The pelvic exam (GYN exam) is an important component of preventive health care. It is essential for early detection and, therefore, better management of genital cancer, infections, sexually transmitted diseases or other abnormalities. It is also important for maintaining good reproductive health.
Some women avoid the pelvic exam because they feel embarrassed by the exposure involved or they have heard from a friend that it is an uncomfortable experience. However, the pelvic exam should not be painful or embarrassing. Sometimes it helps to make women more comfortable if they know what will happen during the exam.
How can I learn more about what my pelvic exams will entail?
When a female schedules her first health maintenance GYN exam or first prescription for oral contraceptives at the Duke Student Health Clinic, she may wish to attend a women's health information session with a health educator before seeing her health care provider. The information session includes a description of the pelvic exam, demonstration of the breast self exam, and information on contraception and safer sex.You may make appointments for both the information session and the clinical exam by calling 681-WELL.
When should I have my first pelvic exam?
Experts differ on the exact age at which you should have your first GYN exam. Most agree that if you are not sexually active, by the age of 21 you should have your first GYN exam. Individuals who are sexually active or those who are experiencing vaginal discharge, irregular periods, or other pelvic problems should have a GYN exam earlier.
How often should a pelvic exam be done?
After the first exam, you should continue to have exams once a year, especially if you are sexually active. A yearly exam will detect an abnormality that may have developed so that it may be treated early. You may also need an exam when you:
- have itching, redness, sores or swelling in the genital area
- have an unusual odor and/or increased vaginal discharge
- suffer from abdominal pain or painful intercourse
- have had sex with a person who might have an infection
- need a contraceptive method
How should I prepare for the exam?
- Schedule the exam when you're not having your menstrual period.
- Do not douche 24 hours before your visit (douches are not necessary for healthy hygiene).
- Use a condom if you have vaginal intercourse less than 24 hours before your exam.
- Write down your questions so you won't forget to ask them.
- Be prepared to tell your provider the date your last period started and how long it lasted.
What happens prior to the examination?
Before beginning the pelvic exam, your health care provider will ask for information concerning your medical background and menstrual, sexual and contraceptive history. Be sure to mention any genital symptoms you have had and ask questions about any special concerns.
The pelvic examination provides an opportunity to talk with your health care provider about safer sex and/or birth control methods. If you are not sexually active, this is an opportunity for you to become well informed before having to make decisions. If birth control is your primary concern, a contraceptive program will be tailored to meet your individual needs. If you are concerned about sexually transmitted diseases or other issues, you can discuss your concerns with your provider.
What happens during the examination?
You will be given a private room in which to remove your clothing, put on an examination gown, and drape your body with a sheet. After a general exam which includes examination of your lungs, heart, breasts, and abdomen, you will be asked to place your feet in the foot rests ("stirrups") at the end of the table. This position makes it easier and quicker for the examination to be done. The health care provider may use a lamp during this part of the examination.
Generally, the examiner will place a hand or arm on your leg or thigh before touching the outer genitals. This is to avoid startling you, in which case your genital muscles might involuntarily contract and make the examination more difficult.
The provider will use a glove to examine the entire vulva area. After the external genitalia has been inspected, your provider will gently insert a plastic or metal speculum. The speculum holds open the vaginal wall. You will feel some pressure when the speculum is inserted but it is done slowly and carefully. If you do feel tenderness or pain, tell the provider so that the speculum can be adjusted to make you feel more comfortable. You should also try taking deep breaths and relaxing as it is inserted because tensing your muscles will make this exam more uncomfortable.
Once the inserted speculum is opened the wall of the vagina and the cervix will be in view. Cells will then be taken from the cervix and vagina with a small flat stick and a small cervical brush. The cells will then be put into a vial with a solution and sent to a laboratory for analysis. This simple procedure, called the Pap smear, allows for early detection of precancerous cells. It is very important to avoid the use of douches, vaginal creams, or vaginal medications for at least 24-48 hours prior to your pelvic exam because these substances can distort the appearance of the cells to be studies in the Pap smear. Pap tests should also be avoided when you are having your period. With the speculum still in place, your provider may also take appropriate samples to determine the presence or absence of vaginal infection or sexually transmitted diseases.
After gradually removing the speculum, the examiner will do a digital examination. This is also referred to as a bimanual examination because both hands are used - one internally and one externally on the abdomen. The provider will insert one or two gloved fingers into the vagina and place the other hand on your abdomen, applying slight pressure. The provider may also insert a gloved finger into the rectum while applying slight pressure on the abdomen. This exam permits the detection of any growths, abnormalities, swellings, or areas of tenderness in the pelvic area. The entire exam takes a few minutes.
What happens after the exam?
You and your provider will discuss the findings of the examination. You'll be told when to expect the results of your Pap smear. Your provider will also advise you when to come in for your next pelvic exam and Pap smear. Sexually active women should have a yearly exam because of the importance of early detection of infections, disease, and precancerous cells.
What is the Pap smear?
A Pap smear is done to check for abnormal changes in the cells of the cervix (the lower opening of the uterus). A Pap smear can detect cervical cancer early, while it is still curable. Usually health care providers recommend that women have a Pap smear annually beginning at age 21 or after becoming sexually active if before age 21.
What if my Pap smear comes back abnormal?
An abnormal Pap smear result may indicate an infection, a precancerous condition or cancer. However, a Pap smear is just a screening; it is not 100% accurate. It may suggest a precancerous condition when in fact everything is normal. Sometimes it fails to detect cancer that is there. Further testing through additional Pap smears, colposcopy , biopsy or specific STD screening may be necessary to accurately diagnose and properly treat the condition.
What is dysplasia?
Dysplasia is one term that has been used to describe abnormal cells seen in a Pap smear that may be precancerous. In dysplasia, normal cervical cells undergo a series of changes in their appearance. It is not cancer, although if left untreated it may develop into an early cancer of the cervix.
Health Needs of Lesbians
All women should follow the same recommendations for maintaining their health. Pelvic exams, Pap smears, and breast self exams are important for detecting problems at an early stage regardless of sexual orientation. Usually, lesbians run a lower risk of getting a STD and various cancers associated with sexual intercourse, however all women are susceptible to STDs and cervical cancer.
The Student Health fee covers one annual gynecological exam.