A vaginal examination includes a complete physical examination of a woman's external genitals by a health professional. Pelvic examination also helps a health professional evaluate the size and position of a woman's pelvic organs. It is an important part of preventive health care for all adult women. Pelvic examination is done to help detect genital cancers, infections, sexually transmitted diseases (STDs), or other genital and vaginal abnormalities.
Vaginal examination includes:
* An external exam of the genital area around the external genitals (called the vulva).
* An internal exam with an instrument called a speculum. A Pap test is done during the internal exam.
* A bimanual internal exam. This exam is done by inserting one or two gloved, lubricated fingers into the vagina while pressing on the abdomen with the other hand.
* A rectovaginal exam (or digital rectal exam). This exam is done by inserting the lubricated, gloved first finger of one hand into the vagina and inserting the lubricated second finger of the same hand into the rectum while pressing on the abdomen with the other hand.
A pelvic examination may be done:
* As part of a woman's regular physical checkup. A Pap smear may be done during the pelvic exam. A pap smear helps detect the presence of abnormal cells in the cervix, cervical infections and inflammation, and thinning of the vaginal lining from lack of estrogen. The Pap smear is the standard screening test to detect the early stages of cervical cancer (see Pap Test).
* To detect vaginal infections, such as yeast infections or bacterial vaginosis.
* To help detect sexually transmitted diseases, such as chlamydia, herpes, gonorrhea, trichomoniasis, or human papillomavirus (HPV).
* To help determine the cause of abnormal uterine bleeding.
* To evaluate pelvic organ abnormalities (such as uterine fibroids, ovarian cysts, or uterine prolapse).
* To evaluate abdominal or pelvic pain. Chronic pelvic pain may be caused by a number of conditions, including pelvic infections (pelvic inflammatory disease), endometriosis, scarring in the abdomen or pelvis following surgery (adhesions), or diseases of the urinary tract or bowel. The exact cause of chronic pelvic pain is not always known.
* Prior to prescribing a method of birth control, or contraception. Many health professionals will not prescribe a method of birth control (such as a diaphragm, intrauterine device, or birth control pills) until a pelvic examination is done.
* Collect evidence in cases of suspected sexual assault.
A pelvic examination should be scheduled when you are not having a menstrual period, since menstrual blood can interfere with the results of a Pap smear. However, if you are experiencing symptoms that need to be evaluated, a pelvic exam may be done while you are having your period.
Do not douche, use vaginal creams or preparations, or have sexual intercourse for 24 hours before the exam.
No other special preparations are needed before having a pelvic examination. For your own comfort, you may want to empty your bladder before the examination.
Before a pelvic examination, tell your health professional the first day of your last menstrual period and how long it lasted. If you have been performing regular vaginal self-exams, discuss any changes you have noticed with your health professional (see the medical test Vaginal Self-Exam). Also tell your health professional if:
* You are or might be pregnant.
* You have any genital symptoms such as itching, redness, sores, swelling, or an unusual odor or increased vaginal discharge.
* You are using a method of birth control.
* This is your first pelvic exam.
A pelvic examination is performed in a doctor's office or a health care facility by a general or family practice doctor, by a doctor trained in the diagnosis and treatment of diseases of women's reproductive systems (gynecologist), by a doctor who specializes in the care of adults (internist), by a physician's assistant, or by a nurse practitioner.
You will be instructed to take off your clothes below the waist and drape a paper or cloth covering around your waist. You will then lie on your back on an examination table with your feet raised and supported by stirrups. This allows the health professional to examine your vagina and genital area.
Your body will be draped for privacy during the test. A female nurse or assistant may stay in the room with you during the exam. The health professional may use a lamp during the test, and you may ask for a mirror if you want to watch while the test is being done.
During the external genital exam, the health professional will check your vulva and the opening of your vagina for signs of redness, irritation, discharge, cysts, genital warts, and other abnormal conditions. The health professional will also check inside the vagina with a finger for any cysts or pus coming from the Bartholin glands.
For the internal exam, the health professional will gently insert the speculum into your vagina. The speculum gently spreads apart the vaginal walls, allowing the inside of the vagina and the cervix to be examined. The speculum may be plastic or metal and may be warmed with water or lubricated with a vaginal lubricant (such as K-Y Jelly). The vaginal walls and cervix will be checked for damage, growths, inflammation, unusual discharge, or discoloration. A Pap smear will be taken using a small brush and a wooden spatula to gently collect a sample of cervical cells. You may have some staining or bleeding after the sample is taken. Sometimes a sample of the cervical mucus is taken with a cotton swab to be tested and cultured for sexually transmitted infections such as gonorrhea or chlamydia. The speculum will then be removed from your vagina.
For the bimanual exam, your health professional will insert one or two gloved fingers of one hand into your vagina while placing the other hand on your lower abdomen. By pressing down on the abdomen and moving the fingers around inside your vagina, your health professional can locate and determine the size, shape, and consistency of the uterus, ovaries, and fallopian tubes. Any unusual growths, tenderness, or pain can also be identified.
Your health professional may then perform a rectovaginal exam (or digital rectal exam) by inserting one finger into your rectum and one into your vagina. This helps your health professional evaluate your ovaries, fallopian tubes, and uterus ligaments.
The entire pelvic exam takes about 10 minutes. After the exam is finished, you will be given a tissue to wipe your vaginal area to remove any discharge resulting from the Pap smear, and you will then dress. Some test results may be available immediately, but results from the Pap smear may take from several days to a couple of weeks.
When the speculum is inserted for the internal exam, you may feel some pressure or mild discomfort. 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 or lubricated with a vaginal lubricant (such as K-Y Jelly) before inserting it into the vagina.
During the bimanual part of the exam, you may feel an uncomfortable sensation of pressure or a slight twinge of pain as your health professional feels your ovaries, but breathing deeply may help you relax. You may feel a brief pinch when the Pap smear is taken. If you feel pain, let your health professional know.
During the rectovaginal exam, you may feel as though you are about to have a bowel movement as the health professional withdraws a finger from your rectum. This is a normal sensation that lasts only a few seconds. In some cases there may be a small amount of vaginal discharge or bleeding after the exam.
There are no risks associated with a pelvic exam.