What is a Pelvic Exam? Purpose, Procedure & Results

A pelvic exam is a routine medical checkup where your doctor examines your reproductive organs to check for signs of disease or other health issues. Think of it as a wellness visit for your pelvic area, much like how you might get your blood pressure checked during a regular physical.

This exam is one of the most important tools doctors use to maintain your reproductive health. While it might feel uncomfortable or nerve-wracking, especially if it's your first time, understanding what happens can help you feel more prepared and at ease.

What is a pelvic exam?

A pelvic exam is a physical examination of your external and internal reproductive organs. Your healthcare provider visually inspects and gently feels these areas to check for abnormalities, infections, or other health concerns.

The exam typically includes three main parts: an external examination of your vulva, an internal examination using a speculum to see your cervix and vagina, and a bimanual exam where your doctor uses their hands to feel your uterus and ovaries. The entire process usually takes about 10-15 minutes.

Most women start having pelvic exams around age 21 or when they become sexually active, whichever comes first. However, your doctor might recommend one earlier if you're experiencing symptoms like unusual bleeding, pain, or discharge.

Why is a pelvic exam done?

Pelvic exams serve several important purposes in maintaining your reproductive health. They help detect problems early, when they're often easier to treat and manage effectively.

Your doctor uses this exam to screen for cervical cancer through Pap smears, check for sexually transmitted infections, and identify conditions like ovarian cysts, fibroids, or endometriosis. It's also a chance to discuss birth control options, menstrual concerns, or any symptoms you've been experiencing.

Sometimes, pelvic exams are done for specific reasons beyond routine screening. If you're experiencing pelvic pain, unusual bleeding, abnormal discharge, or difficulty with urination, your doctor might recommend an exam to investigate these symptoms more thoroughly.

What is the procedure for a pelvic exam?

The pelvic exam procedure follows a gentle, step-by-step approach designed to be as comfortable as possible. Your doctor will explain each step before proceeding, and you can ask questions or request breaks at any time.

Here's what typically happens during your exam:

1. External examination: Your doctor visually inspects your vulva, looking for any irritation, cysts, or unusual growths on the external genital area.
2. Speculum examination: A speculum (a smooth, plastic or metal instrument) is gently inserted into your vagina to hold the walls apart so your doctor can see your cervix and vaginal walls.
3. Pap smear (if needed): Your doctor may collect cells from your cervix using a small brush or spatula for cervical cancer screening.
4. Bimanual examination: Your doctor inserts one or two gloved fingers into your vagina while pressing on your abdomen with the other hand to feel your uterus, ovaries, and fallopian tubes.
5. Rectovaginal exam (sometimes): In some cases, your doctor might perform a brief rectal exam to check the area between your vagina and rectum.

Throughout the exam, your doctor will communicate with you about what they're doing and ask if you're experiencing any discomfort. The entire process typically takes 10-15 minutes, with the actual examination portion lasting only a few minutes.

How to prepare for your pelvic exam?

Preparing for your pelvic exam can help you feel more comfortable and ensure the most accurate results. The good news is that preparation is fairly simple and doesn't require any major lifestyle changes.

Here are some helpful preparation steps to consider:

• Schedule wisely: If possible, schedule your exam for a time when you're not menstruating, as this can make the examination easier and more comfortable.
• Avoid certain products: Don't use douches, vaginal creams, or spermicides for 24-48 hours before your exam, as these can affect test results.
• Empty your bladder: Use the restroom right before your exam to help you feel more comfortable during the procedure.
• Wear comfortable clothing: Choose clothing that's easy to remove and put back on, like a skirt or dress with comfortable underwear.
• Prepare your questions: Write down any symptoms, concerns, or questions you want to discuss with your doctor.

Remember that you don't need to shave or do any special cleaning before your exam. Your doctor has seen it all and is focused on your health, not your appearance. If you're nervous, let your healthcare provider know - they can offer additional reassurance and take extra time to help you feel comfortable.

How to read your pelvic exam results?

Understanding your pelvic exam results helps you stay informed about your reproductive health. Your doctor will typically discuss the findings with you right after the exam, explaining what they observed and what it means for your health.

Most pelvic exams reveal normal, healthy findings. Your doctor might describe your cervix as "normal appearing," your uterus as "normal size and position," and your ovaries as "non-tender and normal size." These are all reassuring findings that indicate good reproductive health.

If your exam includes a Pap smear, those results usually take a few days to a week to come back from the lab. Normal Pap results are often reported as "negative for intraepithelial lesion or malignancy," which means no abnormal cells were found.

Sometimes, your doctor might find minor abnormalities that need monitoring but aren't immediately concerning. These could include small cysts, mild cervical changes, or signs of common infections. Your healthcare provider will explain what these findings mean and whether any follow-up is needed.

What are the risk factors for abnormal pelvic exam findings?

Several factors can increase your likelihood of having abnormal findings during a pelvic exam. Understanding these risk factors can help you take steps to protect your reproductive health and know when to seek medical attention.

Common risk factors that might lead to abnormal findings include:

• Sexual activity: Having multiple sexual partners or a partner with multiple partners increases your risk of sexually transmitted infections.
• Age: Certain conditions like cervical changes or ovarian cysts become more common as you get older.
• Family history: A family history of ovarian, cervical, or other reproductive cancers can increase your risk.
• Smoking: Tobacco use significantly increases your risk of cervical cancer and other reproductive health problems.
• HPV infection: Human papillomavirus is the leading cause of cervical cancer and abnormal Pap smears.
• Weakened immune system: Conditions like HIV or medications that suppress your immune system can increase infection risk.
• Previous abnormal results: If you've had abnormal Pap smears or other findings in the past, you may need more frequent monitoring.

Having these risk factors doesn't mean you'll definitely have problems, but it does mean regular pelvic exams become even more important for your health. Your doctor can help you understand your individual risk level and recommend the best screening schedule for you.

What are the possible complications of abnormal pelvic exam findings?

While most pelvic exams reveal normal findings, abnormal results can sometimes indicate conditions that need attention. Understanding these possibilities can help you recognize when follow-up care is important, though it's crucial to remember that many abnormal findings are treatable.

Common conditions that might be detected during a pelvic exam include:

• Cervical dysplasia: Abnormal cells on the cervix that could potentially develop into cancer if left untreated, though this process usually takes years.
• Sexually transmitted infections: Conditions like chlamydia, gonorrhea, or HPV that can cause symptoms and complications if not treated.
• Ovarian cysts: Fluid-filled sacs on the ovaries that are usually harmless but sometimes cause pain or complications.
• Uterine fibroids: Non-cancerous growths in the uterus that can cause heavy bleeding or pelvic pressure.
• Endometriosis: A condition where uterine tissue grows outside the uterus, potentially causing pain and fertility issues.
• Pelvic inflammatory disease: An infection of the reproductive organs that can lead to chronic pain or fertility problems if untreated.

More serious but less common findings might include signs of reproductive cancers, though these are relatively rare, especially in younger women. Early detection through regular pelvic exams greatly improves treatment outcomes for these conditions.

The key thing to remember is that finding a problem early almost always means better treatment options and outcomes. Your doctor will work with you to develop an appropriate treatment plan if any abnormalities are found.

When should I see a doctor for a pelvic exam?

Knowing when to schedule a pelvic exam helps you stay proactive about your reproductive health. Most women should start having regular pelvic exams around age 21, but there are specific situations where you might need one sooner or more frequently.

You should schedule a pelvic exam if you're experiencing any of these symptoms:

• Unusual vaginal bleeding: Bleeding between periods, after sex, or after menopause
• Pelvic pain: Persistent pain in your lower abdomen, pelvis, or during sex
• Abnormal discharge: Unusual color, odor, or consistency of vaginal discharge
• Urinary symptoms: Frequent urination, burning during urination, or difficulty emptying your bladder
• Missed periods: If you've missed periods and pregnancy has been ruled out
• Concerns about STIs: If you think you might have been exposed to a sexually transmitted infection

For routine screening, most healthcare providers recommend annual pelvic exams for sexually active women or those over 21. However, Pap smears (which are often done during pelvic exams) are typically needed every 3-5 years depending on your age and risk factors.

Don't wait if you're experiencing symptoms that concern you. Your doctor would rather see you for a minor issue than have you worry or let a treatable condition progress. Trust your instincts about your body and seek care when something doesn't feel right.