Vaginoscopy

VAGINOSCOPY, the instrumental examination of the vagina in children and virgins. The method developed primarily in connection with the necessity of resolving a number of questions in childhood gonorrhea (whether the cervix is involved in the pathological process). R. Pott (1883) was the first to point out the importance of vaginoscopy, having begun to use instruments at that time employed in rhino- and otoscopy for the examination of the children's vagina. When using them, however, the integrity of the hymen was in most cases violated. A known improvement of the method was the addition of a mandrin to the speculum. Natural illumination proved insufficient, and physicians began to resort to artificial illumination in the form of forehead reflectors. A sharp turn in the history of the development of vaginoscopy technique occurred with the appearance of special instruments for endoscopy of the urethra in men and women. With these instruments, the integrity of the hymen was not violated. Their disadvantage is the limitation of the field of vision, so that to examine the entire vaginal portion it is necessary to move the tube, during which the ulcerated mucosa is frequently injured, leading to hemorrhages. Thanks to the use of the female urethroscope, vaginoscopy has currently acquired full rights of citizenship. A further step forward is Khan's idea to combine in a single instrument the possibilities of direct examination of all parts of the vagina with the freedom of therapeutic manipulations. Khan's instrument, which he named a "colposcope," is constructed on the principle of expanding gynecological specula of the Cusco type, and its shape and dimensions are adapted to the anatomical structure of the vagina in children and virgins. The colposcope at the end of the tube facing the cervix is equipped with a small electric light bulb. When introduced, a mandrin is inserted into the tube. The instrument is equipped with a small telescope designed to adjust the vision of the investigator and increase the clarity of the image. Indications for vaginoscopy are all cases of chronically progressing genital diseases in children with more or less abundant vaginal discharge. With the help of vaginoscopy, not only topical diagnosis is frequently clarified, but also causal diagnosis (in the case, for example, of the discovery of foreign bodies in the vagina). Using vaginoscopy, local therapy can be performed in the deep parts of the vagina and on the cervix uteri. A contraindication to vaginoscopy is acute inflammation of the vulva and vagina.