Pelvic Exam

Pelvic Exam

How often you have a pelvic exam is up to you and your provider. Experts agree that a woman should have regular pelvic exams within one year after you’ve had intercourse.

You should also have a pelvic exam if you have any of the following symptoms:

  • heavy vaginal discharge that itches, burns, or smells
  • heavy vaginal bleeding
  • bleeding between period
  • painful intercourse
  • menstrual cramps that cause you to miss school or work
  • any signs of pregnancy (a missed period, tender breasts, upset stomach)
  • no signs of puberty (change in breast size, hair under the arms or between the legs) by age 14, or no periods by age 16
  • side effects from birth control

TIPS:

  • If you have any questions, be sure to write them down so you won't forget during the exam.
  • Be prepared to tell the provider the date your last period started and how long it lasted.
  • Be sure to report any unusual symptoms you may have.
  • See the Glossary at the end of this pamphlet for the meaning of any words you don't understand.

BEFORE THE EXAM: Before the exam, the provider will want to know the reason for your visit. A regular check-up? Are you concerned that you may have a problem? Do you need birth control?

You will be asked some questions about your period. When you had your first period, the date or last period started, how many days you bleed (menstruate), how many days between periods, if you have cramps or heavy bleeding. You will be asked if you are using birth control.

You will also be asked to give your medical history, including any pregnancies, major illnesses, or surgery. This information gives the provider clues about your health.

THE EXAM. You will be asked to undress and put on a gown. Be sure to go to the bathroom and empty your bladder. This will make the exam more comfortable for you. But, check with the nurse or provider before you go, we may need a urine sample.

The Breast Exam: First, the provider will check your breasts for lumps. She/he will press gently in a circular motion around the breast and under the arm. The appearance of the breasts - dimpling or puckering of the skin or any discharge from the nipples that might mean a problem - will also be checked.
The provider will teach you how to check your breasts so you can do a self-exam each month (if you don't already).

The Pelvic Exam: The pelvic exam is actually quite simple. It consists of three or four steps, and it only takes a few minutes. This is the part of the exam women find most embarrassing, so it's nice to know it is quick. And remember, your provider does this every day. His or her only concern is for your health.

You will be asked to lie down on a table with foot rests on one end. Your knees and legs will be spread open so the genital area is easier to see.

Now is the time when you should try to relax (easier said than done!) The more relaxed you are, the more comfortable the exam will be. If you are nervous, try closing your eyes and taking deep breaths.

External Exam: First, the vulva or external genitals are checked for signs of growth or rashes. Be sure to say if you have noticed any.

Speculum Exam: The speculum is a metal or plastic instrument that gently spreads the vagina so the cervix (the opening into the uterus) can be seen. The provider carefully puts a warm speculum into the vagina. This shouldn’t hurt because the vagina is flexible. At most, you will feel pressure. If you want, the provider will hold a mirror so you can see for yourself what your cervix looks like.

The main reason for the speculum exam is so the provider can look at the cervix and vagina for rashes or redness. Some of these may be sexually transmitted infections or diseases (STI’s or STD’s). Here she or he may also do a pap smear. During a pap smear, cell tissue is gently taken from the cervix with a swab. These cells will be sent to a laboratory and examined for signs of cancer or other problems. Cervical cancer can be cured if found early, so regular Pap smears are a must.

When the provider is sure everything is normal, the speculum is carefully removed.

Bimanual (two hands) Exam: After putting on a sterile glove and rubbing gel on the fingers, the provider puts one or two fingers in the vagina until they touch the cervix. With the other hand, he or she gently presses the abdomen (belly).

This is to check the uterus to make sure it is normal. The ovaries and fallopian tubes are checked the same way. If you feel any discomfort, be sure to say so.

Sometimes the pelvic exam may include one more step. It is called a recto-vaginal exam. The provider puts one finger into the vagina and one finger into the rectum. Again, with the other hand, he or she gently presses the abdomen. This exam helps the provider feel areas that can't be reached with the bimanual exam.

That's it! The pelvic exam is over. You can get dressed.

AFTER THE EXAM: Once you are dressed, you will have another chance to talk to the provider. This is the time to ask any questions you didn't ask during the exam.

If you are having a pelvic exam because you have a problem, or your provider found anything unusual, she or he will explain what it is and what to do about it. If the purpose of your visit is to get birth control and you need a prescription, the provider will write it for you.

She or he will also suggest when you should return for your next pelvic exam.

GLOSSARY
Cervix The lower part of the uterus; the cervical "os" is the opening between the uterus and the vagina
Clitoris The pea-sized organ located just in front of the opening of the urethra; the center of female sexual excitement.
Fallopian Tube Tube that carries the egg from ovary to uterus. Fertilization takes place here if sperm are present
Genitals The sex or reproductive organs of males and females.
Labia The lips of female's external genitalia. The labia majora are the outer, larger lips covered with hair; the labia minora are the smaller, inner lips.
Menstuation Monthly shedding of the lining of the uterus mixed with blood.
Mons The soft mound that forms the upper end of the female external genitals.
Ovaries The two glands that produce egg cells and the female sex hormones, estrogen and progesterone.
Ovulation The release, about once a month, of a mature egg from an ovary.
Ovum or Egg Female reproductive cell produced in the ovaries.
Urethra The passage in both males and females through which urine leaves the body.
Uterus (Also called the womb). The organ that holds a growing baby during pregnancy. At the upper end are the fallopian tubes and at the lower end the cervix. The uterine lining is shed monthly as menstrual flow.
Vagina Passage between the uterus and the outside of the body. Sometimes called the birth canal, it is the passage through which babies are born and menstrual fluid leaves the body. The penis fits into the vagina during sexual intercourse.
Vulva The external female genitals including the labia, the clitoris, and the opening into the vagina.