Pelvic exam

A pelvic exam is also called a gynecologic exam or internal exam. It is a physical examination of the organs in the pelvis that is done through the vagina. Pelvic exams are done if you are experiencing symptoms such as pelvic pain or abnormal vaginal bleeding or discharge. It may also be done to collect samples of cells for cervical cancer screening (called a Pap test).

A pelvic exam is done:

• to help find the cause of pain, abnormal vaginal bleeding or discharge
• to check for problems such as uterine fibroids or ovarian cysts
• to check the size and position of the organs in the pelvis including the ovaries, uterus and fallopian tubes, vagina and cervix
• before inserting an intrauterine device (IUD)
• to check for infections, including sexually transmitted infections (STIs)
• to collect cells for cervical cancer screening (called a Pap test)

A pelvic exam is done in a doctor’s office or hospital. You will be asked to remove your clothes from the waist down and cover yourself with a sheet. Pelvic exams are done while lying on an examination table with your feet supported by a footrest. It helps to take deep breaths and relax the muscles during a pelvic exam. There are different types of pelvic exams.

The healthcare professional begins by checking the outer appearance of the vulva and the opening of the vagina for signs such as redness, discharge, growths (such as cysts or genital warts) and other abnormal conditions.

An instrument (called a speculum) is gently inserted into the vagina. The healthcare professional uses the speculum to widen the vagina so they can clearly see the cervix and inside of the vagina. The walls of the vagina are checked for growths, inflammation and abnormal discharge. A Pap test may be done during this time. The speculum is then removed.

For the internal exam (bimanual exam), the healthcare professional puts one or two gloved fingers into your vagina and places the other hand on your lower abdomen. A lubricating jelly may be used. By moving the fingers around inside your vagina and gently pressing down on your abdomen, the size, texture and shape of your uterus and ovaries can be felt, as well as any lumps or growths. You may feel pressure, but an internal exam is not usually painful.

Sometimes a rectovaginal exam may be done. The healthcare professional inserts one finger into the vagina and one finger into the rectum. This helps to check the ovaries and ligaments that support the uterus.

Special preparation may be needed before a pelvic exam. Try to avoid having a pelvic exam and Pap test while you are on your period. Avoid having sexfor at least 24 hours before a pelvic exam. Do not use a vaginal douche, vaginal medicines or contraceptive (spermicidal) creams, foams or gels (except as directed by the doctor) for at least 24 hours before having a pelvic exam and Pap test. These products can wash away or hide abnormal cells.

You may feel more comfortable if you empty your bladder before the exam.

Before the exam, the healthcare professional will ask questions about your medical and reproductive history, including:

• the date of your last period
• if you are sexually active and if you use birth control
• if you have any problems with periods, such as spotting or pain
• if you have any symptoms in the pelvic area, such as itching, soreness, unusual vaginal discharge or odour
• if you could be pregnant

If the results are abnormal, your doctor may recommend more tests, procedures, follow-up care or treatment. Abnormal findings may include:

• signs of inflammation, infection and sores
• discharge that is not normal
• swelling of the vulva, vagina or cervix
• unusual pain or tenderness
• a lump or growth
• ovaries that are larger than normal
• a uterus or ovaries that can’t move (are fixed) or not in the normal position