PELVIC EXAM

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.

Usually, at each step along the way, your doctor tells you exactly what he or she is doing, so nothing comes as a surprise to you.

After the pelvic exam
After the pelvic exam is over, you can get dressed and then discuss with your doctor the results of your exam.

Pap smear: Still necessary after hysterectomy?

Are Pap smears still necessary if I'm 62 years old and have had a hysterectomy?

Answer

from Sandhya Pruthi, M.D.

A Pap smear is an important, reliable screening test for early diagnosis of cervical cancer. Whether you need routine Pap smear screening after a hysterectomy depends on the type of hysterectomy.

If you had your uterus and cervix removed (total hysterectomy) for a noncancerous condition, you may be able to stop having Pap smears. However, if your hysterectomy was for a cancerous condition or you had your uterus removed but your cervix remains intact (partial hysterectomy), you still need regular Pap smears. In either case, regular pelvic exams and mammograms are recommended.

Your age matters, too. According to American Cancer Society guidelines, you may be able to stop routine Pap smear screening at age 70 if you've had three or more normal Pap smears in a row and no abnormal Pap smears for the past 10 years. U.S. Preventive Services Task Force guidelines recommend stopping routine Pap smear screening at age 65 if you've had adequate recent testing and you're not at high risk of cervical cancer. Ask your doctor what's best for you.

And even if you've stopped routine Pap smear screening, it's important to resume screening if you have a new sexual partner — whether you've had a hysterectomy or not.

Pap smear: Do I need one if I'm a virgin?

Do virgins need Pap smears? Does a Pap smear cause you to lose your virginity?

Answer

from Sandhya Pruthi, M.D.

If you're a virgin — meaning you haven't had sexual (vaginal) intercourse — you probably don't need a Pap smear. And even if you do have a Pap smear, it will not cause you to lose your virginity. Although the instruments used to collect the cervical cells may stretch or even tear your hymen — the thin tissue covering the vaginal opening, which is present in some women who've never had sex — you will only lose your virginity when you've had sexual intercourse.

The purpose of a Pap smear is to collect cells from your cervix, which is the lower end of your uterus. The cells collected in a Pap smear can detect if you have cervical cancer or suspicious cells that indicate you may develop cervical cancer.

In most cases, cervical cancer is caused by a sexually transmitted disease called human papillomavirus (HPV). If you've never had any type of sexual intercourse, you're unlikely to have HPV. However, there are other risk factors for developing cervical cancer, such as family history and smoking, so talk to your doctor if you have concerns.

For effective cervical cancer screening, the American Cancer Society recommends that all women have an initial Pap smear by the age of 21 or after they've been sexually active for three years, whichever comes first.

pap smear...

What is a Pap smear?

A Pap smear is a test that checks for changes in the cells of your cervix. The cervix is the lower part of the uterus that opens into the vagina. Developed over forty years ago by Dr. George Papanicolaou, this test can help to detect cervical cancer at an early stage.

What are the benefits of this procedure?

Pap smears have made it possible to detect precancerous and cancerous conditions before they can progress to cancer that could spread to other parts of the body, and have save thousands of women's lives by catching cancers before they spread.

Are Pap smears 100% accurate?

No. Occasionally, the results indicate normal cell growth but abnormal cells are actually present. This is called a false-negative test.

What causes false-negative tests?

False-negative tests can occur for several reasons. The abnormal cells may not have been contained in the sample. There may have been too many or too few cells to allow an accurate reading. An infection could also cover up abnormal cells. If a Pap smear is performed on a regular basis, the chances of a problem going undetected are lower.

How do I prepare for a Pap smear?

Do not douche or use vaginal creams for two days prior to the test. Do not have intercourse within twenty-four hours of the test because it could cause inaccurate test results.

What happens during the procedure?

A Pap smear only takes a few moments and is a part of a routine pelvic examination. Yo u will be asked to lie on your back, with your knees bent and feet apart. Your clinician will insert a speculum into the vagina so that the cervix can be seen. Your clinician will use a special swab, brush, or stick to wipe off cells f rom inside the opening of the cervix and from the outer part of the cervix. These cells are smeared onto a microscope slide and taken for analysis.

What happens after the procedure?

If the cells appear normal, no treatment is necessary. If an infection is present, treatment is prescribed. If the cells appear abnormal, more tests may be necessary. A Pap smear is not 100% accurate, so it is always important to talk to your clinician about your results.

Are some women at higher risk for cervical cancer?

Women at an increased risk for cervical cancer include those who:

• have had more than one sexual partner or whose partner has had more than one partner
  
  
• were sexually active beginning at a young age (before age eighteen)
  
  
• have a history of genital warts
  
  

You can find out more about Pap smears by contacting the following organizations:

National Cancer Institute's Cancer Information Service
(800) 422-6237

American College of Obstetricians and Gynecologists (ACOG) Resource Center
(202) 863-2518

College of American Pathologists

Contributing to this FAQ on Pap Smears: University of Michigan's Women's Health Program, a National Center of Excellence in Women's Health, sponsored by the Office on Women's Health in the Department of Health and Human Services.

Reprint provided by the Office on Women's Health in the Department of Health and Human Services