Pelvic Examination

Test Overview

A pelvic examination is a thorough check of a woman's pelvic organs. The exam helps a doctor or nurse see the size and position of the vagina, cervix, uterus, and ovaries.

Why It Is Done

Experts differ on how often a pelvic exam is needed. Talk to your doctor about when to have this test.

A pelvic exam may be done:

As part of a woman's regular physical checkup. The exam may include a Pap test. To learn more, see the topic Pap Test.
To find vaginal infections, such as yeast infections or bacterial vaginosis.
To help find sexually transmitted infections, such as chlamydia, herpes, gonorrhea, trichomoniasis, or human papillomavirus (HPV).
To help find the cause of abnormal uterine bleeding.
To look for problems like uterine fibroids, ovarian cysts, or uterine prolapse.
To find the cause of pain.
Before prescribing a method of birth control. Some methods, such as a diaphragm or intrauterine device, require an exam to make sure the device fits well.
To collect evidence in cases of suspected sexual assault.

How To Prepare

Try to schedule the exam when you are not having your period. The blood can affect Pap test results. But the exam can be done during your period if you have a new vaginal discharge or new or increasing pain in that area.

Before the exam:

Don't use douches, tampons, vaginal medicines, or vaginal sprays or powders for at least 24 hours.
If you have abnormal vaginal discharge, don't have sex for 24 hours before the exam.

At the start of your visit, tell your doctor or nurse:

The first day of your last menstrual period and how long your period lasted.
If this is your first pelvic exam.
If you are using a method of birth control.
If you are or might be pregnant.
If you have pelvic-area symptoms such as itching, redness, sores, swelling, or an unusual odor or increased vaginal discharge. If you have been performing regular vaginal self-exams, discuss with the doctor or nurse any changes you have noticed. To learn more, see the topic Vaginal Self-Examination.
If you have had surgery or other procedures, such as radiation therapy, involving the vagina, cervix, or uterus.

If you have had problems with pelvic exams or using tampons before or have experienced rape or sexual abuse, talk to your doctor or nurse about your concerns or fears before the exam.

No other special preparations are needed. For your own comfort, you may want to empty your bladder first.

Talk to your doctor or nurse about any concerns you have. To help you understand the importance of this test, fill out the medical test information form(What is a PDF document?).

How It Is Done

During a pelvic exam, you will:

Take off your clothes below the waist. You will have a paper or cloth covering around your waist. If it is your yearly exam, you may need to undress completely so your doctor or nurse can also check your breasts.
Lie on your back on an exam table with your feet raised and supported by stirrups. This allows the doctor or nurse to look at your vulva, urethra, vagina, and other reproductive organs.
Have a drape across your body for privacy during the test. The doctor or nurse may use a lamp during the test.

You can ask for a mirror if you want to watch while the test is being done.

A female nurse or assistant may stay in the room with you during the exam. You may also request the presence of your partner or a friend.

A pelvic exam can involve three steps: the external exam, bimanual (two-handed) exam, and rectovaginal exam.

External exam

During the external exam, the doctor or nurse will:

Check your vulva and the opening of your vagina for signs of redness, irritation, discharge, cysts, genital warts, and other abnormal conditions.
Check inside your vagina with gloved fingers for any cysts or pus coming from the Bartholin glands.
Gently insert the speculum into your vagina. The speculum spreads apart the vaginal walls. This lets the doctor or nurse see the inside of the vagina and the cervix. The speculum may be plastic or metal. It may be warmed with water or lubricated with a vaginal lubricant (such as K-Y Jelly).
Check the walls of your vagina and your cervix for damage, growths, inflammation, unusual discharge, or discoloration.

If you are due for a Pap test, the doctor or nurse will use a small brush or a wooden spatula to gently collect a sample of cells from your cervix. You may have some staining or bleeding after the sample is taken. A sample of the cervical mucus may also be collected with a cotton swab. The mucus may be tested for sexually transmitted infections such as gonorrhea or chlamydia.

Bimanual exam

Your doctor or nurse will insert one or two gloved fingers of one hand into your vagina while placing the other hand on your lower belly. By pressing down on your belly and moving the fingers around inside your vagina, the doctor or nurse can find and feel the size, shape, and texture of the uterus and ovaries. Any unusual growths, tenderness, or pain can also be identified.

Rectovaginal exam

Your doctor or nurse will insert one finger into your rectum and one into your vagina. This helps the doctor or nurse evaluate your ovaries and uterus ligaments. This exam is not always done as part of a pelvic exam.

After the exam is finished, you will be given a washcloth or tissue to wipe your vaginal area to remove any discharge from the exam. Then you will get dressed. Some test results may be available right away. But getting results from the Pap test may take several days to a couple of weeks.

How It Feels

A pelvic exam is more comfortable if you are relaxed. Breathing deeply and having a light conversation with the doctor or nurse may help you relax. Try not to hold your breath or tense your muscles.

You may feel some pressure or mild discomfort when the speculum is inserted into your vagina. Try to relax your legs and hips as much as you can. You may feel 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 being inserted.

During the bimanual part of the exam, you may feel an uncomfortable sensation of pressure or a slight twinge of pain as the doctor or nurse feels your ovaries. Breathing deeply may help you relax. You may feel a brief pinch when the Pap test is taken. Tell your doctor or nurse if any part of the exam is painful.

During the rectovaginal exam, you may feel as though you are about to have a bowel movement as the doctor or nurse withdraws a finger from your rectum. This is a normal sensation that lasts only a few seconds. You may have a small amount of vaginal discharge or bleeding after the exam.

Risks

There are no risks linked with a pelvic exam.

Results

A pelvic exam is a thorough check of a woman's pelvic organs. The exam helps a doctor or nurse see the size and position of the vagina, cervix, uterus, and ovaries.

**Pelvic exam**
Normal:	The uterus and ovaries are normal in size and location. The uterus can be moved slightly without causing pain.
	The vulva, vagina, and cervix look normal with no signs of infection, inflammation, or other abnormalities.
	Glands around the opening of your vagina (Bartholin's glands) or urethra (Skene's glands) are not swollen or inflamed.
	No masses (nodules) of abnormal tissue are felt in the area between the uterus and rectum or in the ligaments that attach to the uterus to hold it in place. No fibroids are felt.
	There is no pelvic pain or tenderness.
	No hardening of tissue is felt.
Abnormal:	Sores, signs of infection, inflammation, or abnormalities of the vulva, vagina, or cervix are seen. Signs of a sexually transmitted infection (such as genital herpes, genital warts, or syphilis) may be seen. More tests will be needed to find the cause.
	The glands around the vagina (Bartholin's glands) or urethra (Skene's glands) are swollen or inflamed.
	The uterus cannot be moved (even slightly) during the exam.
	Pain or tenderness is felt when the uterus is moved slightly or when the area between the uterus and rectum is touched. The uterus is pushed away from the midline of the belly.
	The ovaries are enlarged, not movable (fixed), or painful when touched.
	An ovarian mass is found. Or a mass that was found during a previous exam is still there or has grown larger.
	Small masses (nodules) of abnormal tissue are felt. Uterine fibroids are felt.
	Hardening of tissue is felt.
	An area of ulceration or a tear is found.
	A mass can be felt near one or both ovaries.

Many conditions can change the results of your pelvic exam. Your doctor or nurse will talk to you about any significant abnormal results.

What Affects the Test

You may not be able to have the test, or the results may not be helpful, if:

You are having your period.
You have a vaginal infection.
You used a douche or vaginal cream or preparation within 24 hours of the exam.

What To Think About

A pelvic exam is usually not needed to get a prescription for hormonal birth control.

A pelvic exam is not always done to check for sexually transmitted infections (STIs). It depends on your symptoms.

Tests used to check for STIs include:

Pelvic ultrasound is another test used to check a woman's pelvic organs. To learn more, see the topic Pelvic Ultrasound.

Vaginal self-exam may help you better understand your body, know what is normal for you, and find early signs of infections or other abnormal conditions that might require medical attention. A self-exam should not replace a pelvic exam and Pap test done by a doctor or nurse. To learn more, see the topic Vaginal Self-Examination (VSE).

References

Other Works Consulted
Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.
Pagana KD, Pagana TJ (2010). Mosby's Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier.

Credits

ByHealthwise Staff

Primary Medical ReviewerSarah Marshall, MD - Family Medicine

Kathleen Romito, MD - Family Medicine

Specialist Medical ReviewerFemi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology

Current as ofOctober 13, 2016

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Next Section:
Why It Is Done

Current as of: October 13, 2016

Author: Healthwise Staff

Medical Review: Sarah Marshall, MD - Family Medicine & Kathleen Romito, MD - Family Medicine & Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology