Pelvic Examination
Examining the Vagina, Womb And Reproductive Organs

Pelvic Examination

Contents

• What Is A Pelvic Examination?
• What Can It Show?
• How Do I Prepare For A Pelvic Examination?
• Does It Hurt?
• How Is It Done?
• How Often Should I Have An Examination?

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What Is A Pelvic Examination?

It is where a doctor manually inspects the woman's reproductive organs. That is, her vagina, vulva, cervix, ovaries and fallopian tubes. It is usually done as part of a regular checkup or as part of prenatal care. It may also be performed if the woman complains of a problem 'down there' such as pelvic pain or unusual vaginal discharge. The examination is done in a doctor’s office and takes about 5 minutes.

What Can It Show?

A pelvic examination helps determine if a woman:

• Is pregnant
• Is having a miscarriage
• Is still a virgin, if the hymen is intact (which it sometimes is not in virgins).

Among many conditions, it can show for example if she has:

• Enlarged ovaries or uterus
• Inflamed cervix
• Vaginitis
• Yeast infection
• Vaginal atrophy
• Suspicious growths indicating vulva cancer or vaginal cancer
• Genital warts and signs of other STDs.

How Do I Prepare For A Pelvic Examination?

Avoid douching for 24 hours before the examination as it may result in abnormal vaginal discharges being missed. You should urinate before the examination, not only will it make it more comfortable, but it also makes it easier for your physician to spot any problems. You may have sexual intercourse before the examination; it will not interfere with the results.

Does It Hurt?

No, a pelvic examination is rarely painful, even if the woman is still a virgin and has not used tampons. It will probably be a little uncomfortable and you may feel a bit embarrassed if you have not had many before. Remember your doctor has performed hundreds, if not thousands of pelvic examinations, he or she doesn't find it in the least bit awkward.

How Is It Done?

You will be asked to remove the lower half of your clothing and given a sheet to place over your waist for privacy. Some clinics ask the patient to remove all their clothing and give them a gown. You will be told to lie on your back on the examination table and to bend your knees. If your doctor has stirrups, you will be asked to put your feet in these to widen your legs. A complete pelvic examination involves 4 steps. Not all doctors perform the steps in this order, and depending on the reason for the examination, not all steps are always necessary.

Step 1: External Visual Exam
Your clinician will visually inspect the vulva, looking for soreness, swelling, redness and irritations. He will check the Skene's glands and Bartholin's glands that lie beside the entrance to the vagina for signs of abnormal discharges which could indicate infection.

Step 2: Internal Speculum Exam

Next the clinician checks the vagina and cervix. He does this by inserting a metal or plastic instrument called a speculum to widen the vagina. Once in place, it locks into position. While slightly uncomfortable, it rarely hurts. The doctor visually inspects the vagina looking for signs of discoloration, abnormal discharge and lesions. Often doctors perform a Pap smear test at the same time. If there is any abnormal looking discharge a sample can be taken and examined under a microscope. If you have an IUD device in place, it will be checked at this time. Or if you have a diaphragm it can be assessed and replaced if necessary.

Step 3: Bimanual Examination

Next the clinician inserts two gloved fingers into the vagina and presses down on the tummy with his other hand. First he assesses the size and position of the uterus. Any tenderness or lumps can indicate the presence of uterine fibroids, uterine polyps or a prolapsed womb. By inserting his fingers further into the vagina he can feel the ovaries and fallopian tubes and note if there are any lumps or tenderness. Locating the ovaries can be the most difficult bit of the examination, particularly in postmenopause women because they usually shrink.

Step 4: Rectovaginal Examination

Finally the doctor will insert one gloved finger into the vagina and one into the rectum. The purpose of this is to assess the pelvic organs from another angle, but also to check that the wall separating the vagina and rectum is disease free.

How Often Should I Have An Examination?

All women should have a regular gynecologic examination. Most experts agree that the first gynecologic examination should take place between the age of 16 and 19, or sooner if the girl is sexually active. Any woman who is sexually active, is using birth control pills, an IUD device or diaphragm should have an annual test; as should women with a family history of gynecological cancers. Ideally schedule it at time you do not have a period.

Related Articles on Diagnostic Testing

For more tests, see the following:

• Recommended health screenings for women: All ages.
• Vaccines for women: Which vaccination you need and when.

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