Pelvic Examination

A complete pelvic examination is necessary for proper evaluation. The labia and vagina should be inspected for signs of atrophy, because hypoestrogenemia may contribute to incontinence and prolapse symptomatology and impair proper healing after surgery. A vaginal mucosal maturation index can often help with this assessment. Any ulcerations of the mucosa should be noted, particularly in women who have used a pessary. A bimanual examination is important to rule out pelvic masses and assess for pain. A rectal examination should be performed, and the resting tone and power of the rectal squeeze should be recorded. Any rectal mucosal prolapse should prompt further investigation. Impaction should be ruled out, because it is strongly associated with voiding dysfunction in elderly women.

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