A key gesture in the clinical gynecological examination, vaginal examination is often performed routinely at each visit to the gynecologist, and regularly during pregnancy monitoring. However, its usefulness and its systematic nature have been questioned in recent years.

Gesture consists of inserting two fingers into the vagina, the vaginal touch makes it possible to auscultate the female pelvic organs internally: vagina, cervix, uterus, ovaries. With the speculum which allows to visualize the cervix, it is a key gesture of the gynecological examination.

The practitioner (attending physician, gynecologist or midwife) must systematically obtain the patient’s consent before performing a vaginal examination.

The patient is lying on the auscultation table, thighs bent and feet placed in the stirrups, pelvis well at the edge of the table. After putting on a finger cot or a sterile and lubricated glove, the practitioner introduces two fingers to the bottom of the vagina. He begins by feeling the vagina, its walls, then the cervix. With his other hand placed on his stomach, he will then empalm the uterus from the outside. Coupled with the vaginal touch, this palpation makes it possible to appreciate the size of the uterus, its position, its sensitivity, its mobility. Then on each side, he palpates the ovaries in search of a possible mass (fibroma, cyst, tumor).

Touching them in the vagina is normally not painful, but unpleasant, especially if the patient is tense. Intimate and intrusive, this exam is indeed feared by many women.

During the pelvic examination

Vaginal examination is performed during routine gynecological visits to preventively check the cervix, uterus and ovaries. Its usefulness in systematics has however been questioned in recent years by various studies. A study by the American College of Physicians (ACP) thus concluded that the systematic vaginal examination performed during the annual gynecological examination of women was useless, even counterproductive, and recommends its realization only in the presence of certain symptoms: discharge vaginal, abnormal bleeding, pain, urinary tract problems and sexual dysfunction.

In pregnant women

During pregnancy, vaginal examination allows you to check the cervix, its length, consistency and opening, as well as the size, mobility, position and tenderness of the uterus. For a long time, it was performed systematically at each prenatal visit in order to detect a change in the cervix that could be a sign of a threat of premature delivery. But since some studies questioning the relevance of this gesture, many practitioners have reviewed their practice. The HAS recommendations of 2005 on pregnancy monitoring also go in this direction.

The HAS indeed indicates that ” in the current state of knowledge, there are no arguments for carrying out routine vaginal examination. Systematic vaginal examination in an asymptomatic woman compared to an examination performed on medical indication does not reduce the risk of preterm birth. The ultrasound of the cervix would also be more precise to assess the cervix.

On the other hand, in the event of symptoms (painful uterine contractions), ” a vaginal examination to assess the cervix is ​​essential to diagnose a threat of premature labor. He assesses the consistency of the cervix, its length, dilation and position. », Recalls the authority.

With the approach of the childbirth, the vaginal examination makes it possible to detect the signs of maturation of the cervix indicating the imminent childbirth. It also makes it possible to control the height of the fetal presentation (i.e. the baby’s head or its buttocks in the event of breech presentation), and the presence of the lower segment, a small area appearing at the end of pregnancy between the body and cervix.

On the day of childbirth, vaginal examination makes it possible to follow the opening of the cervix, from its erasure to its complete opening, i.e. 10 cm. Previously practiced systematically during admission to the maternity ward, then every 1 to 2 hours during labor, in 2017 the HAS issued new recommendations concerning the management of the patient during a normal childbirth:

• offer vaginal examination on admission if the woman appears to be in labor;
• in the event of premature rupture of the membranes (RPM), it is recommended not to systematically carry out vaginal examination if the woman does not have painful contractions.
• suggest a vaginal examination every two to four hours during the first stage of labor (from the start of regular contractions to full dilation of the cervix), or before if the patient requests it, or in the event of a call sign (slowing of the rhythm baby’s heart, etc.).

After childbirth, vaginal examination is used to control uterine involution, a phase during which the uterus regains its size and its initial potion after childbirth.

If during the routine examination a lump is detected on vaginal examination, a pelvic ultrasound will be prescribed.

During pregnancy, in the presence of painful contractions associated with changes in the cervix, a threat of premature delivery is to be feared. The management will then depend on the stage of pregnancy.