A pelvic exam, also referred to as an internal exam, is a common medical procedure that allows a healthcare provider to assess the health of your reproductive organs. It involves the external and internal examination of your vulva, vagina, cervix, uterus, ovaries, and rectum. Most commonly performed by an OB-GYN, gynecologist, or certified nurse midwife, the pelvic exam may be done as part of routine gynecological care or when investigating certain symptoms.
Why Pelvic Exams Are Performed
Pelvic exams are used to diagnose and monitor a variety of gynecological concerns. While not necessary at every routine visit, they are helpful in certain scenarios, especially when specific symptoms are present. Some common reasons a pelvic exam might be performed include:
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Unusual vaginal bleeding
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Pelvic or abdominal pain
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Painful intercourse
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Abnormal vaginal discharge
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Suspected infections or masses
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Monitoring ovarian cysts, fibroids, or polyps
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Detecting anatomical irregularities
Pelvic exams may also accompany other gynecological procedures like Pap smears. However, they are not required for all birth control prescriptions or STI screenings. Adolescents and individuals without symptoms typically don’t need a pelvic exam unless there's a medical reason.
How To Prepare for a Pelvic Exam
Pelvic exams are outpatient procedures and usually take just a few minutes. There's no special diet or medication restrictions beforehand, but a few simple steps can make the experience more comfortable:
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Wear easily removable clothing
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Empty your bladder before the exam to reduce pressure
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Schedule the exam for a lighter day of your menstrual cycle (if applicable), though it’s still safe during menstruation
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Bring your ID, insurance card, and any necessary medical information
If you're feeling anxious, consider writing down any questions you want to ask your provider ahead of time.
Emotional and Physical Support During the Exam
For many people, pelvic exams can feel uncomfortable, both physically and emotionally. If you're nervous or have a history of trauma or abuse, you’re encouraged to bring a trusted person with you to the appointment. Communicating openly with your provider about your comfort level is key.
People experiencing gender dysphoria may also find pelvic exams distressing. Let your provider know your preferred pronouns and any specific terms you use to describe your anatomy. You can also request that your provider narrate each step and ask for consent before proceeding.
What Happens During a Pelvic Exam
A pelvic exam is generally straightforward and includes several short steps. Here’s what you can expect:
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External examination: Your provider visually inspects your vulva for signs of irritation, infection, or anatomical concerns.
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Speculum insertion: A lubricated speculum is gently inserted into the vagina to hold it open, allowing the provider to view the cervix and vaginal walls. This might feel like pressure or mild discomfort but shouldn’t be painful.
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Sample collection: If you're receiving a Pap smear or HPV test, the provider will use a small brush to collect cells from the cervix.
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Internal manual exam: Your provider will insert one or two gloved fingers into your vagina while pressing on your abdomen with the other hand. This helps assess the size, shape, and position of the uterus and ovaries.
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Rectal exam (sometimes): In some cases, especially for older individuals or if rectal concerns are present, the provider may insert a finger into the rectum for further evaluation.
You can always request that the provider explain each step before proceeding or stop the exam if you feel discomfort.
What To Expect After the Exam
Once the exam is complete, your provider will discuss any findings and outline the next steps if needed. You can return to your regular activities right away. Mild spotting is common after a Pap smear, but it should resolve quickly. You may also notice residual lubrication, which can be gently cleaned.
Risks and Emotional Considerations
Pelvic exams are considered very low-risk. Physical discomfort, if any, is usually mild and short-lived. Some individuals may feel anxious, vulnerable, or embarrassed, particularly if it’s their first time or they’ve had negative medical experiences in the past. Remember, you have the right to stop the exam at any point and should feel empowered to speak up if something feels off.
Finding a provider you trust and who respects your boundaries makes a significant difference.
Understanding Your Results
If your provider notices anything unusual during the exam—like a mass, signs of infection, or structural changes—they may recommend additional tests. This might include a pelvic ultrasound, lab tests, or a biopsy.
If you had a Pap smear or HPV screening, results usually take one to two weeks. Here’s what the results might mean:
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Normal: No signs of abnormal cells or infection.
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Unclear: There may be slight abnormalities, but the cause isn’t definitive. Further testing may be required.
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Abnormal: Some cell changes were detected, potentially linked to HPV or other issues. Additional testing or follow-up may be necessary.
An HPV test result can be either negative (no infection) or positive (infection detected, which may increase cervical cancer risk).
When To Follow Up
Your provider will guide you on any necessary next steps. If abnormalities are found, you may be scheduled for follow-up tests or treatments. It's important to attend all recommended appointments to ensure your reproductive health is well monitored.
A Quick Review
Pelvic exams are an essential part of gynecological health and are used to check for issues related to the reproductive organs. Though not required for everyone or during every visit, they play a key role in diagnosing conditions like infections, fibroids, and abnormal bleeding.
If you’re preparing for your first pelvic exam or feeling anxious about the procedure, know that you can speak openly with your provider, bring support, and set boundaries to make the experience as comfortable as possible.
