Pelvic Exam: When You Need One and How to Prepare
Key takeaways:
A pelvic exam is a quick, painless procedure to look at your internal and external female reproductive organs.
Pelvic exams are useful for assessing both your sexual and reproductive health.
Your provider can perform important screening tests during a pelvic exam. They can detect cancer, cysts, fibroids, and infections before symptoms begin.
Pelvic exams are a key part of women’s health. It’s used as a screening test for infections, cancer, and other reproductive issues. It can also help your provider take a closer look if you’re having reproductive health symptoms. Pelvic exams are useful in evaluating abnormal periods, pelvic pain, vaginal itching, or discharge.
An obstetrician-gynecologist (OB-GYN) or other healthcare provider can perform a pelvic exam. The exam has two parts. The first is a visual assessment of the external female pelvic organs (the vulva and labia). The second part is a physical assessment. This is where your provider checks your internal organs, including your vagina, cervix, uterus, and ovaries.
What’s involved in a pelvic exam?
Your first pelvic exam can be a scary experience. But knowing what’s going to happen during the procedure can help to ease any anxiety you may be having about the exam. Here’s what you can expect at your next pelvic exam:
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Preparation
The first step is getting ready for the exam. You’ll go to the treatment room where you’ll meet the provider while you’re fully dressed. They’ll explain what to do and then step out to give you privacy.
You’ll need to undress from the waist down. You’ll get a paper or cloth gown or a sheet to cover yourself. Once you’re undressed, you’ll get on the exam table and put the sheet over your lower body. The provider will then knock to make sure you’re ready before they come back in.
Positioning
Once your provider is in the room with you, they’ll ask you to lie down on the exam table to get you in the proper position. They’ll pull out footrests (stirrups) from the exam table. They’ll help you put your feet into the footrests and have you slide your hips to the end of the table.
Your provider will encourage you to open your legs and drop your knees to each side. This puts you in the correct position for the exam and allows your provider to have the most complete view.
Outer inspection
Your provider will sit on a stool between your legs for the first two parts of the exam. They’ll take a close look at your external genitalia. This includes the outer portions of the female anatomy — including the labia, clitoris, urethra, and opening of the vagina. Your provider is looking for:
Redness
Irritation
Bumps
Sores
Cysts
Abnormal discharge
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Speculum exam
The next step is the speculum exam. A speculum is a plastic or metal tool that’s shaped like a duck’s bill. They’ll insert this in the vagina. Try your best to breathe and relax during this stage.
Your provider will gently slide the closed speculum into your vagina and then open it slowly to separate the walls of the vagina. This lets them see the entire vagina and the cervix.
If you need cervical cancer screening, you’ll have a Pap test or HPV test. The provider will use a tiny spatula or brush to rub against the cervix and collect cells to send to the lab.
You can also get tested for sexually transmitted infections (STIs) during the pelvic exam. Your provider will use a cotton swab to get a sample of any discharge.
Bimanual exam
The bimanual exam comes next. Your healthcare provider will stand and put one or two gloved fingers into your vagina. They’ll use lubrication for added comfort.
With their other hand, your provider will press on your lower abdomen during the exam. This lets them see if there are any areas of tenderness. They can also feel for lumps or masses and check the size, shape, and position of the uterus and ovaries. Your provider can also detect any fibroid tumors that you may have.
Rectal exam
At the end of the exam, depending on your age and your history, your provider may change their gloves and do a rectal exam. They’ll insert a gloved finger into the rectum to assess for lumps or abnormal areas.
When do you need a pelvic exam?
A pelvic exam may be used as a screening tool or to check for any reproductive or sexual health issues you may have. Here are some common situations for which someone gets a pelvic exam:
Cervical cancer screening (through a Pap test and HPV test)
Change in menstrual periods (frequency, intensity, or duration)
Symptoms of vaginitis (vaginal itching, swelling, or discharge)
Vaginal odor
Change in the appearance of the vagina (rash, lumps or bumps)
How often do you need a pelvic exam?
Experts recommend that you get your first Pap test at age 21. Thereafter, the recommendation is to have your pelvic exam and cervical cancer screening (Pap or HPV test) every 3 years between the ages of 21 and 65.
In addition to that, you should get a pelvic exam if you’re pregnant, have symptoms, or have a history of certain gynecologic conditions. For example, if you’ve had dysplasia (abnormal Pap smears), you may need more frequent checks.
Your provider will let you know how often you need to have pelvic exams based on your medical history.
How do you prepare for a pelvic exam?
While no true preparation is necessary, there are a couple of things you can do to make it a better exam. Some helpful tips include:
Avoid having sex 24 hours before the exam. Sex can cause irritation and may interfere with some tests.
Don’t insert any products in the vagina before the exam. Avoid vaginal douches, vaginal medications, or spermicides for at least 24 hours. These can make it difficult to see abnormal cells.
Avoid having a pelvic exam during your period, if possible. Minor spotting shouldn’t interfere. But heavy menstrual bleeding may make a full inspection challenging.
Empty your bladder first. It will be more comfortable if you empty your bladder. And your provider may also want to get a urine sample from you.
If there are any issues of concern, make sure to address them ahead of time. Talk with your provider before the exam begins if:
You’re getting your first pelvic exam
You could be pregnant
You’re having any issues such as pain, discharge, itching, an odor, or sores
You’ve had surgery or other procedures on your vagina, cervix, or uterus
You’ve had difficulty with pelvic exams in the past
How long does a pelvic exam take?
The pelvic exam itself is quick and generally takes only 3 to 5 minutes. Most of the actual visit will be the provider obtaining a history before your exam. There will also be time to discuss your health and any areas of concern.
Do pelvic exams hurt?
Pelvic exams are generally painless, although some people may feel a little pressure or discomfort when the provider places the speculum. Let your provider know if you feel any pain. They can try to make you more comfortable. Deep breathing can often help to relax the body.
After the exam, you may have some light spotting. This doesn’t mean something is wrong. This is very common and will go away in a few hours.
How long does it take to get the results of a pelvic exam?
The time to get your results will depend on what the provider is testing for. Some conditions — such as a yeast infection — can be diagnosed and treated right away in the office.
But it may take up to 3 days to get results for other conditions, such as STIs. Cervical cancer screening can take anywhere from 1 to 3 weeks for the results to return.
Do you need more testing after a pelvic exam?
Depending on what the pelvic exam finds, you may need more testing or treatments.
For certain STIs (like chlamydia or gonorrhea), you should get retested 3 months after treatment. The retest can either be through another pelvic exam or a urine screen.
For an abnormal cervical cancer screening test, further testing may vary. Based on your history, your provider may recommend another pelvic exam, a colposcopy, or other cervical biopsies to take a closer look.
If your provider finds any lumps during the bimanual exam, they may order a pelvic ultrasound or other imaging study. This would allow a better look at any cysts, fibroids, or masses.
The bottom line
For some people, a pelvic exam may stir up feelings of anxiety — but don’t skip it. Pelvic exams play an important part in preventive care. They also help check any reproductive or sexual symptoms you may have. Talk to your provider for guidance on how often you need to have a pelvic exam. It’s a quick and painless procedure that just may save your life.
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References
American Cancer Society. (2020). When cervical screening test results are abnormal.
American Pregnancy Association. (n.d.). Spermicide.
Centers for Disease Control and Prevention. (2022). Screening recommendations and considerations referenced in treatment guidelines and original sources.
National Cancer Institute. (n.d.). Pelvic exam.
Nguyen, J. D., et al. (2021). Anatomy, abdomen and pelvis, female external genitalia. StatPearls.
The American College of Obstetricians and Gynecologists. (2021). Cervical cancer screening.
The American College of Obstetricians and Gynecologists. (2021). Colposcopy.
U.S. Preventive Services Task Force. (2018). Cervical cancer: Screening.
