The Pelvic Exam
Before You Go
Schedule your appointment about a week before you anticipate your period will start, or the week after your period is likely to end, because bleeding can make it impossible to analyze your Pap smear sample under the microscope. The Pap smear is a key part of the pelvic examination, and it is a test for cancer or precancer of the cervix.
To help your doctor get the most information from the exam, here are a few ways to prepare:
- Don't douche or use vaginal creams or lubricants for at least 24 hours before the exam, unless they are for birth control or are prescribed by your doctor.
- Prepare a written list of questions. It's easy to forget things once you're in the doctor's office. Make notes of any symptoms or concerns, such as menstrual irregularities. Consider whether you want advice or assistance with birth control.
- Anticipate questions that a doctor routinely asks at the time of a pelvic exam. It may be helpful to write down dates, previous illnesses or medications before your visit. See Get Your Answers Ready.
The General Checkup
In the waiting room, you may be asked to complete a detailed form about your health and lifestyle.
The information may be helpful in your treatments. If you are under 18 and want to talk about something you don't want your parents to know, ask if your conversation can be kept confidential.
When you are called into the office, a nurse or medical assistant will weigh you, take your blood pressure and check your pulse in a typical visit. You also may be asked to provide a urine sample, which can be used to test for pregnancy, diabetes and certain infections.
To give the urine sample, you go into a bathroom and urinate into a wide-mouthed plastic cup. You can start urinating, then move the cup under the stream to catch a small amount.
You will either be asked to leave the cup of urine in the bathroom, where a nurse will get it when you're done, or you will be asked to bring the sample to a nurse or to your exam room. Even if you aren't asked to provide a urine sample, let the nurse know you would like to urinate before the exam. This will help you feel more comfortable when your doctor does the internal exam.
Your doctor will typically begin by reading your answers to the questionnaire and asking you questions if he or she needs more information or if the answer isn't clear. If you let the office know this is your first visit, many doctors will also take time to explain the procedures before starting the examination. Let the doctor know if you have any questions you would like answered. Your visit for your pelvic exam is an ideal time for you to discuss questions you may have about your sexual function and to discuss problems in your bladder and bowel function, including incontinence. It is also an ideal time to inform your doctor about intimate partner violence, if you have experienced this.
Before the internal exam, your doctor may listen to your heart and lungs and feel your abdomen to see if the liver or spleen is enlarged. He or she will then examine your breasts. The breasts can be examined while you are sitting up, lying on your back on the exam table, or both ways. Your doctor will press lightly on your breasts to check for lumps, thickening or other irregularities. Lightly pressing or squeezing the nipples allows your doctor to check for discharge.
This shouldn't hurt, but some women's breasts can be tender in the days leading up to the start of their period. If the exam is uncomfortable, let the doctor know.
Your doctor may offer to schedule a mammogram X-ray for you as an additional check for breast cancer. A yearly mammogram is recommended for all women over 50 and for any woman over 40 who chooses to begin her testing at that age.
The pelvic exam will be done next. The exam usually doesn't hurt and takes only a few minutes.
A nurse or medical assistant may or may not be present to accompany your doctor and hand him or her exam materials during a pelvic examination. Male doctors commonly ask a nurse to come into the room during the exam as a professional courtesy, because many patients are more comfortable having an additional person in the room during a pelvic exam. If a nurse is not in the room when your exam is about to begin and if this would make you more comfortable, feel free to ask for a nurse to be in the room during your exam. This is a very standard practice and will not offend your physician.
You'll be asked to lie on your back on the table, place your feet in the stirrups (footrests) at the end of the table, and slide or slowly scoot your hips to the edge of the table.
Your doctor will wear gloves during your pelvic exam. He or she will begin by checking the skin around your vagina and the shape of the labia ("lips" or tissue folds outside the vagina) for irritation, rashes, sores or swelling.
Your doctor will use a tool called a "speculum" to do your pelvic exam. This is either a metal or plastic device shaped like a duckbill that holds the vagina open. The speculum may attach to a light, in which case the light may plug into the wall. A speculum is either professionally sterilized between uses or (if it is plastic) it is new for each patient exam. Your doctor may warm the speculum first and may moisten it with water or lubricant to make this part of the exam more comfortable.
Then your doctor will insert the speculum into your vagina. Your doctor inserts the duckbill portion of the speculum with the two pieces closed together, and then spreads them open slightly so the cervix can easily be seen. You may feel a little pressure, and some women with a narrow vagina may experience a little discomfort.
If your muscles are relaxed during the exam, it will be easier for your doctor to examine you. If your muscles are tense, it may make the exam more difficult. See How To Relax During The Pelvic Exam.
Your doctor will examine the cervix (the opening of the uterus) and the inside of the vagina for irritation, lumps or discharge. Then your doctor will collect a sample for your Pap smear (Papanicolaou smear), a test for cervical cancer or precancerous cells. Collection tools that may be used to obtain your Pap sample can include a soft brush, a narrow wooden or plastic spatula, or a miniature broom-shaped tool with rubber fringes (called a "cervical broom") that can be gently rubbed against your cervix. Your doctor will lightly brush the tool against your cervix to collect cells. You may feel a little cramping or a scratchy sensation. The cells will be prepared for the laboratory by spreading them on a microscope slide or suspending them in liquid. A pathologist will evaluate the Pap smear by examining the cells under a microscope. Your doctor will usually have the results in one to two weeks and will notify you if the results show any abnormalities.
If you have excess mucus or pus in the vagina (a discharge), your doctor can take a sample using a cotton swab. After your exam is completed, your doctor can inspect your discharge under a microscope to see if it contains normal secretions or if it has signs of a yeast infection, a bacterial infection, or parasites (trichomonas).
If you are sexually active, your doctor may suggest that you have a screening test for a chlamydia infection. Commonly, this is combined with a test for a gonorrhea infection. To check for these infections, your doctor uses a cotton swab to take a sample. These tests typically require several days for a result to be known.
Right after your Pap sample and any other needed samples have been obtained, your doctor will remove the speculum and will do what is called a bimanual (two-handed) exam. For this exam, your doctor will either place two fingers into the vagina or will place one finger in the vagina and one in the rectum. With these fingers your doctor can feel the position and size of your pelvic organs. With the other hand, he or she presses gently on your abdomen to guide your uterus and ovaries into a position where they are easily felt. This part of the test shows:
- The shape and size of the uterus, cervix and ovaries
- Whether there are noticeable fibroid growths in the uterus or cysts on the ovaries.
- Signs of infection or irritation, such as tenderness and pain
Some doctors may do the rectal part of the exam as a separate step. In this case, he or she will lubricate a finger and insert it into your anus to feel for lumps that could represent cancer. At the end of your rectal exam, your doctor can test stool or mucus from the fingertip of the glove to see if it contains blood.
When the exam is over, you can get dressed. Let the doctor or nurse know if you have any questions.