Pelvic examination

The pelvic examination is an important component of preventive health care. It is essential for early detection of genital cancers, infections, sexually transmitted diseases, or any other abnormalities. In addition to being valuable in preventing disease, the pelvic examination plays a very important part in the diagnosis and course of such diseases as uterine fibroids, pelvic inflammatory disease, status of pregnancy, etc.

It is recommended that women have an annual exam every year beginning at age18, or within six months of the first sexual intercourse. During the exam, the vulva, vagina, and cervix are examined for any signs of diseases, infection, or abnormalities. The routine pelvic exam is done by a medical professional(gynecologist, general practitioner, or nurse practitioner).

When a woman first arrives for the pelvic exam, she will be asked for information regarding her medical background and menstruation and contraceptive history. During the pelvic exam, the woman will be asked to lie on her back on the examination table, with knees bent and feet in stirrups at the end of the table. This position makes it easier for the clinician to conduct the examination. First, the medical practitioner visually examines the vulvar (genital) area for any abnormalities.

After the external genitalia has been checked, a metal or plastic speculum will be inserted into the vagina. The speculum holds open the vaginal wall so that the practitioner can see the cervix (the opening to the uterus). With thehelp of a tiny cervical brush that is inserted through the speculum, the physician will lightly scrape the cervix and vagina in order to obtain some cells from it. These cells will be smeared on a glass slide and sent to the laboratory for examination. This procedure called a Pap smear allows for the earlydetection of precancerous cells. The physician may also take extra cell samples to test for sexually transmitted diseases or vaginal infections.

After this procedure, the speculum is gently removed, and the physician conducts a bi-manual examination. It is called bi-manual because both hands are used. The clinician places one hand on the abdomen and inserts a gloved fingerinto the vagina. While applying slight pressure on the abdomen with one hand,with the other hand the physician will feel the uterus, fallopian tubes, andovaries. This helps the doctor to determine the size, mobility, shape, position, surface texture, and amount of tenderness of the uterus and ovaries. Italso enables identification of any cysts or masses that may be present.

While the entire procedure may feel awkward and cause a small amount of painand discomfort, this can be greatly minimized by relaxing the pelvic muscles.It is very important to avoid the use of douches and vaginal creams or medications for at least 48 hours prior to the pelvic exam because these substances can distort the appearance of the cells that will be studied in the Pap smear. For this reason, the test should not be scheduled when the woman is having her monthly period. It is also recommended that a woman not have sexual intercourse for 24 hours before the Pap smear is done

It is recommended that a woman have a pelvic exam and Pap smear once a year.If a woman has several sexual partners or has had an abnormal Pap smear in the past, her doctor may recommend that she be seen more often.

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