What's Going to Happen During my Exam?

You've had checkups or physical exams before and the first part of your pelvic exam won't be much different. After the nurse or medical assistant shows you back to the exam room, he or she will take your vital signs including your blood pressure, weight, and temperature. If you're nervous you might mention that its your first pelvic exam. Your doctor's office may be very busy and it might seem like no one cares, but they will be understanding and try to make you feel more comfortable if they know its your first time. After your initial discussion with the nurse, you'll be directed to take all of your clothes off (you may leave your socks on.) Most gynecologists provide a short examination gown and a paper sheet to cover yourself until your examination begins. When you're finished, and sitting on the examining table, your gynecologist comes in, accompanied by the nurse. A female nurse should always be present during your annual exam, particularly if your gynecologist is male. The presence of the nurse provides protection for both you and your gynecologist. Your physician will listen to your heart and lungs, check your breasts for any changes or lumps, and palpitate your abdominal area for any irregularities. A reliable examination of your breasts takes approximately 30 seconds per breast.

During your breast examination your physician should discuss monthly breast self- exam with you and also provide instructions if you are unfamiliar with how to perform BSE. If you are 35 or older, your physician should also discuss mammogram screening for breast cancer.

During the pelvic exam/ Pap smear portion of your visit, you'll need to lay down on the table and put your feet in the stirrups. You may need to scoot down to the end of the table and spread your knees apart. Next a speculum is inserted into your vagina to hold your vaginal walls open so your physician can view the inside of the vaginal walls and the cervix, and collect a sample of cervical tissue for your Pap test.

Obtaining the Pap smear requires that your gynecologist insert a long cotton swab into your vagina. The cotton swab gently swabs against your cervix so that a sample of cervical cells is retrieved for evaluation by a pathologist. Labs generally require about five days for your test results to return to your gynecologist.

In the unlikely event that your Pap results are abnormal, the first thing you should not do is jump to the conclusion that you have cancer. In the majority of abnormal Pap smears, the cause is not cervical cancer, but one of a variety of other causes that include inflammation, the presence of blood or sperm, or an infection such as a vaginal yeast infection or bacterial vaginosis, and sometimes the presence of an undiagnosed sexually transmitted diseases.

Try to remember that the Pap smear is not a diagnostic tool -- it does not diagnose cancer or any other disease. The Pap test is a screening tool that indicates whether further evaluation is necessary. If you receive abnormal Pap results your gynecologist may recommend a follow-up Pap test in three to six months. Or other options for further testing such as colposcopy or the LEEP may also be recommended.

Another part of your annual pelvic exam is called a bimanual exam. This test is performed when your gynecologist inserts two fingers into your vagina and places the other hand on top of your lower abdomen, while feeling for any abnormalities that might have occurred since your last pelvic exam. During this part of your examination, your doctor checks the size, shape, and mobility of your uterus. Changes in your ovaries, such as ovarian cysts may be detected during the bimanual exam, as well as other uterine changes including endometriosis, fibroid tumors, or other common uterine conditions.

Sometimes your provider will do a rectal exam while you are still in the stirrups. This involves inserting one finger into your anus. Since your uterus is on top or in front of your rectum, this allows your caregiver to feel any abnormalities of the uterus. Some women's uterus tilts back toward their spine, which is a normal variant, a rectal exam will help feel a retroverted uterus. A rectal exam will also allow your caregiver to make sure there are no masses or problems with your rectum. Sometimes they will do a fecal blood test which will tell them if there is blood in your stool. This is an easy test and you may not even realize that it was done. Don't be embarrassed by having a rectal exam. This is usually done at the end of the bimanual exam. Like other parts of the exam, if you relax and take slow deep breaths, it should not be uncomfortable.

When the examination portion of your appointment is complete, your gynecologist will go over your health diary and answer any questions you have. This is when you should tell your gynecologist about the timing and frequency of any illness or other condition you might have experienced since your last appointment. Also make sure to include information about whether you have experienced irregular periods or painful periods, or any other menstruation menstrual problems, vaginal infections, or painful sexual intercourse.

Other health issues to discuss include any dramatic weight change, hair loss or skin changes.

You've done it! You've had your first pelvic exam. You can now get dressed and leave knowing that you're taking care of your body. The whole thing probably lasted 15 minutes and the actual pelvic exam was maybe five minutes. Its important that you have this done once a year.