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The Pelvic Exam:

The word “pelvic” refers to the pelvis. This exam is used to look at a woman’s:

  • Vulva (external genital organs).
  • Uterus (the womb).
  • Cervix (opening from the vagina to the uterus).
  • Fallopian tubes (tubes that carry eggs to the womb).
  • Ovaries (organs that reproduce eggs).
  • Bladder (the sack that holds urine).
  • Rectum (the chamber that connects the colon to the anus).

When are pelvic exams done?

Pelvic exams are performed:

  • During a yearly physical exam.
  • When a woman is pregnant.
  • When a doctor is checking for an infection (such as Chlamydia, vaginosis, trichomoniasis and others).
  • When a woman is having pain in her pelvic area or low back.

How to prepare:

  1. Schedule the exam when you are not having your period, since blood can interfere with the results of a pap test. However, if you have a new vaginal discharge or new increasing pelvic pain, a pelvic exam may be done during your period.
  2. Do not use douches, tampons, vaginal medications or vaginal sprays or powders for at least 24 hours.
  3. Do not have sex 24 hours prior to the exam if you have abnormal discharge. The presence of semen can interfere with test results.

At the beginning of your pelvic examination; tell your health professional if:

  1. You are or might be pregnant.
  2. If you have any reproductive Urinary Tract Infection (UTI) symptoms such as itching, redness, sores, swelling or unusual odour or increased vaginal discharge.
  3. If you are using a method of birth control.
  4. If it’s your first pelvic exam.
  5. The first day of your last menstrual period and how long it lasted.
  6. If you have had surgery or other procedures involving the vagina, cervix or uterus.

How it feels:

A pelvic exam is more comfortable if you and the health professional are relaxed during the procedure. Breathing deeply and having a light conversation with your health professional may help you relax. Try not to hold your breath or tense your muscles.

You may feel pressure or mild discomfort when the speculum is inserted into your vagina. Try to relax your legs and hips as much as you can. You may experience pain or irritation, especially if you have a vaginal infection. If a metal speculum is used, the metal may feel cold and hard. The speculum may be warmed with water of lubricated with a vaginal lubricant before being inserted.

During the bi-manual part of the exam, you may feel an uncomfortable sensation of pressure or a slight twinge of pain as the health professional feels your ovaries. Breathing deeply may help you relax. You may feel a brief pinch when the Pap test is taken. Tell your health professional if any part of the exam is painful.

How is a pelvic exam performed?

During a typical pelvic exam, your doctor or nurse will:

  1. Ask you to take off your clothes in private (you will be given a gown or other covering).
  2. Talk to you about any health concerns.
  3. Ask you to lie on your back and relax.
  4. Press down on areas of the lower stomach to feel the organs from the outside.
  5. Help you get into position for the speculum exam (you may be asked to slide down to the end of the table).
  6. Ask you to bend your knees (some doctors will place your feet in holders called stirrups).
  7. Perform the exam. During the exam, a device called a speculum will be inserted into the vagina. The speculum is opened to widen the vagina, so that the vagina and cervix can be seen.
  8. Perform a Pap smear. Your doctor will use a plastic spatula and small brush to take samples of cells from the cervix (a sample of fluid also may be taken from the vagina, to test for infection).
  9. Remove the speculum.
  10. Perform a bi-manual exam. Your doctor will place two fingers inside the vagina and uses the other hand to gently press down on the areas he or she is feeling. Your doctor is noting if the organs have changed size or shape.
  11. Sometimes a rectal exam is performed. Your doctor inserts a gloved finger into the rectum to detect any tumours or other abnormalities.
  12. Talk to you about the exam (you may be asked to return to get test results).

What tests are taken?

A sample of cells may be taken as part of a regular test called a Pap smear or Pap test, to screen for cervical cancer or cells that look like they might lead to cancer. The sample is placed in a solution and sent to a lab where it is examined. Tests also may be taken to screen for sexually transmitted diseases.

How often should I get a pelvic exam?

It’s a good idea for women to begin having yearly pelvic exams within three years of becoming sexually active or at the age of 21, whichever comes first. The exam should also include a yearly Pap smear. Some women who have a higher risk of cancer may need to have a Pap smear more often. Women who have had normal Pap smear results for several years and only one sex partner may need a Pap smear less often. Talk to your doctor to see what is right for you.

Dr. K. K. Bal is a practicing Gynaecologist/ Obstetrician at the Aga Khan University Hospital Doctors Plaza.