The Pelvic Exam

Schedule your appointment about a week before your period starts, or the week after your period ends, because blood can alter the results of the Pap smear, a key test for cancer.

To help your doctor get the most information from the exam, here are a few ways to prepare:

Don't douche or use vaginal creams or lubricants for at least 24 hours before the exam.
Prepare a list of questions. It's easy to forget things once you're in the doctor's office. Make notes of any worrisome symptoms or concerns, such as menstrual irregularities. Feel free to ask about any health problems that may be worrying you, even if they don't involve your reproductive health. No question is stupid. This is the place to get answers to your questions or advice about where to find answers.
Prepare your answers to questions the doctor may ask you. You may forget dates, previous illnesses or other important information when you are sitting in the office. You also may want to think about your answers to some questions, such as whether you want to use birth control.

Here are some questions you may be asked in a questionnaire or by the nurse or doctor. Prepare your answers to these questions before your appointment, so you will have dates and your medical information ready to discuss as needed. It is also helpful to bring with you any calendar or record of your menstrual bleeding pattern and related symptoms of pain, cramps, discharge or other problems.

When did your last period start?
How long do your periods last? Is the bleeding heavy or light? How many days between periods?
What medications are you taking? Are you allergic to any medications?
Do you smoke? Do you drink alcohol? Do you take any vitamins, herbs or recreational drugs?
What disease or medical conditions have you had or do you have now? What about members of your family? List past surgeries and hospitalizations.
Are you having sexual intercourse?
Do you think you might be pregnant?
Are you using birth control and/or are you interested in learning more about birth control options?
Do you perform breast self-examinations?
How often do you exercise?

The General Checkup

In the waiting room, you may be asked to complete a detailed form about your health and lifestyle.

Be honest, even if some of the questions make you feel uncomfortable or embarrassed. The information may be helpful in your treatments. If you are under 18 and want to talk about something you don't want your parents to know, ask if your conversation can be kept confidential.

When you are called into the office, a nurse or medical assistant will weigh you, take your blood pressure and check your pulse. You also may be asked to provide a urine sample, which is often used to test for pregnancy, diabetes and kidney or other infections.

To give the urine sample, you go into a bathroom and urinate into a wide-mouthed plastic cup. It's not as difficult as it may sound. You can start urinating, then move the cup under the stream to catch a small amount.

In some cases you'll be asked to leave the cup of urine in the bathroom — someone will get it when you're done. Or you may be asked to bring the sample to a nurse or laboratory technician in the office. Even if you aren't asked to provide a urine sample, take a moment to urinate before the exam. This will help you feel more comfortable when your doctor does the internal exam.

Your doctor will begin by reading your answers to the questionnaire and asking you questions if he or she needs more information or if the answer isn't clear. If you let the office know this is your first visit, many doctors will also take time to explain the procedures before starting the examination. Let the doctor know if you have any questions you would like answered.

Before the internal exam, your doctor may listen to your heart and lungs and feel your abdomen to see if the liver or spleen is enlarged. He or she will then examine your breasts. Some doctors will do this exam either while you are sitting up or lying your back on the exam table. Your doctor will examine your breasts for lumps, thickening or other irregularities, or discharge. Sometimes the breast tissue and nipple may be firmly pressed or squeezed slightly during the exam.

This shouldn't hurt, but some women's breasts can be tender at certain times of the month just before the period starts. If the exam is uncomfortable, let the doctor know.

During the exam, your doctor usually explains how to examine your own breasts at home. Monthly self-examination may help you discover lumps or irregularities that could be early signs of breast cancer. Identifying breast cancer in its early stage increases your chances for successful treatment and complete recovery.

The pelvic exam will be done next. Though it may make you feel awkward, it is an important part of taking good care of your health. Remember that the exam usually doesn't hurt and takes only a few minutes.

It is common for doctors to have a nurse or medical assistant chaperone and hand them exam materials during a pelvic examination. Male doctors usually ask a female nurse to come into the room during the exam. If he doesn't do this, feel free to ask for a woman to be in the room during your exam.

You'll be asked to lie back on the table, place your feet in the stirrups or footrests at the end of the table, and slide your hips to the edge of the table.

Your doctor will begin by checking the external parts of the genitals for irritation, sores or other abnormalities.

Then your doctor will insert an instrument called a speculum into the vagina. This is either a metal or plastic device shaped like a duckbill that holds the vagina open. Your doctor may warm the speculum first with water to make this part of the exam more comfortable.

The doctor inserts the duckbill portion of the speculum with the two pieces closed together, and then spreads them open slightly so the cervix can easily be seen. You may feel a little pressure, and some women with a narrow vagina may experience a little discomfort.

Try to relax during the exam. This will make you more comfortable and it will be easier for your doctor to examine you. If your muscles are tense, it will make the exam more difficult.

How To Relax During The Pelvic Exam

Having a pelvic exam may be a little uncomfortable, but it shouldn't be painful. However, some females get so anxious before and during the exam that all of their muscles tighten, including muscles in the abdomen, thighs, buttocks and vagina. This makes the exam more uncomfortable than it should be.

To relax, try the following:

Breathe slowly and deeply when the exam starts.
Relax the muscles in your stomach, thighs and buttocks.
Let your knees fall out to either side as if you are sitting cross-legged on the floor.
Resist the impulse to lift your pelvis off the table.
Distract yourself by thinking of something that makes you feel calm. Some women find talking with the doctor about what's happening during the exam helps to decrease their fear and anxiety.

Your doctor will examine the cervix (the opening of the uterus) and the inside of the vagina for abnormalities, such as irritation, growths or discharge. Then your doctor will perform a Pap smear (Papanicolaou smear), a test for cervical cancer or precancerous cells. Using a soft brush and then a plastic spatula, your doctor will lightly scrape the cervix to collect cells. You may feel a little cramping or a scratchy sensation. The cells will be prepared for the laboratory by spreading them on a microscope slide or suspending them in liquid. A pathologist will evaluate the Pap smear by examining the cells under a microscope. Your doctor will have the results in one to two weeks and will notify you if the results show any abnormalities.

Your doctor will then remove the speculum and do what is called a bimanual (two-handed) exam. He or she will place two fingers into the vagina while pressing the abdomen with the other hand. This part of the test shows:

The shape and size of the uterus, cervix, fallopian tubes and ovaries
Whether there are fibroid growths in the uterus or cysts on the ovaries.
Signs of infection, such as tenderness and pain

Finally, your doctor may do the rectal part of the exam. He or she will lubricate a finger and insert it into your anus to evaluate the internal organs from a different angle. He or she will also check the layers of muscle and connective tissue that separate the vagina from the rectum.

When the exam is over, you can get dressed. Again, let the doctor or nurse know if you have any questions.