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What to Expect at Your First Pelvic Exam

Why an exam is a good idea

Are pelvic exams even necessary? If so, when? Although there is some controversy among medical specialists about who needs an exam and how often, current recommendations state that, in the absence of symptoms or problems, young women need not have their first pelvic before the age of 21, and then every three years for most. Tests for the more common STDs can be done with a simple urine sample or a self-administered vaginal swab, so that’s no longer an essential reason for a visit to the doctor.

There are, however, two less tangible but still important reasons why a young woman might choose to get a pelvic exam. In my experience as an adolescent medicine specialist who has performed many reproductive health evaluations on teens, I’ve found that this visit is possibly most valuable as an educational tool: to clear up misconceptions, instruct on anatomy and function, discuss sexuality and sexual activity, and review the patient’s knowledge of pregnancy and STD prevention. Another reason is to reassure teens that they are normal — this might be their only opportunity to ask questions they’d ordinarily bottle up.

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Do I need to do anything to prepare for a pelvic exam?

You do not have to do anything special to get ready for a pelvic exam procedure. When you arrive at the office, your healthcare provider may ask if you need to use the bathroom. Sometimes, a urine sample is requested. If you’re on your period on the day of the exam, the doctor may suggest rescheduling for your comfort.

Does a pelvic exam hurt?

You can expect to feel a little discomfort, but you should not feel pain during a pelvic exam. Take slow, deep breaths and urinate before the exam to help with any discomfort. If you feel pain or discomfort during your exam, tell your doctor.

It can also help to talk to your provider about your worries or concerns that the pelvic exam might be painful before your exam starts. They can walk you through the process and address your concerns.

How can I relax during a pelvic exam?

It is normal to feel a little nervous prior to a pelvic exam. It can help to:

  • Take slow and deep breaths.
  • Relax your shoulder, stomach and leg muscles.
  • Ask your provider to explain what is about to happen.

If you have experienced sexual trauma, speak with your healthcare provider so that they can be supportive of your feelings and make your exam as comfortable as possible.

How is a pelvic exam performed?

When it’s time for your pelvic exam, you’ll start by taking off your clothes in private. You are given a gown, sheet or other covering. You will be asked to lie on your back and relax the muscles of your stomach and legs. Your healthcare provider will have you to slide down to the end of the table and place your feet in holders called stirrups.

There are a few things that may happen during your pelvic exam:

  • External exam: Your healthcare provider will visually inspect your vagina and vulva.
  • Manual exam: Your provider will place one or two fingers inside the vagina and use the other hand to gently press down on the area they can feel from the outside. They will feel the size and shape of your organs or if any areas are tender or enlarged.
  • Speculum exam: A duck-billed shaped device called a speculum will be inserted into the vagina. The speculum is then opened to widen and spread the vaginal wall so that the vagina and cervix can be more easily seen.
  • Pap test: Your provider will use a plastic spatula and small brush to take a sample of cells from the cervix. A sample of fluid may also be taken from the vagina to test for infection. This is called a Pap test or Pap smear. This test looks for precancerous cells on the cervix. A Pap test is not always performed during a pelvic exam. You should not place anything inside your vagina for 48 hours prior to your Pap test.
  • Rectal exam: Your healthcare provider may insert a finger into the rectum to detect any tumors or other abnormalities.

What do pelvic exams check for?

During your pelvic exam, your provider may test for:

  • Cervical cancer: If your healthcare provider performed a Pap test during your exam, it’s to look for precancers, or cell changes on the cervix that could become cancer.
  • HPV (human papillomavirus): This test is also used to screen for cervical cancer. The test looks for HPV, which can cause cell changes in the cervix. These cell changes can lead to cancer.
  • Sexually transmitted diseases or infections (STIs): Your doctor may swab your vagina to test for chlamydia and gonorrhea.

The samples your provider takes during the pelvic exam are sent to a lab where they are examined. Results can take several days.

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