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Pelvic Exam
A pelvic examination is looking at and feeling the size and shape of the external and internal reproductive organs. These include the vulva (outside), and vagina, uterus, ovaries and fallopian tubes (inside).The exam helps to make sure that your reproductive organs are healthy. It also helps your health care provider detect medical conditions (such as infections or abnormal Pap smears) that could become serious if not treated. Many clinicians recommend that you have your first pelvic exam when you become sexually active or reach the age of 18 years.
The pelvic examination will not hurt. Many women describe the experience as a sensation of crowding or fullness in the vagina; however, there should be no pain. Sometimes a woman will feel discomfort, especially if she is tense.
It is normal to feel uncomfortable, embarrassed, or even scared. Many women complain that the most objectionable part of the exam is that it feels undignified to have to expose one’s genitals to a stranger. You may be less embarrassed if you remember your clinician is highly trained and has probably performed hundreds or thousands of exams. The exam is not an emotional or sexual experience for the clinician. It is okay to have someone with you, such as your mother or close girlfriend.
Ordinarily, yes. You will be given a gown and asked to remove your clothes, including your bra and panties. You can undress in privacy and put on the gown before the clinician comes in for the exam.
You will feel touching with gloved fingers on the outside of your genitals. During the bimanual exam you will feel two fingers in the vagina and the other hand on the abdomen gently pressing the tissue between the two hands. At one point during the exam, the clinician will insert an instrument called a speculum into the vagina. The speculum will generally be warmed to minimize discomfort. Clinicians will commonly complete the exam by doing a rectal examination, placing one finger in the rectum and one finger in the vagina. The reason for this is the clinician can feel much higher and deeper in the pelvis to make sure everything is normal.
A speculum is an instrument designed to spread the walls of the vagina open gently so that the clinician can see inside. Speculums (made of metal or plastic) come in many shapes and sizes to fit a woman’s reproductive anatomy. The plastic ones sometimes make clicking noises when opened. Should the speculum cause you discomfort, tell your clinician immediately; often a smaller speculum can be used.If you are a virgin, it is important to have a pelvic exam if you have not begun to menstruate around the same time as other young women your own age, or if you have had problems with bleeding, pain or discharge. You will still be a virgin after the exam. Women who have used tampons for menstrual hygiene may find the first pelvic exam easier than those who have used external protection such as pads or panty liners.
A Pap test or Pap smear is a screening test that helps clinicians detect cellular changes in the cervix (the opening to the womb at the end of the vagina). The Pap smear includes taking a sample of cells by wiping or scraping a small wooden stick (similar to a tongue depressor) over the cervix. The cells are then put on a glass slide and examined by laboratory personnel to look for changes that might warrant further investigation. During the Pap smear you will feel the swab being wiped across the cervix; this feels somewhat scratchy, but is not painful. It’s important to understand that the Pap test is a screening test only. Clinicians do not base treatments on the Pap test, but use it to determine whether further diagnostic tests are needed. The reason a Pap test is done is to detect changes before they can become cancer. If your Pap test is abnormal, don’t be alarmed. Many women incorrectly believe an abnormal Pap test means they have cancer. In fact, the cause of 90% of cervical cell changes is a virus called human papillomavirus (HPV). Most conditions detected by an abnormal Pap test are minor and easily treated in the office.
The frequency of your Pap smear depends on your age and other factors. You should discuss how often you need a Pap test with your clinician.
Various positions can be used for a pelvic exam; however, the most common one is laying on your back with your feet resting in foot rests, called stirrups. You will be asked to move your buttocks down to the end of the table and let your knees fall wide apart. The reason for this position and the stirrups is to provide the clinician adequate access to the genital area.
The reaction of many women to having fingers or a speculum placed in the vagina is to close the legs or squeeze the vaginal muscles. While it may be instinctive to clamp down, tensing the muscles often will make you more uncomfortable. The key to the pelvic exam is relaxation. Take slow, deep breaths and try to distract your mind to help you relax.
Ask your clinician if you can watch the exam. Many clinicians are happy to show women their external and internal organs and can use a hand held mirror to help you see. Please ask if you’re interested.
Generally, the whole exam takes no more than 5 minutes. Although no one likes to have the exam done, it is important to your health now and in the future. After the first exam, almost everyone says it wasn’t as bad as they had imagined. You can be proud of yourself for taking responsibility for your health.