Pelvic Exams: Answers to Your Uncomfortable Questions
Published: June 15, 2020
Pelvic exams are powerful tools in gynecological health and cervical cancer prevention. They also can feel invasive, uncomfortable and, frankly, a little weird. Whether you’re preparing for your first or your fifth, you might be nervous as your pelvic exam approaches, or you might have questions you’ve always wondered about. Either way, knowing what to expect during an exam can help ease anxiety.
Pelvic exam FAQs
Q: Why do I need pelvic exams?
A: Pelvic exams are essential to women’s health. They check the vulva and internal reproductive organs – the vagina, cervix, ovaries, fallopian tubes and uterus – for sexually transmitted infections (STIs), ovarian cysts, uterine fibroids, early stages of cervical cancer and more.
Q: When do I need to get my first pelvic exam?
A: Girls should have their first gynecological appointment between the ages of 13 and 15, and sexually active girls and younger women should be offered testing for common STIs.
You typically won’t need your first pelvic exam and Pap test – or cervical cancer screening – until age 21 unless you’re presenting symptoms such as abnormal bleeding, vaginal discharge, pain during sex, trouble inserting a tampon or other discomforts.
Q: I can’t remember when I had my last pelvic exam and Pap test. How often do I need to get them?
A: Women with a low risk of cervical cancer should get a pelvic exam with Pap test every three years from ages 21 to 29. From ages 30 to 65, you should be screened every three to five years, with additional testing for HPV. Women can stop screening altogether at age 65 unless they’ve had irregular Pap tests in the last 10 years or serious precancerous cells in the last 20.
Q: What kind of questions will my provider ask me at my appointment?
A: If you’re a new patient or coming in for your annual physical exam, you might be asked basic information about your sexual history, your gender identity or potential risk factors for STIs. You’ll most likely be screened for common concerns such as depression and history of sexual assault and domestic violence.
These are all big questions, and you might hesitate to answer them truthfully because you’re scared or uncomfortable. But your provider cares about your whole health and can give you more resources to help your mental and emotional health as well.
Q: So what actually happens during a pelvic exam?
A: Your provider will first conduct an external exam of your vulva and opening of your vagina for signs of STIs or other visible issues. Next, your provider uses a narrow instrument called a speculum to gently open your vagina to better visualize the cervix and upper vagina. The speculum holds your vaginal walls apart while the provider collects samples from your cervix for a Pap test or other samples to further evaluate unusual discharge and discomfort.
The next part of the exam is called the bimanual exam. With a gloved hand, a provider may insert one to two fingers into the vagina and up to the cervix while the other gloved hand is pressed down on the abdomen. This allows the provider to feel any abnormalities in the shape, size and consistency of the uterus, fallopian tubes and ovaries.
Q: Do pelvic exams hurt?
A: No. Pelvic exams may feel uncomfortable, but they shouldn’t feel painful. If any part of your exam is painful, please share your concerns with your provider. Pelvic exams last only a few minutes.
Q: I just know I’m going to be tense. What can I do?
A: Communicate with your provider that you’re feeling nervous and tense. They can help position you to feel more comfortable. Practice slow, deep breathing. Try to relax your shoulders, your stomach muscles and the muscles between your legs. Your provider should already be describing each step of the exam, but you can ask for more explanation or for them to go more slowly.
Q: Should I douche before a pelvic exam and Pap test?
A: Douching – or washing out the inside of the vagina – is not recommended in general, and it’s especially not recommended to douche or use any sort of vaginal cleansing solution prior to a pelvic exam and Pap test. It can interfere with the accuracy of screening tests or tests for yeast infections and other types of vaginitis. The vagina creates its own lubrication and, in effect, cleanses itself.
Q: What if I’m on my period? Do I need to cancel my appointment?
A: It depends. If the purpose of your exam is to evaluate abnormal vaginal bleeding or the possibility of an infection, it’s OK if you’re having your period. If the purpose is to have a Pap test or procedure like a colposcopy, your provider may want you to reschedule. If in doubt, call your provider before your appointment.
Q: I had a rectovaginal exam once and didn’t really know why. When are they needed?
A: If a rectovaginal exam is performed, the provider should warn you ahead of time and explain what they will be doing and why. This exam requires your provider to put gloved fingers into your rectum and vagina at the same time.
Rectovaginal exams might be performed if a woman has a retroverted uterus – one that curves backward toward her tailbone – or if she is being evaluated for a pelvic mass or significant pelvic pain. The rectovaginal exam may be used to better examine the area behind the uterus and in front of the rectum, which can be a common spot for endometriosis to occur or a mass to be positioned.
Q: What happens after a pelvic exam?
A: You may have a small amount of clear or blood-tinged vaginal discharge, which is normal. If any results come back irregular, your provider will contact you for further testing.
Communicate with your provider, talk to other women
Pelvic exams may feel routine to some women, but for those who are newer to them or for those with a history of sexual trauma, they can be anxiety-inducing. If you’re still nervous about your pelvic exam, communicate that with your provider. If you’ve suffered sexual trauma, share that with them when you’re ready – whether that’s in a verbal or written form. Have you had an unpleasant or painful pelvic exam in the past? Again, tell your provider, and they can work with you to make your exam as comfortable as possible. The better you communicate with your provider, the better they can care for you.
You have all the power. You can request the gender of your provider. You can ask your provider any questions you want – and remember that you can ask them to break down the steps of the exam and go more slowly. You can request less invasive versions of procedures. You can have someone you trust in the room with you during the appointment. You can also end your appointment at any time.
If something in your exam felt off, talk to other women in your life about their experiences during pelvic exams. Maybe something was normal and just new to you – or maybe it shouldn’t have happened. You might not know if you need to take action unless you talk to people you trust and normalize conversations about gynecological health. Pelvic exams are for you and your health, and it’s important to follow the recommended schedule to catch issues as they arise and prevent cervical cancer. Don’t let anything stop you from protecting yourself.