary examination of the external genital organs is completed, the gynecologist proceeds to the internal examination, one of the main methods of which is examination with mirrors.

This type of examination is aimed primarily at identifying any diseases of the vagina or cervix. For all its simplicity, the method is very effective in terms of diagnostics. Depending on the situation, this type of research uses different types of mirrors: cylindrical, folding, spoon-shaped and some others. Mirrors are medical instruments made of metal (they are sterilized after examining each patient) or plastic (they are disposable, they are thrown away after a single use). Other medical instruments used are also single use (disposable) or sterilized after each patient. Mirrors come in different sizes, the doctor selects an instrument depending on the size of the vagina. Without mirrors, it is impossible to fully examine the vagina and the vaginal part of the cervix. Mirrors allow, on the one hand, to separate the walls of the vagina and see them, and on the other hand, they “untie” the doctor’s hands. That is, during the examination, the doctor can perform various manipulations. Folding mirrors are more often used (Fig. 1) - the doctor can use these tools without anyone's help, since there is a special lock on the folding mirrors to hold the mirrors open.

During the examination, the doctor pays attention to the following indicators: the condition of the walls of the vagina, the condition and physiological nature of the cervix, the presence of abnormalities such as ruptures, erosion (violation of the integrity or change in the structure of the mucous membrane covering the cervix), endometriosis (the appearance of foci of the inner membrane uterus - endometrium on the surface of the cervix) and, finally, the features of vaginal discharge (color, smell, volume, etc.). There are glands in the cervix that normally produce a secret. This secret is transparent, it is released with different intensity at different periods of the menstrual cycle. So, in the middle of the menstrual cycle, the discharge is more intense. During the inspection, you can evaluate the amount, color and nature of the discharge. The so-called "mucus tension symptom" can be evaluated. So, in the middle of the menstrual cycle, the mucus stretches well, it can be
pull out into a “thread” up to 10 cm. Thus, upon examination, you can even determine the phase of the menstrual cycle. In the presence of inflammation caused by different pathogens, different discharges can be observed. So, for example, with a candidiasis lesion of the mucous membrane (thrush), white discharges similar to cottage cheese are observed, with trichomoniasis, the discharge foams, and with gonorrhea, they are purulent. All this information is essential for an accurate diagnosis.

During the examination in the mirrors, material is taken for the study of a smear to determine the microflora of the vagina, as well as a smear from the cervix for a cytological examination - a study of cervical cells to detect cancer.

The next in order after the screening in the mirrors is one-handed or two-handed vaginal examination. In this study, the doctor determines the position, size, condition of the uterus itself, fallopian tubes and ovaries. With the help of a vaginal examination, it is possible to suspect endometriosis. Diseases such as uterine fibroids, inflammation of the appendages, ovarian cysts, ectopic pregnancy, uterine pregnancy, etc. are diagnosed.

A one-handed vaginal examination is performed by the doctor with one (right) hand. First, the labia majora are parted, and then the index and middle fingers are carefully inserted into the vagina. All manipulations are carried out with the utmost care, the woman does not experience any discomfort. The duration of the vaginal examination depends on the situation, on average it is several minutes. Using this method, you can determine such important parameters for health as:

• condition of the pelvic muscles;
• the state of large vestibular glands located in the thickness of the labia majora;
• condition of the urethra (urethra). With its inflammation, by squeezing out, you can get a discharge that is necessary for further analysis and diagnosis;
• the condition of the vagina, which is assessed by such characteristics as volume, extensibility, folding, the presence of any changes (for example, scars, etc.). In addition, it is necessary to determine the features of the vaginal vaults. So, with inflammatory processes in the uterus, the vaults can change their shape, become shortened, painful.
• condition of the cervix. Here, such characteristics as size, shape, surface features (smooth or bumpy), consistency (normal, softened, dense), mobility, and soreness are important. All these parameters provide great information both about the presence of any gynecological disorders and about the physiological characteristics of a woman's body, which must be taken into account in any life situations.

In turn, the two-handed vaginal examination is a continuation of the one-handed one and is mainly aimed at recognizing diseases of the uterus, uterine appendages and pelvic peritoneum. With a two-handed examination, one hand of the doctor is located in the vagina, the other - on the anterior abdominal wall.

One of the most important points in the study of the uterus is to determine its position. In a normal state, it is in the small pelvis. The body of the uterus is slightly tilted forward and up, and the lower, vaginal, part is turned back and down. In the event that the position of the uterus differs significantly from the norm, it can be concluded that there is a certain disease or disorder. No less important for the doctor are the size of the uterus, its shape, consistency (for example, during pregnancy, the uterus is soft) and mobility. Here are the average indicators for these parameters, which are within the normal range. During a vaginal examination, these parameters are determined approximately. So, the length of the uterus in nulliparous women is 7-8 cm, in those who have given birth - 8-9.5 cm, the average width is 4-5.5 cm. At the same time, 2/3 of the length of the uterus should fall on her body and 1/3 - on the neck.

The form The uterus of an adult woman is usually pear-shaped, with a smooth surface. For example, the spherical shape of the uterus, as a rule, is observed during pregnancy and endometriosis of the uterus. And in the presence of a disease such as fibroids (benign tumor of the uterus) and a number of anatomical malformations, the shape of the uterus is incorrect.

Consistency uterus can give the specialist information about pregnancy, in which the uterus softens. In the normal state, muscle density is observed.

Regarding the mobility of the uterus: normal - a slight displacement when moving up, to the left, to the right. In the event that some adhesive formations are present (adhesions are formations from the connective tissue that usually remain after certain inflammatory processes or surgical interventions), the mobility of the uterus is limited or absent altogether. If the uterus is excessively mobile, there is reason to suspect deviations in the ligamentous apparatus.

In addition to the above parameters, the gynecologist pays great attention to the soreness of the uterus. In the normal state, the uterus is painless, i.e. on examination, the woman does not experience any discomfort. Soreness is characteristic of such disorders as inflammatory processes, myomatous nodes and some other conditions and diseases.

After the specialist finishes examining the uterus, he proceeds to examine its appendages (the doctor examines the areas located on the side of the uterus on both sides), in which the presence of neoplasms (for example, ovarian tumors) and adhesive processes can be detected. At the same time, healthy ovaries should be located on the side of the uterus, closer to the wall of the small pelvis, and normally have an oblong shape. In general, about examining the uterus and appendages, we can say that this is a necessary and completely painless procedure.

Vaginal examination during pregnancy and childbirth

During pregnancy vaginal examination is carried out in the following cases:

1. At registration and twice more during pregnancy (before maternity leave - at approximately 28 weeks - and at the end of pregnancy - at 36 weeks). It should be noted that one should not be afraid of vaginal examinations in case of a threatened abortion. If you are concerned about pulling or cramping pains in the lower abdomen or lower back, warn the doctor about this. The doctor will use warm instruments, conduct an examination very carefully. Such measures will prevent the progression of the threat of abortion. It should also be remembered that an examination in this case is necessary, since it helps to clarify the situation, to establish whether there is an opening of the cervix, which largely determines the further treatment tactics.
2. If you suspect the occurrence of infectious diseases of the genital tract. The reason for such suspicions may be pathological discharge from the genital tract, rashes in the genital area, discomfort.
3. With the appearance of bloody discharge from the genital tract. In this case, a vaginal examination is carried out in a hospital, since if massive bleeding occurs at the time of the examination, it may be necessary to have surgical intervention.

Before childbirth during vaginal examination, special attention is paid to the condition of the cervix, since the degree of maturity of the cervix largely determines the body's readiness for childbirth. So, the readiness of the cervix for childbirth is said to be when it is soft, shortened, its length is 2 cm or less, the cervical canal freely passes a finger, the cervix is ​​centered, that is, it is located in the center of the small pelvis, but not closer to the sacrum.

During childbirth, a vaginal examination allows you to determine the presenting part of the fetus, which first passes through the birth canal (head or pelvic end), the state of the birth canal, observe the dynamics of the opening of the cervix during childbirth, the mechanism of insertion and advancement of the presenting part, etc. Vaginal examination of pregnant women and childbirth is a serious intervention that must be carried out in compliance with all the rules to prevent the entry of pathogens into the uterus and vagina.

During childbirth, a vaginal examination determines the state of the fetal bladder (integrity, violation of integrity, degree of tension - filling with water, the amount of anterior water). When examining childbirth, the degree of cervical smoothness (preserved, shortened, smoothed), the degree of opening of the uterine pharynx in centimeters (10-12 cm of the uterine pharynx is considered complete), the condition of the edges of the pharynx (soft or dense, thick or thin). Before a vaginal examination of a woman in labor, the birth canal must be treated with an antiseptic solution (a solution that has a detrimental effect on pathogens that can enter the birth canal). This greatly reduces the risk of developing postpartum infections. During the examination, the identification points on the head are the sutures, fontanelles, at the pelvic end of the fetus - the sacrum and coccyx. Correlating the location of these identification points of the fetus and identification points on the bones of the pelvis of the woman in labor, the doctor determines how the fetal head is moving.

Vaginal examination during childbirth is performed by:

• upon admission to a maternity facility, then every 4 hours of regular labor;
• after the outflow of amniotic fluid;
• in the event of attempts (attempts resemble the urge to defecate);
• in the event of any complications during childbirth (bleeding, deterioration of the fetus or woman in labor, suspicion of weakness in labor, etc.).

Immediately after childbirth(after the placenta was born) they also examine the cervix. In this case, large spoon-shaped mirrors are used. You may experience some discomfort at the time of insertion. Next, the cervix around the entire perimeter is examined using special tools. If necessary, restore the integrity of the cervix, and then the vagina and perineum.

Thus, a vaginal examination is a painless and safe procedure that is very effective for diagnosis. If a woman is ready for her not only physiologically, but also psychologically, the examination will not bring her any discomfort and will significantly help the doctor.

The frequency of gynecological examinations is determined by the age, health status of the woman, the presence or planning of pregnancy. The doctor interrogates the patient, conducts an examination on the chair and takes swabs.

Features and methods of gynecological examination

A visit to the gynecologist is a necessary measure for the prevention of diseases of the reproductive system. Timely detection of pathologies helps to carry out treatment in the early stages and prevent the development of complications that can cause infertility. Girls start visiting a doctor at the age of 13-15, the first gynecological examination should be carried out no later than 21 years.

Before a visit to the doctor, it is necessary to perform hygiene procedures, while it is not recommended to use deodorants, you should wash with ordinary soap. One day before the scheduled examination, you can not douche, put tampons, have sexual contacts. Failure to follow these rules may distort the results of the study.

The best period to visit a gynecologist is the first week after the end of menstruation, but you can get an examination on any other day when there are urgent complaints. If a woman took antibiotics, then it is necessary to go to the clinic 1-2 weeks after the end of therapy. Anti-inflammatory drugs can change the composition of the microflora of the vagina.

Immediately before visiting the gynecologist, you should empty your bladder and, if possible, your intestines.

You need to bring the following with you to your doctor's appointment:

• clean socks or shoe covers;
• diaper;
• sterile gloves;
• disposable vaginal speculum (according to Cusco).

In a pharmacy, you can purchase a gynecological kit, which, in addition to the above items, includes tools for taking a smear (Eyre spatula, cytobrush), laboratory glasses for applying vaginal secretions. In most modern clinics, the necessary tools are present, and you do not need to bring them with you. It is necessary to clarify this when making an appointment with a gynecologist.

Inspection principles

Consultation and examination by a doctor is recommended for all girls who have begun menstruation and sexual relations. And also the reason for an appointment with the clinic can be menstrual irregularities, inflammatory, infectious diseases of the gynecological sphere, pregnancy planning.

Various sized speculums are used to examine the vagina and cervix (1–6). The tool is selected individually for each woman, taking into account the ongoing manipulations. For examination of pregnant women, a tazomer and an obstetric stethoscope are used. For girls aged 12–17, only the external genitalia are examined or a rectal examination is performed.

Questioning the patient

First, the doctor collects an anamnesis, asks questions of interest to him, listens to complaints. These data will help to establish the correct diagnosis and prescribe treatment. Most often, the gynecologist asks at what age menstruation began, and how long ago the last critical days ended, whether the menstrual cycle is regular, whether sexual relations are present, and when the first sexual contact occurred.

Women explain the reason for their visit: it can be a preventive examination, symptoms of the disease, pregnancy planning or suspicion of a conception that has already happened, selection of contraceptives. The doctor's questions should be answered honestly, without embarrassment, as this will help to quickly establish a diagnosis and carry out treatment.

It is important to inform the doctor about the number of births, abortions or interrupted pregnancies, past gynecological diseases, the presence of chronic ailments, allergies to drugs, and congenital pathologies.

General examination

After the interview, a general examination is carried out. The gynecologist assesses the condition of the skin, hair, body weight, measures blood pressure. Characteristic external signs may indicate the presence of hormonal disorders. For example, acne, increased body hair growth appears with an increased level of androgens in the blood. Against this background, the woman's health worsens, there are problems with conceiving a child.

Hair loss, swelling of the face, excess weight may indicate a decrease in thyroid function, the development of diabetes. For this reason, the doctor may prescribe an additional consultation with an endocrinologist, testing for the level of thyroid hormones.

Examination of the mammary glands

The next step is the examination of the mammary glands. To do this, the patient undresses to the waist and lies down on the couch. The doctor performs palpation of the chest in various positions. Such a procedure is necessary to identify seals, nodes. The doctor pays attention to the condition of the nipples, skin, swelling of the mammary glands, the presence of discharge.

During the examination, fibrocystic mastopathy, a tumor can be detected. The ovaries (polycystic) are often involved in the pathological process. These diseases can cause dysfunction of the reproductive system, lead to infertility, deterioration of a woman's well-being, and menstrual irregularities. In this regard, the examination of the mammary glands is a mandatory event.

Examination on a gynecological chair

Gynecological examination begins with an assessment of the condition of the external genitalia. If a woman suffers from venereal, infectious diseases, then the labia will be swollen, the skin integuments are inflamed, red. With candidiasis, a characteristic whitish cheesy coating appears. External manifestations also include the formation of genital warts, rashes of a different nature.

The doctor evaluates the condition of the clitoris, large and small labia, the vestibule of the vagina, the skin of the perineum, can diagnose vaginal prolapse.

The next step is an intravaginal examination. For this procedure, the doctor uses a special metal or plastic mirror. The instrument is gently inserted into the vagina and expands its walls. Such manipulation is necessary to check the condition of the mucous membranes and cervix for the presence of erosion or other pathological processes. An intravaginal examination is not performed for girls who have not had sexual intercourse.

Then the gynecologist, using a special spatula, takes a secret from the cervical canal, the walls of the vagina (smear). The material is sent to the laboratory for research on the subject of pathogenic microflora.

If cervical erosion is present, a colposcopy is performed and a piece of damaged tissue is taken for cytological examination. This is how cancer cells are detected. If there are no signs of an oncological process in the material, then cauterization of erosion is indicated.

Bimanual study

After examination with a speculum, a manual examination is performed. The doctor inserts fingers into the vagina, with the second hand probes the uterus and appendages from the outside through the abdominal wall. In a healthy woman, the procedure does not cause pain, with inflammatory diseases.

Bimanual gynecological examination allows you to determine the depth of the vaginal vaults, to detect an increase in the size of the uterus, ovaries, fallopian tubes. This is how fibroids, ectopic pregnancy, ovarian cysts, pregnancy, endometriosis and other pathologies are diagnosed. In some cases, it is possible to identify inflammation of the bladder or rectum, damage to the parauterine tissue, accumulation of exudate in the tissues.

Rectal examination

The rectal method is carried out by inserting the finger of one hand into the rectum, while the doctor palpates the patient's abdomen with the other hand. Such an examination is an alternative to intravaginal, the following situations serve as indications for the procedure:

• examination of girls under 17;
• atresia, vaginal stenosis;
• uterine cancer;
• assessment of the state of the sacro-uterine ligaments;
• parameters;
• ovarian tumors.

Rectal examination helps to assess the condition of the ligaments of the pelvic floor, the degree of prevalence of the inflammatory or oncological process.

Examination of virgins on a gynecological chair

When examining girls under 17 years old, the doctor determines the degree of sexual development: the growth of the mammary glands, pubic hair and armpits,. Physical data and sexual characteristics must correspond to the calendar age.

Girls who have not had sexual contact are not examined with a mirror. The gynecologist checks only the condition of the external genitalia. If there are complaints, there is a suspicion of an inflammatory process, then the examination is performed rectally.

The doctor gently inserts a finger into the rectum, and with the other hand palpates the inguinal region. This allows you to determine the size of the uterus, ovaries and appendages. The hymen is not violated.

If a vaginal examination is required, a special baby speculum is used. The tool has a special structure and minimally injures the hymen. A vaginoscopy of the vagina can also be performed using the introduction of an apparatus equipped with a video camera.

Additional Research

In some cases, instrumental studies are required to make the correct diagnosis. The doctor gives a referral for ultrasound, hysteroscopy or laparoscopy. With the help of ultrasound, the condition of the mammary glands, the endometrium of the uterus, the size and shape of the ovaries, fallopian tubes are determined. is prescribed for polycystic, ovarian apoplexy.

If there is a suspicion of a cancerous tumor, a biopsy, computed tomography is indicated. CT allows you to get clearer data on the state of the reproductive organs. With symptoms of endocrine disorders, an analysis of the level of hormones in the blood is required.

How often do you need to be examined

Examination of girls under 17–18 years of age should take place with the consent of the parents, only the condition of the external genitalia is diagnosed. If inflammatory diseases are concerned, a rectal examination may be performed.

Women suffering from chronic ailments need to see a gynecologist more often. The doctor selects a treatment regimen, monitors the course of the disease and the course of recovery. In case of infertility or at the stage of pregnancy planning, the doctor must monitor the condition of the woman, so the patient will have to appear in the clinic more often.

An examination by a gynecologist is a necessary measure for the prevention of pathologies in the organs of the reproductive system. Detecting them at an early stage helps to carry out treatment on time and prevent the development of complications.

Even in adult women, an examination by a gynecologist often causes fear. And for the most part, not because the doctor himself is so terrible, but because he conducts an examination with a gynecological mirror. How is the examination with a gynecological mirror?

At a certain period of life, girls begin to visit a gynecologist. Often this happens long before the first sexual intercourse. And all because elementary hypothermia can lead to discomfort in the abdomen.

And in order to diagnose this or that, the gynecologist must conduct a complete examination, which will include:

• Examination of the external genitalia. To do this, the doctor simply approaches the woman, who has already settled down on the gynecological chair at this point, and examines how well the external genital organs are developed, whether there are any signs of infection or damage. It is believed that this is the most harmless stage, since the doctor practically does not touch the woman.
• Examination with a gynecological mirror, during which the doctor examines the condition of the mucous membrane, but already inside. And although this process is unpleasant, it is very important.
• Feeling the uterus. This must be done if the doctor suspects the presence, or the uterus does not match the size
• Palpation of the appendages, during which the doctor examines the presence of growths that can cause pain, especially in young girls whose hormonal levels have not yet fully returned to normal
• Taking analyses. Usually, a microflora analysis is taken to determine the presence or absence of some kind of infection or fungi.

In fact, an examination by a gynecologist is not as scary as many people think. Yes, purely from an aesthetic point of view, it can cause a lot of inconvenience and stress, more moral. But it is necessary to pass it, because women's health is very important, especially her reproductive system, since the ability to give birth to a child depends on it.

Gynecological speculum

Due to the fact that the most, so to speak, terrible moment in the process of examination by a gynecologist is the manipulation of the mirror, it is necessary to dwell in more detail on the instrument itself.

So, today there are several types of mirrors, primarily differing from each other in size, since each woman has her own complexion. And it is necessary to strictly observe all proportions so as not to cause harm.

By size it is customary to allocate:

• XS size. It is used in children and adolescents, since the organs are not fully formed, or rather, not formed, and their size is much smaller than in an adult
• Size S. This mirror has a diameter of 23mm. It is used mainly in girls who have not yet given birth.
• Size M. This mirror has a diameter of 25 mm. It is mainly used in women who have already given birth, who are distinguished by a thin complexion.
• Size L. This mirror has a diameter of 30mm

Depending on the woman's complexion, on whether she gave birth or not, is sexually active, etc., the choice of a mirror will depend.To date, there are reusable gynecological mirrors and disposable.

More information about the gynecological examination can be found in the video.

As for reusable mirrors, they are used in antenatal clinics and hospitals. They are made of metal and must be sterilized after each inspection. But since most women do not inspire much confidence in this process, they prefer to use disposable mirrors.

A disposable mirror can be purchased at any pharmacy kiosk, but the main thing is to indicate the size correctly.

The main advantages of such a mirror are that it cannot be used more than once, that is, accordingly, the risk of transmission of sexual infections is reduced, more rounded shapes, which makes the process itself much more pleasant.

Before you buy a gynecological speculum at a pharmacy on your own, you need to consult a doctor so that he can tell you exactly what size is needed.

For many women, the question arises whether an examination with a gynecological mirror is so necessary, and whether it can be avoided.

In fact, an examination is necessary, since during it the doctor can establish such deviations as:

• Tears in the mucous membrane, which will not only cause discomfort, but will also cause infection, or rather, will be its conductor further through the body
• Edema, which also causes malaise. And when it is detected, it is necessary to establish the cause as soon as possible.
• Changing the color of the mucosa, as well as its structure
• The presence of scars that may appear after an illness or surgery

And that is not all. Examination with a mirror is necessary to consider a disease such as erosion, which is very dangerous and is considered precancerous. Therefore, it is important not only to undergo such an examination, but also to pass all the relevant tests.

How is the inspection

Many women become calmer when they find out how the examination is carried out with the help of a gynecological mirror, moreover, in detail and with a list of points.

So, it consists of the following steps:

1. After examining the external organs. The doctor will gently part the labia and insert a mirror. And he will do it slowly. But there is a category of doctors who prefer to do it quickly, since such an acceleration seems to them less painful.
2. A woman should remove all clothes up to her waist, including underwear, and sit in a gynecological chair
3. You need to relax so that the discomfort is invisible. If a woman is tense, then the muscles are also tense, which makes the examination difficult, and the girl will feel pain.
4. The introduction of a mirror, during which a woman will feel pressure, and she may also develop pain, mostly against the background of excitement
5. After the introduction of the mirror, the doctor will begin a full examination, during which he will just consider the main points
6. After the inspection is over, the mirror will be removed, and also carefully, because these are the two most difficult moments.

Doctors say that you should try to avoid any movements with your body during the examination, as this can lead to muscle tension, and therefore pain and a spoiled mood.

Preparing for an inspection

And although many believe that it is not necessary to somehow prepare for this kind of examination, all doctors love cleanliness and order.

Therefore, if a woman is scheduled for an examination, then she needs to prepare:

1. Try to avoid sexual contact about a day or two before viewing
2. A few hours before the procedure, you need to prepare, namely to swim
3. Try not to go to the toilet a few hours before the examination

The view is not so scary. Just someone scares other women in his soreness. Examination with a speculum scares many. And not only from the medical side, but also from the aesthetic side.

But if you properly prepare and listen to the doctor, then it will go unnoticed.

If the woman prepared correctly, and the doctor completely carried out his actions as needed, then the result can be obtained in about 3 or 5 working days, but on condition that they are handed over at the clinic. If they are rented elsewhere, the result will be ready in a few hours.