mittelschmerz: June 2007

During a pelvic exam, your doctor visually and manually assesses your reproductive organs. A pelvic exam usually is done as part of a woman's regular checkup, or your doctor may recommend a pelvic exam if you're having symptoms such as unusual vaginal discharge or pelvic pain.

A pelvic exam is a relatively short procedure. In the course of a pelvic exam, your doctor checks your vulva, vagina, uterus, rectum and pelvis, including your ovaries, for masses, growths or other abnormalities. A Pap test, which screens for cervical cancer, may be performed during a pelvic exam.

Why it's done

To assess your gynecologic health. A pelvic exam often is part of a routine physical exam for women to find possible signs of a variety of disorders, such as ovarian cysts, sexually transmitted infections, uterine fibroids or early-stage cancer. Your doctor can recommend how frequently you need to be examined, but many women have a pelvic exam once a year.

To diagnose a medical condition. Your doctor may suggest a pelvic exam if you're experiencing gynecologic symptoms, such as pelvic pain, unusual vaginal bleeding, skin changes, abnormal vaginal discharge or urinary problems. A pelvic exam can help your doctor diagnose possible causes of these symptoms and determine if other diagnostic testing or treatment is needed.

No special preparation is required for a pelvic exam, although your doctor may recommend that you schedule your pelvic exam on a day when you don't have your period.

If you have questions about the exam or its possible results, write them down and bring them with you to the appointment, so you don't forget to ask about them during the visit with your doctor.

What you can expect

A pelvic exam is performed in your doctor's office and takes only a few minutes.

You'll be asked to change out of your clothes and into a gown. You also may be given a sheet to wrap around your waist for added comfort and privacy. Before performing the pelvic exam, your doctor may listen to your heart and lungs and perform a breast exam.

During the pelvic exam
During the pelvic exam, you lie on your back on an examining table, with your knees bent and your feet placed on the corners of the table or in supports called stirrups. You'll be asked to slide your body toward the end of the table and let your knees fall to the sides.

External visual exam. First, your doctor visually inspects your vulva, looking for irritation, redness, sores, swelling or any other abnormalities.
Internal visual exam. Next, your doctor uses a speculum — a plastic or metal-hinged instrument shaped like a duck's bill — to spread open your vaginal walls and view your vagina and cervix. Often, the speculum is warmed before it's inserted. Inserting and opening the speculum can cause pressure or discomfort for some women. Relax as much as possible to ease discomfort, but tell your doctor if you're in pain.
Pap test. If your pelvic exam includes a Pap test (Pap smear), your doctor collects a sample of your cervical cells before removing the speculum. After the speculum is removed, your doctor examines your other pelvic organs for signs of abnormalities. Most experts agree that you should have your first Pap test within three years of becoming sexually active or by age 21, whichever comes first. How often you need a Pap test depends on your age and medical history. Talk to your doctor about when you should have a Pap test.
Manual exam. Because your pelvic organs, including your uterus and ovaries, can't be seen from outside your body, your doctor needs to feel (palpate) your abdomen for this part of the exam. To do this, your doctor inserts two lubricated, gloved fingers into your vagina with one hand, while the other hand presses gently on the outside of your lower abdomen. This is to check the size and shape of your uterus and ovaries and identify tenderness and unusual growths. After the vaginal examination your doctor also inserts a gloved finger into your rectum to check for tenderness, growths or other irregularities.