Pelvic Exam Possible Complications
Pelvic exam complications can be encountered in a number of special circumstances. In women with atrophic vaginitis, the speculum exam may be very painful and liberal lubrication, and a narrow speculum is recommended for these patients.
There may be challenges when encountering a patient with a history of sexual trauma a pelvic examination may trigger anxiety or post-traumatic stress disorder. Consent must be acquired. Especially during these examinations, thorough explanations of the procedure should be emphasized. Mental health counseling, anxiolytics, and various alternatives to the exam can be suggested such as only removing the underwear, having a chaperone present, self-insertion of the speculum, offering the option to have a female provider present or having a friend or family member in the room for comfort. It should be stressed that the examiner can stop the exam at any time when requested by the patient 3).
Does A Pelvic Exam Hurt
You can expect to feel a little discomfort, but you should not feel pain during a pelvic exam. Take slow, deep breaths and urinate before the exam to help with any discomfort. If you feel pain or discomfort during your exam, tell your doctor.
It can also help to talk to your provider about your worries or concerns that the pelvic exam might be painful before your exam starts. They can walk you through the process and address your concerns.
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The internal exam occurs with the help of a speculum which allows the doctor to see the cervix and vaginal walls. The external exam includes checking up on your vulva to observe any abnormalities like irritation, sores, swelling, etc.
During the second part, i.e., palpation, the doctor will place 2 lubricated fingers in your vaginal canal with one hand, and with the other hand, they press down on your abdomen to feel your internal organs.
A lot of people prefer to get a pelvic exam on an annual basis, but it can also be done every three years now. It lasts for about 10 minutes, so its a fairly short procedure.
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How Often Do I Need A Pelvic Exam
Recommendations on how often you should get a pelvic exam can vary. The timing for your pelvic exams are typically based on your medical history, or if youre experiencing problems or symptoms. Some healthcare providers may recommend annual visits. Others may recommend an exam every three years until you are 65 years old. Ask your provider when they recommend you come back for routine pelvic exams.
Components Of The Female Pelvic Examination
Few guidelines address visual inspection and bimanual examination. The United States Preventative Services Task Force provides guidance only on Pap smear recommendations and absence of benefit of ovarian cancer screening.10,11 The American College of Obstetrics and Gynecology states that annual gynecologic examinations may still be appropriate even if cervical cytology is not performed at each visit, but offers no evidence to support this recommendation or guidance on specific components of annual examinations.12 The American Cancer Society suggests that pelvic examinations may facilitate detection of non-cervical pelvic malignancies and gynecologic conditions,13 but does not specify what components comprise an annual pelvic examination nor cite evidence.
The most evidence-based approach would therefore suggest Pap smear collection alone and the speculum examination required to achieve that goal. We suggest that bimanual and sometimes rectovaginal examinations may be important in evaluating pelvic symptoms but are not required for routine screening. We suggest that other components of the pelvic examination need not be done.
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Dont Routinely Do A Pelvic Examination With A Pap Smear
During a routine cervical smear for screening , a bi-manual pelvic examination has no proven benefit, as it has not been shown to improve the detection of ovarian cancer or to benefit other outcomes. In a large study of Australian women undergoing routine screening pelvic examination, no ovarian malignancies were found, and the high prevalence of benign abnormalities often led to further investigation.
A recent US review concluded that no data supports the effectiveness of speculum or bimanual pelvic examinations in the asymptomatic, average-risk woman. The procedure causes pain, fear, anxiety, and/or embarrassment in a third of women and can lead to unnecessary, invasive, and potentially harmful diagnostic procedures. Pelvic examinations require additional clinician time and, for consultations not otherwise requiring intimate examination, the consideration of a chaperone. Therefore, unnecessary examinations lead to resource and opportunity costs.
Recommendation released March 2016
Recommendations 1 – 5
Following an NPS Representatives meeting, two on that list were found to duplicate other Colleges’ choices, and it was felt the RACGP could endorse these rather than replicate them. Therefore the next two highest voted options were selected instead.
What Does A Pelvic Exam Feel Like
Your pelvic exam will only take a few minutes. Some parts of the exam may be uncomfortable, but it shouldn’t be painful. If it hurts, say something. Your doctor or nurse may be able to make things more comfortable. This exam is for you, so don’t be afraid to speak up.
You’ll feel less tense during your pelvic exam if you
Breathe slowly and deeply.
Let your stomach muscles go soft.
Relax your shoulders.
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Preparing For A Pelvic Exam
If youve never had a pelvic exam before, let your healthcare provider know when making your appointment. Schedule your pelvic exam for a date when you will not be on your period. However, if you have a menstrual issue you are concerned about, your doctor may suggest an examination during your period.
Do You Really Need An Annual Pelvic Exam
The annual pelvic exam has been routinely performed on American women for decades. Controversy over the effectiveness vs. the embarrassment factor has recently taken center stage. Dr. Kirtly Jones re-examines the necessity of the procedure. She discusses who really needs a pelvic exam, how often and options for women that may choose to decline.
Dr. Jones: There is an annual rite of American womanhood, the yearly Pap and pelvic exam. Many of us did it, but most of us didn’t want to. Maybe we believed, as we were told, that it was a way to keep our lady parts safe and detect cancers and diseases before there was real harm. What is the evidence that this annual ritual is necessary and saves lives, and what is the raging debate? This is Dr. Kirtly Parker Jones from the Department of Obstetrics and Gynecology here at the University of Utah Healthcare, and today we’re going to jump right into the fray and debate the pros and cons of the annual pelvic exam on The Scope.
Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You’re listening to The Scope.
Announcer: We’re your daily dose of science, conversation and medicine. This is The Scope, University of Utah Health Sciences Radio.
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Main Differences Between Pelvic Exam And Pap Smear
What Happens During A Pelvic Exam
Your doctor will have you undress and put on a robe. A breast exam may be included in the examination in which case youll be asked to remove your bra. You may be given something to put around your waist for added privacy. You will lie on an exam table with your legs spread and your feet on footrests called stirrups.
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Pap Smear: A Vital Screening Tool
The Pap test remains a vital screening tool, says Dr. Guido. It looks for precancerous cell changes on the cervix that can be treated to prevent cervical cancer. The test also can find cervical cancer early when treatment is most effective.
So, how often should you get a Pap test? Here are the current ACOG guidelines for low-risk women:
- Under 21: No Pap test necessary, regardless of sexual activity.
- Age 21-29: Pap test every three years.
- Age 30-65: Pap test every three years, or a Pap test every five years if it is combined with the HPV test for the human papilloma virus, which causes cervical cancer. Women who have received the HPV vaccine still need regular cervical screening.
- Over 65: No test if there has been adequate prior normal screening.
Women who are HIV positive, or who have been treated for a precancerous cervical lesion or cervical cancer, may need to have more frequent screenings, or continue screening beyond age 65.
Women who have had a hysterectomy do not need to have a Pap test, unless the surgery was done to treat a precancerous cervical lesion or cervical cancer.
For more information or to schedule an appointment with a gynecologist near you, call 1-866-MyMagee .
What Is A Pelvic Exam
The inspection part of a pelvic exam involves both an external and internal visual exam. The internal exam requires the use of a speculum so that the doctor can see the cervix and vaginal walls. The external exam consists of looking at your vulva to check for any abnormalities such as swelling, irritation or sores.
Regular Pap smears and pelvic exams are an important aspect of womens health. Consult your doctor to find out how often you should undergo a pelvic exam or a Pap smear. Depending on several different factors, such as general health or sexual history, some women may need to have them more often than others.
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When Should You Have A Pelvic Exam
Leslie says that many women dont need a pelvic exam every year. But when it takes place, its part of your annual well-woman visit with your healthcare provider.
Be sure to discuss with your provider whether you need a pelvic exam during your well-woman visit. Leslie says you should have a pelvic exam if you have any concerns about:
- Experience any unusual symptoms.
- Have any other concerns.
Some women request a pelvic exam because they have personal concerns that they want to discuss with their physician and not the person scheduling the appointment, Leslie says. She says these can include sexual problems, pain, and/or bladder and bowel leakage.
The pelvic exam can pave the way toward counseling or treatment of these concerns. A pelvic exam may also uncover medical conditions that are producing unreported or unnoticed symptoms.
Frequently Asked Questions Expand All
Adolescents usually dont 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 arent pregnant, experiencing symptoms, or at risk for gynecological conditions. The American College of Obstetricians and Gynecologists 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
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 always ask permission before touching you.
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Preparing For Your First Pelvic Exam
Topics in this Post
Setting up your appointment for your first pelvic exam, including a Pap test, can be nerve-wracking. Even though it’s the most accurate way to screen for cervical cancer and HPV, the uncertainty of what it all entails can still leave questions.
Here are a few things you should know before your first exam:
- You should have your first Pap test at age 21. Regardless of your sexual activity, when you turn 21, it’s time for your first Pap test. If you have concerns about sexually transmitted infections, pelvic pain or vaginal discharge prior to 21, talk to your health care provider.
- You don’t need to reschedule if you have your period. In most cases, your Pap test can still be accomplished during your period. If you’re uncomfortable with the thought of a pelvic exam during your period, you can reschedule your appointment.
- You should avoid some things beforehand. Two days before your Pap test, avoid intercourse, vaginal creams, suppositories, medicine and douches, as these may obscure abnormal cells.
- Should you groom or not groom? However you take care of your body, you should keep doing it. It is important for you to feel comfortable during your first exam.
- Use body image positivity. Your provider isn’t judging how your body looks. Everyone and every body is different, and all women need these types of exams to promote health.
Here’s what you’ll encounter during your first exam:
Consider these tips to mentally prepare for your exam:
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What Is Pap Smear
A pap smear, also commonly known as a Pap test, is a test that is done to examine the presence of cervical cancer. Sometimes, a pap smear can be done while a doctor is performing a normal pelvic exam as well.
During a Pap smear, a sample of cells is taken from the interior walls of your cervix and then sent to a lab so they can be screened for cervical cancer. In the lab, the cells are assessed for several abnormalities that can indicate cancer or pre-cancerous cells.
The average duration of a Pap smear is around 10 to 20 minutes, and it will take 1 to 3 weeks for the test results to get back, depending on your doctor.
Your doctor will ask you to put up your legs in stirrups. Then they input an instrument known as a speculum in the vaginal canal to widen it and help reach your cervix. This wont cause any pain whatsoever but main put some pressure on you. After collecting the required sample of cells, the doctor will remove the speculum, and further prepare the sample for analysis.
It is recommended for every woman to have their first Pap smear at the age of 21 and then after every three years. After turning 30, they can get a Pap smear every five years if everything is found normal.
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The Controversy Of Pelvic Exam Vs Pap Smear
Women in the Desoto, TX Raleigh NC area need an annual wellness / pelvic exam. The new guidelines issued by the United States Preventive Services Task Force have resulted in great confusion for women. Much of the confusion was intentional. According to the CDC, women are 33% more likely to visit a doctor than men and their annual visits for exams and preventive services are double that of men. The health care reform agenda is focused on cutting costs. Decreasing womens visits to the doctor is the first place they have started. While it is true that many women can safely have pap smears every three years, every woman should have a breast exam, pelvic exam, and rectal exam annually.
The gynecologist is uniquely qualified to evaluate and examine the breast along with regional lymph nodes, as well as the uterus, ovaries and rectum. We are seeing colorectal cancer at younger ages and breast cancer continues to be a threat to all women.
As women age, certainly beyond age 35, their odds of developing cancers of the breast, colon, uterus, ovary and fallopian tube increase. These conditions can be elusive and difficult to diagnose. It is in the womans best interest to see a gynecologist annually to optimize their surveillance of these deadly cancers. Remember, pap smear and pelvic exam are not interchangeable terms. The pap smear is done during a pelvic exam.
Discuss with me at your annual visit whether you need a pap during your pelvic exam.
Do Menopausal Women Need Pelvic Exams
Because the risk of cancer increases with age, having regular pelvic exams may help prevent certain cancers in both menopausal and postmenopausal women. Your healthcare provider will advise you on how frequently you will need pelvic exams in the future and the best recommendations for this exam as you age.
A note from Cleveland Clinic:
Talk to your healthcare provider about how often you should schedule a pelvic exam. Feel free to discuss any worries or concerns you may have about the test. Your provider is there to listen to you and work with you to make sure you are receiving the care you need.
Last reviewed by a Cleveland Clinic medical professional on 07/23/2021.
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