Pelvic Exam

Pelvic exam at a glance

• A pelvic exam is a quick procedure that should be part of every adult woman’s ongoing health care and annual exam.
• A pelvic exam typically involves several gentle techniques performed by a doctor or nurse practitioner that can
  detect many problems and diseases, ranging from yeast infections to early-stage cancer.
• The exam requires little preparation and is a good opportunity for doctor and patient to discuss overall health.

What is a pelvic exam?

During a pelvic exam a doctor or nurse practitioner examines a woman’s pelvic organs, evaluating the size, position and overall health of the ovaries, uterus, cervix and vagina. A pelvic exam may also precede prescription of birth control, notably an intrauterine device.

Along with Pap smears, regular pelvic exams should be part of a woman’s routine health care throughout life, as they can help evaluate or detect a number of problems and diseases such as:

• Abdominal or pelvic pain
• Uterine fibroids (non-cancerous growths in or on the uterus)
• Uterine prolapse, a drop of the uterus from its usual position
• Ovarian cysts, an unnatural swelling of the ovarian sacs in which maturing eggs are held
• Sexually transmitted diseases such as genital herpes, syphilis and chlamydia
• Vaginal infections such as bacterial vaginosis and yeast infections
• Early-stage cervical cancer

When to start pelvic exams

• At age 18
• During menstrual problems such as unusual bleeding or pain
• When experiencing vaginal discharge
• When becoming sexually active or plan to be
  

What happens during a pelvic exam?

In a pelvic exam, a patient usually disrobes from the waist down, places a paper or cloth drape around the waist and lies on an exam table with feet in stirrups. During the exam, a doctor or nurse practitioner, wearing gloves, starts by checking the vulva and vagina for redness, warts, cysts, discharge and any other abnormalities.

Next the examiner inserts a tool called a speculum into the vagina, gently spreading the vaginal walls to allow examination of the inside of the vagina and of the cervix.

The process generally includes what’s called a bimanual exam – the doctor or nurse practitioner places one hand on the abdomen and presses downward in a technique called palpation. Using the other hand, the examiner inserts fingers into the vagina in order to examine the uterus and ovaries. This technique can reveal any pain, growths or tenderness that might require attention.

Pap smears & rectovaginal exams

Often a Pap smear is part of a pelvic exam, and the examiner will use a special spatula or brush to sample cells from the cervix. The cells are placed on a glass slide and delivered to a laboratory for evaluation, which typically takes about three weeks.

Abnormal Pap smears can indicate the beginning of cervical cancer. Abnormal results are rare, but when they do occur, a doctor usually calls for more tests, as often the cause is a small problem with the cervix.

Some pelvic exams include a rectovaginal exam, in which the examiner also examines the ovaries and uterus ligaments from the rectum.

The typical pelvic exam takes only 10 to 15 minutes. Doctors and nurse practitioners often take the opportunity to do a breast exam as well in order to detect any unusual breast changes.

The pelvic exam is a time for the patient and doctor to review and address any questions or concerns about women’s health overall.

For patients who see gynecologists as their only doctors on a regular basis, those doctors may also order routine tests such as urinalysis, blood sugar levels and cholesterol as part of the appointment or annual exam.

How to prepare for a pelvic exam

Before a pelvic exam, a patient should follow these guidelines:

• Schedule the exam either before or after your menstrual period. However, you should schedule an exam right away if you’re experiencing increasing pain or a new vaginal discharge during menstruation.
• Avoid sexual intercourse for 24 hours prior to the exam.
• Do not use douches, tampons, vaginal medications, sprays or powders for at least one day in advance.
• For a more comfortable experience, be sure to empty your bladder just before the exam.

What to tell the doctor during the exam:

• The first day of your latest period and how long it lasted.
• If this is your first pelvic exam.
• If you’ve had any symptoms in the urinary or reproductive tract such as itching, swelling, redness, sores or discharges.
• If you are using birth control.
  
• If you have had surgery, radiation therapy or any other medical treatments involving the reproductive organs.