Frequently Asked Questions

Why should I get a Pelvic exam?
Pelvic exams are an integral part of a woman's comprehensive health care. Pelvic exams are not only for sexually active women and are not only for heterosexual women. ALL women, regardless of their sexual orientation or their level of sexual activity, should have regular Pelvic exams. Pelvic exams allow women to maintain an up-to-date knowledge of their reproductive health, to become familiar with what is normal for their body and in turn to be able to identify future health problems.

Having regular Pelvic exams can help you:

* Prevent illness
* Detect cancers such as cervical, uterine and breast cancer at an early and potentially more treatable stage
* Detect Sexually Transmitted Infections (STDs) before they cause infertility or other damage
* Provide health care before, during and after pregnancy

You also want to visit your medical provider for a Pelvic exam if you are experiencing:

* Unusual or severe abdominal, vaginal or pelvic pain
* Abnormal vaginal bleeding or discharge
* Pain or swelling or the vulva and/or vagina
* Sores, lumps or itching of the vulva and/or vagina
* Thickening, dimpling, puckering or other changes in the breasts
* Retracted nipple(s) or abnormal discharge from the nipple(s)
* Unusual or severe menstrual pain


What are Pelvic exams?
Many women would rather do just about anything else besides having a Pelvic exam. While it's true that it's not a favorite experience of many women, it's not as bad as you may think. Learning what the exam involves and how quick and painless it will be should help ease any reservations you might have about scheduling your exam. Typically, a Pelvic exam involves a medical history, brief physical exam, breast exam, pelvic exam, STD tests, and other lab tests and counseling.

Here are the details about what you can expect to happen during a Pelvic exam:

Medical History
A medical provider will take you to an exam room and will ask you about your medical history. Important questions s/he will ask include:

* When was your last period?
* How regular are your periods and how long do they last?
* Do you have any spotting between periods?
* Do you experience painful intercourse?
* Do you have any unusual genital pain, itching or discharge?
* Do you have any other medical conditions?
* Are there family members with significant medical conditions?
* Are you using birth control if you are heterosexually active?
* Do you use methods to prevent STDs?


Use this time to bring up any concerns you have or questions you'd like to get answered. Try not to be embarrassed about asking sexual health questions - your medical providers have heard these questions before! Talk openly with your provider and s/he will be able to help you become much more informed. The provider will also ask about past health issues and whether you smoke, drink, or use other drugs. To round out the medical history, your provider will take your blood pressure, weight, and have you step out to the bathroom to empty your bladder, which will help you be more comfortable during your exam. Your provider may also ask you to give a urine sample at this time if there is any chance of pregnancy.

Breast Exam
Next, the provider will leave the room and ask you to get fully undressed and put on one of the lovely paper gowns. You can leave your socks on if you like!

Your medical provider will return to the exam room once you've changed, and will start by listening to your heart and lungs and checking your thyroid. Next s/he will ask you to lie back on the exam table and will perform a breast exam. S/he will feel your breasts to detect any lumps or thickening. If you don't know how to perform breast self-exams (BSEs) your provider will show you how.

Pelvic Exam and STD/Lab Tests
Next, the provider will ask you to move to the end of the exam table and place your feet in the footrests. Let your knees and thighs spread wide open and relax. The more relaxed your muscles are, the more comfortable your exam will be. As you take a few deep breaths and check out the posters on the ceiling, your provider will begin to look at your vulva - your external genitalia - looking for any symptoms of irritation, growths, cysts, genital warts or discharge. You will feel your provider's gloved hands touching your vulva.

Next, your provider will use what is called a speculum (also affectionately called "duck lips") - a plastic instrument that s/he will gently insert into your vagina. The speculum spreads the vaginal walls slightly apart so that the cervix can be seen. When the speculum is opened it is no bigger than a sex toy or penis would be. At this point there is usually some pressure, but if you feel pain, let your provider know so s/he can adjust the speculum for greater comfort. Your provider will look at your cervix to make sure it looks healthy. If you'd like to see your cervix you can ask your provider for a mirror to see for yourself!

Once the speculum is in place, your provider will look for any irritation, growths or abnormal discharge from the cervix. S/he will use a small plastic spatula and either a long, soft mascara brush or broom-shaped device to take a quick sample of your cervical cells - a test called the Pap Smear. This test will be sent off to a lab to determine if there are any abnormal cervical cells. Also at this time, your provider will offer to perform a test for chlamydia and s/he may suggest other STD tests if there are concerns that you have been exposed to other STDs. Talk to your provider if you are worried about symptoms you may have experienced or if you are concerned about a sex partner. Some of these tests use what looks like a long Q-tip to take samples of your cells which are sent off to a lab. All of these steps only take a few minutes!

Next, your provider will gently remove the speculum and perform a bimanual exam. With a gloved hand s/he will insert 2 fingers into the vagina and with the other hand on top of your abdomen will feel your uterus, fallopian tubes and ovaries. S/he is feeling the size, shape and position of the uterus and whether there is any tenderness or swelling. Again, some pressure is felt here and you may experience the sensation of having to urinate, but it is quick. If you have had anal sex play or if your uterus is positioned a certain way, your provider will sometimes perform a rectal exam, again with a gloved finger to feel if there are any tears or any weakness in the muscles that separate the rectum and the vagina.

Counseling
At this point the exam is complete. Your provider will leave the room so you can get dressed, and will return to discuss any questions you have. Use this opportunity to ask those questions you've always wanted to ask! Write them on a slip of paper if you think you'll forget or be too embarrassed to ask. You can learn a lot in these few minutes - make the most of it. You may have questions about:


* Sexuality
* STDs
* Birth control
* Pregnancy
* Abortion
* Infertility
* Breast self-exams
* Any other general health topic


Do I need to prepare for the exam?
It's a good idea to refrain from having intercourse or douching for the 24 hours before your exam. These activities can irritate the genital area and vaginal lining and obscure test results.

What if I have my period?
If you are having your period at the time you are scheduled to have a Pelvic exam, you will need to reschedule. When you're having your period it can be difficult for the provider to clearly see your anatomy and it can obscure test results.

How long does it take?
The actual pelvic exam may take about 5 minutes - not long at all! The entire time you're in the exam room including the Q & A session with your provider may take up to 45 minutes, especially if you have questions or are seeking a contraceptive method.

Does it hurt?
For most women, Pelvic exams are at worst mildly uncomfortable and a bit awkward. You can tell your provider what you're feeling during the exam so s/he can slow down or make adjustments so that you'll be as comfortable as possible. Your medical provider will take the time to describe what s/he is doing. If at any point you decide that you don't want to go further with the exam, that is ok. You are in complete control of the exam and can ask your provider to stop at any time you are uncomfortable.

When should I have my first Pelvic exam?
A woman should have her first Pelvic exam as soon as she becomes sexually active or when she reaches the age of 18 - whichever happens first.

How often do I need to have Pelvic exams?
A woman should have a Pelvic exam every year if she is sexually active or over the age of 18. Hence, women often refer to it as their "annual."

Do I have to be tested for STDs?
You don't HAVE to do anything, but if you have been sexually active your medical provider most likely will recommend that you have at least a chlamydia STD test performed. It is also good to know that your providers are required by law to offer HIV testing, so this would be another STD test that will be discussed with you.

Can I request a female medical provider?
Yes, of course. If you are more comfortable having a female medical provider, you can make that request when you call to schedule your appointment. If there is a particular medical provider you feel the most comfortable with, you can also request that person. It is important to note that if you choose to have a male provider, you may request a female chaperone to be present during the exam as well.