A gynecologist specializes in the health of the female reproductive system, including the uterus, ovaries, fallopian tubes, and vagina. A routine visit involves a pelvic examination, which assesses structures within and surrounding the pelvis. This comprehensive exam often extends to adjacent areas, and in certain circumstances, the anal and rectal areas are included in the assessment.
External Visual Check of the Perineum
The pelvic exam begins with a visual inspection of the external genitalia, including the perineum. The perineum is the area of skin and muscle situated between the vaginal opening and the anus. This is a quick, non-internal visual check of the entire region.
The gynecologist looks for abnormalities on the skin of the external anal region and surrounding tissues. This includes searching for signs of irritation, rashes, lesions, warts, or skin color changes that could indicate an infection or dermatologic condition. Conditions like human papillomavirus (HPV) or hemorrhoids can manifest here and are often detected during this routine survey.
The Rectovaginal Examination Procedure
Beyond the external visual check, a gynecologist may perform an internal assessment involving the rectum, known as a rectovaginal examination. This procedure is not always performed as a routine part of every annual visit. The doctor uses one gloved, lubricated finger inserted into the vagina and a second finger simultaneously inserted into the rectum.
The purpose of this technique is to palpate the rectovaginal septum, the thin wall of tissue separating the two canals. This two-finger approach allows the clinician to feel higher up into the pelvis than a standard bimanual exam. It provides a clearer assessment of the posterior surface of the uterus, the uterosacral ligaments, and the cul-de-sac (the pouch of tissue between the rectum and the uterus). Detecting masses, scarring, or tenderness in these deep pelvic structures helps identify conditions like endometriosis, ovarian tumors, or certain cancers.
Specific Symptoms That Require Anal Assessment
A focused assessment of the anal and rectal area is often prompted by a patient’s specific symptoms or medical history. Persistent or unexplained pelvic pain, especially pain radiating toward the rectum, is a common reason to perform a rectovaginal exam. This procedure helps determine if the pain is caused by a gynecologic issue, such as a mass pressing on the bowel, or by a condition affecting the bowel itself.
If a patient reports symptoms like rectal bleeding, severe constipation, or a change in bowel habits, the gynecologist may perform a digital rectal exam or a rectovaginal exam. They check for hemorrhoids, anal fissures, or masses within the rectal wall. Evaluating the tone of the anal sphincter muscle is also important for patients experiencing issues with fecal control. Patients should always be informed about the necessity of this assessment.