If you are experiencing symptoms that may be indicative of endometriosis or another gynecologic issue, you may consider visiting your OB-GYN for a check-up. Additionally, if you visited your primary care provider or another specialist and reported symptoms that could be related to your gynecologic health, they may refer you to an OB-GYN. When you visit this provider, they will most likely perform a pelvic exam after they take your medical and symptom history.
What is a pelvic exam?
A pelvic exam generally lasts a few minutes in length, and is a comprehensive evaluation of your reproductive system. When your provider performs a pelvic exam, they are checking your vagina, cervix, uterus, ovaries, pelvis, rectum, and vulva (the external portion of your vagina) for any issues. In order to examine these, your provider will look at the outside and the inside of your vagina, feel some of these structures internally, and may also take a small, internal sample of your cells called a Pap test. Typically, pelvic exams are recommended annually once a woman turns 21, however, their frequency or the timing of a woman's first exam may vary based on when she becomes sexually active or if she has a history of a previous gynecologic issue.1,2 Your provider will be able to determine how frequently you need to receive a pelvic exam, however, you can schedule your own anytime you are experiencing gynecologic symptoms that need addressed.
What to expect
When you see your provider for a pelvic exam, they will first ask you about your medical history and any symptoms you may be having. After this, they will begin the exam. You will need to get undressed, however, your provider will leave the room in order to give you privacy. You will be asked to put on a gown once undressed and before your provider returns. You may be able to keep clothes on the top half of your body, depending on whether or not your provider will be doing a breast exam as well. Once your provider comes in, they will ask you to move to the exam table and lie on your back with your knees bent and your feet in holders called stirrups. This allows for them to examine you efficiently. They will first examine the outside of your vagina, to look for any external issues such as sores, irritation, and inflammation.
After the external exam, your provider will begin the internal exam, which will start with inserting a speculum into your vagina. The speculum is small and hollow, and will be lubricated before insertion. It can be slowly and gently opened once inside to spread the vaginal walls. This allows for your provider to examine the inside of your vagina and your cervix (the bottom, narrow portion of the uterus that connects it to the vagina). When examining your cervix, your provider may use a small brush to take a sample of your cervical cells. This is called a Pap test, and it is used to look for signs of cervical cancer. They may also take a sample of your vaginal discharge to check for signs of a sexually transmitted infection.
Although some women do report that this part of the internal exam may be uncomfortable, it should not be painful. Let your provider know if at any point you start experiencing pain when the speculum is inserted or when they are taking cell samples.
The last part of the internal exam involves your provider removing the speculum and performing a bimanual exam. When they do this, they insert two lubricated fingers into your vagina while also pressing on your lower abdomen with their external hand. This allows them to assess your uterus, any pelvic tenderness or pain, and any ovarian abnormalities. In some cases, they may also need to examine your rectum. Your provider will let you know if this is necessary in your specific situation.
Once the exam is done, your provider will leave so you can get dressed. The results from your Pap test and any other exams may take a few days to come back. Your provider will let you know what tests, if any, they are running, and when you should expect to hear back from them.1,2
How to prepare
In general, there aren't many steps to take to prepare for a pelvic exam. In some cases, it may be beneficial to schedule an exam when you're not on your period, however, if you are having a period-related problem, you may be asked to schedule only when you're on your period. It is recommended that you not have sex, douche, or insert anything into your vagina for 24 hours before your exam.2 You may also feel more comfortable going to the bathroom before your provider begins the examination.
You will be asked about your menstrual cycle, including when your last period was. Having this information on hand may be helpful, along with a list of any medications you're taking and any symptoms you've been experiencing.
What if I'm nervous or uncomfortable about my pelvic exam?
It is very common to be nervous or uncomfortable before receiving a pelvic exam. This is especially the case before your first pelvic exam, or when receiving an exam after experiencing gynecologic symptoms. If you are uncomfortable about your exam, consider talking to your provider about your concerns. They may be able to talk you through what they're doing at each step, as well as ease some of your concerns. If you are concerned about your pelvic exam because you have experienced a past gynecologic trauma, such as sexual abuse, consider letting your provider know this as well. Many OB-GYN's are experienced in dealing with individuals in these situations, and will work with you to respect your needs, while also providing you with appropriate care.