Taking your first pelvic exam

You may be worried about taking your first pelvic exam. It is normal to feel anxious or embarrassed about it. But there’s no need to be once you know that it is a simple procedure that usually doesn't hurt and takes only a few minutes.

A “pelvic exam,” also called “gynecological exam,” is a way for your health care provider to examine your female organs and check for any gynecological problems. Pelvic exams are useful as a screening tool for sexually transmitted diseases and some forms of cancer that may affect the genitalia. There are no definite rules as to when you should have your first pelvic exam. But the American Cancer Society and the American College of Obstetricians and Gynecologists recommend pelvic exams for women who are 18 years old or older, sexually active or plan to be, have vaginal discharge, or have menstrual problems. Before you go for your first pelvic exam and to subsequent ones, you should not have sex, use vaginal creams, lubricants, or douche for at least 24 hours before the exam. Make sure to schedule your appointment about a week before your period starts, or the week after your period ends.

What happens during a pelvic exam?

You may be asked to complete a detailed form about your medical history. Then a nurse or medical assistant will weigh you, take your blood pressure and may be asked to provide a urine sample. Before the internal exam, the doctor may check your heart, lungs, liver or spleen, and the breasts. You will then be asked to lie down on the exam table, place your feet in the stirrups or footrests, and slide your hips to the edge of the table. There are usually four parts to the exam.

The External Exam

The doctor will first examine the external parts of the genitals to check for irritation, sores, discharge, cysts, warts, or other abnormalities.

The Speculum Exam

Then the 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. The doctor checks for any irritation, growth, or abnormal discharge from the cervix. Usually a small spatula of tiny brush is used to gently collect cells from the cervix for a Pap test, a test for cervical cancer or precancerous cells.

The Bimanual Exam

The doctor will then insert two fingers into the vagina while pressing the abdomen with the other hand. The doctor checks for: the size, shape and position of the uterus, cervix, fallopian tubes and ovaries; fibroid growths in the uterus or cysts in the ovaries; signs of infection such as tenderness or pain.

The Rectovaginal Exam

Finally, the doctor inserts a finger into the rectum to check the condition of muscles that separate the vagina and rectum. The doctor will also check for possible tumors located behind the uterus, on the lower wall of the vagina, and in the rectum.

When the exam is over, your health care provider will answer any questions you have and tell you when and how to get the results of your first pelvic exam. Even with the invasiveness of the procedure, you should be able to immediately resume normal daily activities.

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