A pelvic examination is a physical examination of the organs in the pelvis that is done through the vagina. A woman often has a pelvic examination as part of a regular physical checkup and after a Pap test is done. A pelvic exam is also called a gynecologic examination or internal examination. After women start having their menses (monthly period), they usually have a pelvic exam each year.
Why a pelvic examination is done
A pelvic examination is done to:
- check the size, shape and position of the organs in the pelvis, including the ovaries, uterus and Fallopian tubes
- check for abnormalities, such as pain or abnormal bleeding
- 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
Back to top
How a pelvic examination is done
A pelvic examination is done in a doctor’s office or hospital. It may be done as part of a physical examination. Special preparation may be needed before a pelvic examination, including the following:
- Avoid having a pelvic examination and Pap test during menstruation. It is best to have the exam in the middle of a woman’s cycle, between 10 and 20 days after the first day of a menstrual period.
- Avoid having sexual intercourse for 48 hours before a pelvic examination and Pap test.
- Do not use a vaginal douche, vaginal medications or contraceptive (spermicidal) creams, foams or gels (except as directed by the doctor) for 48 hours before having a pelvic examination and Pap test. These products can wash away or hide abnormal cells.
- A woman may feel more comfortable if she empties her bladder before the examination.
- It helps to take deep breaths and relax the muscles during a pelvic examination.
Before the exam, the healthcare professional will ask questions about a woman’s medical and reproductive history, including:
- date of last period
- whether she is sexually active and, if so, if she is using birth control
- any problems with periods, such as spotting or pain
- whether she could be pregnant
A pelvic examination usually follows these procedures:
- Clothing is removed from the waist down and the woman covers herself with a sheet while lying on an examination table. Usually the knees are bent and spread apart.
- The healthcare professional checks the outer appearance of the vulva and opening of the vagina.
- An instrument (called a speculum) is gently inserted into the vagina.
- Doctors use a speculum to widen the vagina so they can clearly see the cervix and vagina and perform a Pap test.
- The speculum is removed after the Pap test.
- For the internal exam, the doctor puts a gloved finger into the vagina to check the cervix and pelvic organs (such as the uterus, ovaries and Fallopian tubes) while gently pressing on the lower abdomen with the other hand. A lubricating jelly may be used. The woman may feel pressure, but this is not usually painful.
- In some cases, a rectovaginal examination may be done to check the ovaries and ligaments that support the uterus. This is done by inserting one finger into the vagina and one finger into the rectum.
During the exam, a woman may feel some pressure and mild discomfort, but it is not usually painful to have a pelvic exam. A pinching or scraping sensation may be felt during a Pap test.
Back to top
What the results mean
Abnormal findings may mean that further investigation is needed. Abnormal findings may include:
- inflammation
- ulceration (open sores)
- discharge that is not normal
- swelling of vulva, vagina or cervix
- unusual pain or tenderness
- a lump or growth
- enlarged and unmoveable (fixed) uterus or ovaries
- uterus or ovaries are not in the normal position in the abdomen
Back to top
What happens if a change or abnormality is found
The healthcare professional will discuss whether further tests, procedures, follow-up care or treatment are needed. Additional tests may include:
- biopsy
- A sample of the endometrium, cervix, vagina or vulva is examined under a microscope.
- colposcopy
- A colposcopy may be done if results from the Pap test are abnormal or if an abnormality is found on the cervix, vagina or vulva.
- Where it is available, the human papillomavirus (HPV) test can be done for women 30 years of age and older as followup to abnormal Pap test. The HPV test is not used as a replacement for the Pap test.
- endoscopy
- A hysteroscopy or laparoscopy may be done to investigate abnormalities.
- pelvic or transvaginal ultrasound
- dilation and curettage (D&C)
Back to top