What Is a Pelvic Exam?

What to expect when undergoing this checkup

A pelvic exam is an examination of the internal and external organs in your pelvis, including the vagina, vulva, uterus, cervix, rectum, ovaries, and fallopian tubes. During the exam, your doctor checks your pelvic area visually and physically to make sure everything is normal. You may also have a Pap smear and a test for certain sexually transmitted diseases (STDs) at the same time.

What to expect during a pelvic exam
Illustration by Emily Roberts, Verywell

Purpose of Test

A pelvic exam often takes place as part of your preventive care during a routine checkup to look for any changes and screen for early signs of cancer, cysts, fibroids, and STDs. If you're pregnant, you'll likely have several pelvic exams during the course of your pregnancy.

Pelvic exams are also used to help diagnose a medical condition when you're having symptoms such as:

Any of these symptoms can indicate a vaginal infection or an STD, which could affect your future fertility. They may also indicate other conditions like endometriosis, pelvic inflammatory disease (PID), or a number of other reproductive disorders.

Components: The pelvic exam generally consists of three parts: an external visual exam, an internal visual exam, and a physical exam called the bimanual exam.

If it's time for your Pap smear, a screening for cervical cancer, you'll have that as well. Most women only need to have a Pap test starting at age 21 years and then again every three to five years.

If you have symptoms of an STD or you're at high risk for contracting one, your doctor may also take a sample for an STD test.

Frequency: There is currently no consensus among experts on how often a pelvic exam should be performed as preventive care. The American College of Obstetricians and Gynecologists (ACOG) recommends that women who are 21 years or older have a pelvic exam every year to screen for cancer and infection and that women under 21 only have a pelvic exam if they are having symptoms of a medical problem. Other professional societies have different recommendations.

Your doctor likely has her own opinion regarding how often you'll need a pelvic exam based on your medical history and general health, so she'll tell you how often you need to have one.

Before the Test

The best time to schedule your annual pelvic exam and to obtain the most accurate results from your gynecological examination and Pap smear, if applicable, is one or two weeks after your period.

Vaginal douching is never a good idea because of the risk of infection it presents. It's particularly important not to douche for at least two or three days before your pelvic exam. You should also refrain from sexual intercourse for at least 24 hours prior to your examination.

Timing: A pelvic exam itself only takes a few minutes, but planning on about an hour for the whole appointment is generally a safe bet. This includes time spent waiting, filling out forms, completing your medical history, and so on.

Location: This test is done in your doctor's office or a health clinic.

What to Wear: You'll need to remove your clothes and put on a gown for a pelvic exam. You may also be given a sheet to cover your bottom half.

Food and Drink: There are no food, drink, or medication restrictions for this evaluation.

Cost and Health Insurance: Since a pelvic exam is often performed as a part of a routine physical or checkup, the cost may vary depending on factors such as whether or not you have a Pap smear or STD testing and what else is included in the cost, such as a separate physical exam. The exam alone can range from $100 to $300 or more.

If you have health insurance through the Affordable Care Act's Marketplace or other insurance that covers preventive care, an annual pelvic exam will be completely covered as part of your annual well-woman visit. This means you won't need to pay any out-of-pocket costs.

If you need a pelvic exam for diagnostic purposes because you're having symptoms, this should also be covered by your health insurance. Contact your insurance agent or company for more information, including details about any co-pay or deductible you may need to pay.

If you don't have health insurance, are under-insured, or considered low-income, check with your local or county community health clinic. Many of these offer free or low-cost pelvic exams, STD testing, and Pap smears that you pay for based on your income. You can also find local providers who do free or lost-cost exams via the Centers for Disease Control and Prevention (CDC)'s National Breast and Cervical Cancer Early Detection Program.

What to Bring: You may want to keep a period diary that you can go over with your doctor during your appointment. You can use a calendar or app to keep track of the dates of your periods, the amount of flow, any pain experienced, discharge, or other symptoms that occur during the month.

Bring along any questions you have about the exam or your gynecological health as well.

Have your insurance card handy, as well as your co-pay, if needed.

During the Test

A pelvic exam is performed by a doctor, physician assistant, or nurse practitioner. You can see your regular primary care physician or family doctor for this or you can go to an obstetrician-gynecologist (OB-GYN).

Your doctor may have a nurse present during your pelvic exam as a means of protection for both of you, but if you're not comfortable with someone else being there, feel free to request that it just be the two of you. Conversely, if your doctor doesn't have a nurse in the room and you would feel more comfortable with someone else there, you can have your partner or friend in the room or request that a nurse comes in during this part of your checkup.

Pre-Test: After checking in and filling out any necessary forms, which may include an authorization to bill your insurance or an updated health history, it's a good idea to empty your bladder so you can be more comfortable during your exam.

Once called into the exam room, you will usually start by having your blood pressure, weight, pulse, and potentially your urine checked. Be prepared to give the nurse the date of the first day of your last period. Also, tell the nurse about any concerns that you want to discuss with the doctor such as irregular periodspainful periods, or any other menstrual problemsvaginal infections, or painful sexual intercourse.

After your initial discussion with the nurse, you'll be directed to take all your clothes off, with the exception of your socks. You will be given a gown and drape to cover yourself until your examination begins.

Your doctor will knock to make sure you're ready and then enter the room. He'll run through your medical history and discuss any problems you're having. It’s important for you to be as accurate and complete as you can in answering the questions and describing any symptoms you may have.

Your physician may listen to your heart and lungs, check your breasts for changes or lumps, and feel 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're unfamiliar with how to perform this. If you're 35 or older, your physician should also discuss mammogram screening for breast cancer.

Throughout the Test: The pelvic exam itself only takes a few minutes. During each part of the exam, your doctor will probably tell you what she's doing to do, especially if this is your first pelvic exam.

First, you'll need to lie back, scoot down to the end of the table, put your feet in the stirrups or on the corners of the table, and spread your knees apart. This feels uncomfortable, especially the first time or two, but keep in mind that your doctor does pelvic exams regularly. Try taking deep breaths to help relax your muscles if you're feeling tense.

At this point, your doctor may look at the outside of your vaginal area to check for any abnormalities, swelling, sores, or irritation.

Next, a speculum, a metal instrument that looks like a duck's beak, is inserted into your vagina with a lubricant to make it more comfortable. The speculum widens your vaginal walls so your physician can view them, as well as your cervix. The speculum can be uncomfortable and you may feel some pressure as it's opened, but you shouldn't feel pain. If you do, be sure to tell your doctor. There may be a smaller one she can use instead.

If you're having a Pap smear, a sample of cervical tissue is taken with a small wand or spatula once your cervix is in view. This may cause some brief discomfort, but again, it shouldn't be painful and it only lasts for a second or two as your doctor collects the tissue.

If you're also being tested for STDs like chlamydia or gonorrhea, or other infections such as a yeast infection, pelvic inflammatory disease, or bacterial vaginosis, your doctor will use a cotton swab to take a sample of your cervical discharge for the STD test or your vaginal secretions to test for other infections. The speculum is gently slid out once this part of the exam is complete.

The next part is the bimanual exam. To perform this, your doctor wears gloves and inserts two lubricated fingers into your vagina, places her other hand on top of your lower abdomen, then compresses the tissue between her two hands, feeling for any abnormalities that might have occurred since your last pelvic exam.

The bimanual exam allows your doctor to check the size, shape, and mobility of your uterus to feel for any changes in your ovaries, such as ovarian cysts, and to feel for any tenderness or other abnormalities in your uterus or the surrounding tissues like endometriosis, fibroid tumors, or other common uterine conditions.

The bimanual exam can be a bit uncomfortable, but should not result in overt pain. Fortunately, this part of the examination usually lasts for less than 30 seconds. Because it can give your doctor important information, it's worth a bit of temporary discomfort.

After checking your vaginal area, your doctor may also do a rectal exam by inserting one lubricated finger into your rectum to check for any pain or abnormalities there like hemorrhoids or tumors. This is an optional part of a pelvic exam, but if your doctor does do this, try to relax as much as you can.

Post-Test: Once your pelvic exam is completed, you will be given privacy to get dressed. You may be offered some tissues to wipe off any excess lubricant and a maxi pad or panty liner in case the speculum causes any spotting.

After the Test

When you're ready, your doctor will come back to the room to discuss the results of your pelvic exam with you. After your visit is through, you can go home and resume your normal activities. You may have light spotting, but this shouldn't last long.

Interpreting Results

Your doctor can usually tell you right away if she found any problems or abnormalities during your pelvic exam or if it was normal.

In cases where your doctor took a vaginal fluid sample during your exam to look for a yeast infection or bacterial vaginosis, this sample will be looked at under a microscope for signs of fungus, bacteria, or viruses. Your doctor may even look at the slides herself after your pelvic exam. The presence of these microorganisms is immediately obvious, so you will likely know before you go home if you have one of these infections and leave with a prescription to treat it.

If you had a Pap smear, the results for this may take a few days and up to three weeks to get back. Your doctor's office will likely mail the results to you or call you, but if you don't hear anything after three weeks, be sure to call.

Results from a cervical swab to check for gonorrhea and chlamydia will take a few days to come back.

Follow-Up: If your pelvic exam was normal, you'll need to schedule another one in a year or the time frame your doctor recommends.

If your pelvic exam showed any abnormalities, your doctor will talk to you about what these findings may mean, as well as about additional testing, follow-up, and/or treatment options.

For instance, if you come in with symptoms of endometriosis, your doctor may have felt cysts or scars on or around your reproductive organs during your pelvic exam—another piece of evidence that you could have this condition. However, you will likely need more testing to confirm this diagnosis like ultrasound, magnetic resonance imaging (MRI), and, in some cases, laparoscopy. Treatment for endometriosis typically involves medication and/or surgery.

If your pelvic exam and/or vaginal fluid sample revealed that you have a yeast infection or bacterial vaginosis, treatment will depend on what's behind the infection. Bacterial vaginosis is typically treated with antibiotics, while yeast infections are treated with prescription or over-the-counter antifungal medications. If you have recurrent yeast infections, your doctor may also send your vaginal fluid sample to a lab to be cultured to find out exactly what kind of fungus is causing your infection in order to treat it more specifically and effectively.

In the case of suspected pelvic inflammatory disease, your doctor will order additional cultures on your vaginal and cervical fluid and may recommend ultrasound, blood and urine tests, and laparoscopy to confirm the diagnosis, find what's causing the infection, and to see how widespread it may be. It will likely take a few days for culture results to come back. Treatment for PID involves antibiotics for both you and your partner.

Your doctor may have felt an ovarian cyst during your pelvic exam. If so, she'll potentially order more tests to see what kind it is and if you need treatment. These tests may include a pregnancy test, laparoscopy, and blood tests. Treatment for ovarian cysts depends on factors like your age, medical history, symptoms, and the size and kind of cyst you have, but can include monitoring your condition, medication, or surgery.

Uterine fibroids are often detected during a pelvic exam as well. These noncancerous growths in your uterus rarely develop into cancer and can range in size from microscopic to large enough to cause your uterus to bulge out. These fibroids don't cause symptoms for most women. If your doctor needs confirmation that you have fibroids, he may order additional tests to check such as ultrasound, blood tests, and possibly another imaging test like MRI. Treatment for this condition ranges from watching it closely to taking medications to opt for a variety of procedures that can make the fibroids smaller or remove them completely.

A pelvic exam can be the first step in diagnosing cancers that occur in the ovaries, uterus, rectum, vulva, cervix, fallopian tubes, and bladder. Sometimes the tumors or abnormal cells can be seen or felt during your exam. In cases where cancer is detected or suspected, your doctor will likely want to do additional testing. Depending on the type of cancer, tests may include ultrasound, a biopsy of your tissue, hysteroscopy, imaging tests, blood tests, and urinalysis.

Positive results on your gonorrhea and chlamydia tests will show which infection you have (though you can have both at the same time). You'll need to be treated with an antibiotic to clear up the infection.

Other Considerations: If you have any questions or concerns about the results of your pelvic exam, discuss these with your doctor. This is also a good time to discuss contraception, fertility, sexual health, and any other areas or issues you're concerned about.

A Word From Verywell

Your doctor knows how personal this exam is, so feel free to talk openly and honestly about any feelings of nervousness or anxiety so she can help you feel as comfortable as possible. This might prompt her to take things a little slower, make sure she explains everything she's doing before she does it, and check to make sure you're doing alright as the exam proceeds.

If you really feel like you can't bear enduring a pelvic exam, you absolutely have the right to decline. However, your health could be at stake if you avoid this exam for too long, especially if you're having symptoms. Consider talking with a therapist about your fears, or what may be behind them, so you can get to a point where you're able to have a pelvic exam. Find a doctor with whom you feel comfortable and establish trust with him or her during other visits. Taking these steps can empower you to take control of your reproductive health and conquer your fears.

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