What Is a Pelvic Exam?
Whether you are straight, lesbian, bisexual, married, single, sexually active or not, your pelvic exam is a normal and important part of taking care of your body. During a pelvic exam, a health care provider examines your pelvic area. It includes your vulva and your internal reproductive organs — your cervix, ovaries, fallopian tubes, uterus, and vagina.
During your pelvic exam, your provider will look for signs of infection and other conditions. It will most likely include taking a few cells from your cervix for a Pap test. This is to protect you from cervical cancer. Detecting problems early can help you get the treatment you need to keep healthy.
When Should I Have My First Pelvic Exam?
Unless you have a medical problem, you should have your first pelvic exam when you turn 21.
Before needing pelvic exams, young women are encouraged to have periodic gyn visits with their health care providers. During these visits, a young woman can ask questions and talk with her health care provider about growing up, changes in her body, and any concerns she has. These checkups help make sure that she is healthy and developing as she should. Most often, these early visits do not include a pelvic exam.
After your first pelvic exam, your health care provider will tell you how often you should have gynecological care, including pelvic exams. How often you need exams will depend on your medical history and personal health needs. You may need more frequent pelvic exams if you have
a history of abnormal Pap test results
a history of sexual health problems
a family history of certain kinds of cancer
a sexually transmitted infection or a sex partner with an infection
In some cases, a pelvic exam is needed in order to prescribe hormonal birth control — the pill, the patch, the ring, or the shot. A pelvic exam is always needed for inserting an IUD or fitting a diaphragm.
There are some simple steps you can take to prepare for your exam.
Plan your pelvic exam for a day you when you will not have your period — unless you have a bleeding problem your health care provider wants to see. Menstrual fluid can affect the results of some lab tests.
Don't have vaginal intercourse or insert anything in your vagina for a day or two before your visit.
Women shouldn't douche. But if you do, don't douche for at least 24 hours before your visit. For more accurate test results, don't use any other vaginal products, either. They can hide many vaginal conditions.
Make a list of the questions you want to ask your health care provider. Some women write them down so that it is easier to remember them during the appointment.
Ask if you can have a friend in the room with you if you think you would feel more comfortable.
How Will My Pelvic Exam Feel?
The pelvic exam part of your gyn exam should only take a few minutes. Some parts of the exam may be uncomfortable, but it shouldn't be painful. If it hurts, be sure to tell your health care provider, who may be able to adjust things to help you be more comfortable. This exam is for you, so don't be afraid to speak up.
You'll feel less tense during your pelvic exam if you
Breathe slowly and deeply with your mouth open.
Let your stomach muscles go soft.
Relax your shoulders.
Relax the muscles between your legs.
Ask your health care provider to describe what is happening.
What Does the Health Care Provider Do During My Pelvic Exam?
Your health care provider will ask you to undress and put on a paper or cloth gown. Next, you will be asked to lie down on the exam table and put your feet on footrests at the end of the table. (Some tables have knee rests instead.)
Slide your hips down to the edge of the table. Let your knees spread out wide. Relax as much as possible. Relax your buttocks and your stomach and vaginal muscles. This will make you more comfortable. The exam will be more complete, too. You can cover your lower abdomen and thighs with a sheet to feel less exposed.
There are usually four parts to the pelvic exam:
1. The External Exam — Your health care provider will look at the folds of your vulva and the opening of your vagina. This part of the pelvic exam checks for signs of cysts, discharge, genital warts, irritation, or other conditions.
2. The Speculum Exam — Your health care provider will gently insert a lubricated speculum into your vagina. Made of metal or plastic, the speculum separates the walls of the vagina when it opens. This may feel uncomfortable but not painful. Let your health care provider know if it is. She may be able to adjust the size or position of the speculum. If you would like to see your cervix, just say so. You may be able to see it using a mirror.
The provider will then use a tiny spatula or small brush to take a small sample of cells from your cervix. This sample will be given a Pap test to see if there is any precancer or cancer in the cervix.
If you think you may be at risk of having a sexually transmitted infection, tell your health care provider. Your health care provider can use a cotton swab to take a sample of the discharge from your cervix. This sample will be tested for sexually transmitted infections.
3. The Bimanual Exam — During this part of the exam, your health care provider will insert one or two gloved and lubricated fingers into your vagina while gently pressing on your lower abdomen with the other hand. This is a way to check for
the size, shape, and position of the uterus — which could affect your fertility and birth control choices
an enlarged uterus — which could mean pregnancy or fibroids
tenderness or pain — which might mean infection or other conditions
swelling of the fallopian tubes — which might mean an ectopic pregnancy
enlarged ovaries, cysts, or tumors
4. The Rectovaginal Exam — Your health care provider may put a gloved finger into your rectum. This checks the muscles between your vagina and your anus. This also checks to see if there are tumors behind the uterus, on the lower wall of the vagina, or in the rectum. Some health care providers put another finger in the vagina, too. This lets them examine the tissue in between more thoroughly.
You may feel like you need to have a bowel movement during this part of the exam. This is normal and only lasts a few seconds.
The doctor gives Mrs. Wilson a pelvic exam.