Pelvic Exam and Pap Screenings

A typical pelvic exam only lasts a few minutes. You undress below the waist and cover your lower body with a sheet or gown. You lie down on the exam table with your legs raised in footrests or leg rests called stirrups.

A pelvic exam generally has three parts:

1. Looking at the vulva—Your ob-gyn looks at your external genitals.
2. Looking at the vagina and cervix—Your ob-gyn inserts a speculum into your vagina. This tool keeps the walls of your vagina open during the exam. This is when a Pap test (also called a Pap smear) or a test for human papillomavirus (HPV) may be done, if you need cervical cancer screening.
3. Checking the internal organs with a gloved hand—Your ob-gyn removes the speculum, places one or two gloved fingers into your vagina, and pushes their fingers up toward your cervix. The other hand presses on your abdomen from the outside. This helps your ob-gyn feel your internal organs, including your uterus and ovaries.

Sometimes you also may need a rectovaginal exam. This may be done to check for cancer or other health problems. For a rectovaginal exam, your ob-gyn will insert one gloved finger into your vagina and another into your rectum.

A pelvic exam can be recommended for several reasons, including the following:

• If you have symptoms—Symptoms such as abnormal bleeding, abnormal vaginal discharge, pelvic pain, or pain during sex could point to a gynecological problem. A pelvic exam can help your ob-gyn diagnose the issue.
• As part of a pelvic procedure—Pelvic exams are recommended when getting an intrauterine device (IUD) or having an endometrial biopsy.
• When you’re pregnant—A pelvic exam is typically performed at your first prenatal care visit.
• If you have a history of gynecological conditions—Certain conditions, such as cervical dysplasia, may require regular screenings.

A pelvic exam is not needed to screen for sexually transmitted infections (STIs). You also don’t need one to get birth control, other than an IUD.

Adolescents usually don’t need a pelvic exam at their first gynecologic visit unless they are having problems.

There is not much research on the usefulness of annual pelvic exams for women who aren’t pregnant, experiencing symptoms, or at risk for gynecological conditions. The American College of Obstetricians and Gynecologists (ACOG) recommends women have pelvic exams only when they have symptoms or have a medical history that requires it.

Ultimately, you and your ob-gyn or other health care professional should make this decision together. Discuss your medical history and the risks and benefits of a pelvic exam.

The potential benefits of a routine pelvic exam include:

• Possible early detection of treatable conditions, such as infections or cancer
• Detection of other problems, such as changes to the skin in your pelvic area
• A better understanding of your body
• Reassurance about your sexual and reproductive health

There is not much research on the potential harms of pelvic exams. There is some evidence that a pelvic exam may cause some women fear, anxiety, embarrassment, or pain and discomfort. Talk with your ob-gyn if you have concerns about getting a pelvic exam.

A pelvic exam may feel strange if you have not had one before. There may be minor discomfort, but it should not be painful. Tell your ob-gyn right away if you have pain during the pelvic exam. They may be able to make the exam more comfortable. Relaxing your body also may help ease your discomfort.

There may be a chaperone in the exam room. This person usually is a nurse or medical assistant. You may be given a chaperone automatically. If you are not given a chaperone, you can ask for one. ACOG recommends that a chaperone be present for all breast, genital, and rectal exams.

If you do not want a chaperone in the room, make your wishes known. You also can have a partner, friend, or family member with you during the exam.

Pelvic exams can be triggering or painful for survivors of sexual abuse. If this is true for you, let your ob-gyn know. The following may help make the pelvic exam easier:

• Your ob-gyn should explain what they will be doing ahead of time. They also should be able to talk you through the steps as they happen.
• Your ob-gyn should always ask permission before touching you.
• You may want to have a partner, friend, or family member in the room during the exam.
• You may feel more in control if you can direct the pace of the exam, see more of the exam (such as with a mirror), or put your hand over the ob-gyn’s hand to guide the exam.
• Remember that you can ask to stop the exam at any time.

If you think one or more of these steps might help, let your ob-gyn know.

Experts recommend that you visit your ob-gyn at least once a year for a well-woman visit. The purpose of this checkup is to help you stay healthy and prevent health problems at all stages of life. Well-woman visits are an important part of your health care, even if you do not need a pelvic exam. They are a chance for you and your ob-gyn to talk about sex, birth control, planning for pregnancy, and more.