Pelvic exam

A pelvic exam is also called a gynecologic exam or internal exam. It is a physical exam of the organs in the pelvis that is done through the vagina. A woman usually starts having pelvic exams after she becomes sexually active or turns 18 years of age.

A pelvic exam is done to:

• check the size and position of the organs in the pelvis, including the ovaries, uterus and fallopian tubes, vagina and cervix
• help find the cause of pain, abnormal bleeding or discharge
• check for problems such as uterine fibroids or ovarian cysts
• check for infections, including sexually transmitted infections (STIs)
• check the fit of a diaphragm or the placement of an intrauterine device (IUD) for birth control

A pelvic exam is done in a doctor’s office or hospital. It is often part of a regular physical checkup and may include a Pap test.

Special preparation may be needed before a pelvic exam. Try to avoid having a pelvic exam and Pap test during menstruation. Avoid having sexual intercourse for 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

You will be asked to remove your clothes from the waist down and cover yourself with a sheet while lying on an examination table. Usually the knees are bent and spread apart. It helps to take deep breaths and relax the muscles during a pelvic exam.

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. 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. 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. Growths can be felt and tenderness or pain can be identified. A lubricating jelly may be used. 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.

Abnormal findings may mean that further investigation is needed. Abnormal findings may include:

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

The doctor will decide whether further tests, procedures, follow-up care or additional treatment are needed.