. The diagnosis of diseases of women . e opposite hand is insertedinto the vulvar opening, with thepalmar surface resting upon theperineum. Firm pressure is madeby the finger upon the vulvar outlet is thereby deep-ened, and into it the index fingercan be readily inserted. The twofingers are now passed into thevagina, making firm pressure uponthe perineum and avoiding press-ure upon the clitoris and the fingers are fully insertedthe palm of the hand is turnedupward. When the vulvar outletis small, the mucosa sensitive orthe hymen intact, a single fingershould be employ
. The diagnosis of diseases of women . e opposite hand is insertedinto the vulvar opening, with thepalmar surface resting upon theperineum. Firm pressure is madeby the finger upon the vulvar outlet is thereby deep-ened, and into it the index fingercan be readily inserted. The twofingers are now passed into thevagina, making firm pressure uponthe perineum and avoiding press-ure upon the clitoris and the fingers are fully insertedthe palm of the hand is turnedupward. When the vulvar outletis small, the mucosa sensitive orthe hymen intact, a single fingershould be employed. Where painis caused by inserting the finger,it is well to ask the patient to beardown while the examination isbeing made. The following conditions are determined by a simple vaginalexamination: the size, form, and position of the vulva, vagina,and vaginal portion of the cervix; the condition of the hymen,whether present or absent, perforate or imperforate; the integrityof the pelvic floor; the presence of new-growths in the vulva,. Erect position. 70 GENERAL DIAGNOSIS vagina, and vaginal portion of the cervix; sensitiveness and fulnessin the vault of the vagina and the capacity of the pelvic outlet. The knee-chest position is especially used when it is desired todo away with intra-abdominal pressure for the purpose of per-mitting the uterus and freely movable pelvic tumors to rise out ofthe small pelvis. The erect position is practised chiefly in determining the degreeof prolapsus of the uterus. After concluding the examination the finger is withdrawn andthe secretion on the finger inspected. The Combined Vaginal Examination (Bimanual). The advan-tages of a combined examination over a simple vaginal or rectalexamination are evident. The combined method may be regardedas the most valuable of all physical explorations of the combinations may be utilized, they being designated asabdominovaginal, abdominorectal, abdominovesical, abdomino-vesicovaginal, abdominove
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