Read Our Bodies, Ourselves Online
Authors: Boston Women's Health Book Collective
Our Bodies, Ourselves (10 page)
To begin the pelvic exam, your provider will ask you to lie back on the exam table, move your bottom down to the end of the table, and place your feet in the stirrups, which are metal foot-rests on either side of the table. Bend your knees and let them relax and fall to each side. Most of us feel vulnerable and exposed in this position, but a good provider will try to make you feel safe. If you feel really uncomfortable, ask if you can sit up more. The exam can be done just as well in this position.
Your provider will first examine your vulva by visually checking to see if your anatomy is healthy. She or he will examine the distribution of your pubic hair, the size and condition of your clitoris, and the architecture of your vulvar lips and opening to the vagina. The provider will look for irritation, discoloration, swelling, bumps, skin lesions, lice, and any unusual vaginal discharge. Sometimes a Q-tip is used to evaluate the entry to the vagina for pain or tenderness.
Next, the provider will begin the pelvic exam by inserting a metal or plastic speculum in your vagina. Speculums are shaped a bit like duck bills and they come in different sizes and lengths. The speculum will hold the walls of the vagina apart so your provider can examine your vaginal walls and cervix. If your provider is using a metal speculum, she or he may warm it before inserting it. If you are not used to a speculum or what it feels like to have something placed in your vagina, it may be uncomfortable, but it shouldn't be painful. You may feel some pressure in your bladder or around your rectum. Take deep, slow breaths and relax your stomach muscles, your shoulders, the muscles between your legs, and especially your vaginal muscles. A pinching sensation isn't normal. If you are in pain, ask your provider to readjust the speculum or use a different size speculum.
MEDICAL HISTORY: WHAT A HEALTH CARE PROVIDER NEEDS TO KNOW
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When you see a provider for a gynecological exam, she or he will probably ask about your medical history and your family's medical history, especially if it's your first visit with a new provider. Questions will likely include these:
⢠When was your last period?
⢠How often do you have periods?
⢠How long do they last?
⢠Do you ever have bleeding between periods?
⢠Do you have any unusual pain, itching, or discharge from your vagina or vulva?
⢠Do you have any other medical conditions?
⢠What medical problems do other members of your family have?
⢠Are you having sex?
⢠Do you have sex with men, women, or both?
⢠Do you have any pain during sex?
⢠Do you have bleeding after sex?
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Adapted from content on the Planned Parenthood website, plannedparenthood.org.
⢠Are you using birth control?
⢠Do you suspect you are pregnant?
⢠Are you trying to become pregnant?
⢠What do you do to prevent sexually transmitted infections?
⢠Do you want to be tested for STIs?
You should also be asked about alcohol or other drug use, what medications you take (both prescription and over-the-counter), allergies, illnesses, previous pregnancies, problems holding urine, risk for infection, smoking, and any surgery you have had, as well as about health-related lifestyle issues such as diet, stress, and sleep. You can ask questions, too. You might want to ask about:
⢠Birth control
⢠Bleeding after sex
⢠Heavier than usual menstrual flow
⢠Pelvic pain or pain with sex
⢠Pregnancy testing
⢠Tests for sexually transmitted infections
⢠Unpleasant vaginal odor
⢠Vaginal discharge
⢠Questions or concerns about sexuality
WILL A PELVIC EXAM AFFECT MY VIRGINITY?
The short answer is: No. If you were a virgin before your pelvic exam you will be one afterward. Virginity is not a medical or physical condition. Virginity is defined differently by different people, but it most often refers to whether a woman has had penis-in-vagina intercourse. Some people define virginity based on the state of the hymen, a thin, flexible membrane located just inside the entrance to the vagina. But because hymensâalso called vaginal coronasâcan break and stretch during exercise, masturbation, tampon use, or any form of vaginal penetration, they do not reflect whether a woman has had sex. (For more information, see
“Vaginal Corona or What You May Know as the Hymen,”
and
“Virginity.”
)
Your provider will probably describe the process, step by step. If you want to know more about what's happening, ask. Similarly, if it's easier for you not to hear, ask not to be informed every step of the way. Some practitioners keep a hand mirror available. If you want to watch the exam to learn more and to see what your cervix looks like, ask for help in positioning the mirror and light source. If you want to do self-exams
in the future
, this is a great opportunity to ask questions about how it's done and what to look for.
When the speculum is in place, your provider will examine your vaginal walls for lesions, inflammation, or unusual discharge and look at your cervix and check for any unusual discharge, signs of infection, discoloration, damage, or growths. A Pap test may be done to check for abnormal cervical cells (see below). Sometimes a smear of vaginal discharge is taken as well, to test for vaginal infections or certain sexually transmitted infections. The speculum will be removed at the end of the pelvic exam.
After removing the speculum, your provider may insert one or two gloved fingers into your vagina while pressing down on your abdomen with the other hand. This is called a bimanual exam and is done to locate and determine the size, shape, and consistency of the uterus and ovaries. Your provider will feel for any unusual growths or tender areas. Pressure on the uterus is usually painless, but pressure on the ovaries may cause discomfort (like a slightly painful electric shock). The ovaries are difficult to find, and sometimes the twinge you feel is the only way the practitioner is aware that he or she is touching them. The bimanual examination is more comfortable and more accurate if you are able to relax your neck, abdomen, and back muscles and keep your arms by your side. Breathing slowly and deeply, exhaling completely, may also help.
© Peggy Clark
A bimanual pelvic exam
PAP TESTS
A Pap test checks for cervical cell changes that can signal potential health problems, including human papillomavirus (HPV), a common sexually transmitted infection, and cervical cancer. It's done during a pelvic exam using a small spatula or a device that looks like a long Q-tip with a tiny bottle brush on the end. This swabbing may feel unusual or even uncomfortable, like a cramp, light brushing, or scraping sensation.
In 2009, the American College of Obstetrics and Gynecology released new recommendations about Pap tests for women whose risk of cervical cancer is low or average.
© Nina Reimer
Placement of speculum for a pelvic exam. Spatula scrapes cervix for Pap test (this is usually painless).
⢠Women should have their first Pap test at age twenty-one.
⢠Women in their twenties should have a Pap test every two years (assuming prior Pap tests have been normal).
⢠Women age thirty and older who have had three consecutive normal Pap tests should have a Pap test every three years.
⢠Women who have had a hysterectomy for noncancerous reasons do not need a Pap test unless they have retained their cervix.
⢠Women no longer need to have Pap tests after the age of 65.
⢠Women who have received an HPV vaccine still need to get Pap tests, because the vaccines do not protect against all types of HPV associated with cervical cancer.
If you have had an abnormal Pap result, you should discuss with your clinician how often you should repeat a Pap test, as what is recommended and what you choose to do will depend on your own particular situation. (For more information, see
“Cervical Dysplasia and Cervical Cancer,”
)
Sometimes a rectovaginal exam is part of the pelvic exam. If so, your provider will insert one finger into the rectum and one into the vagina to assess your internal pelvic organs from a different angle. This enables your provider to feel behind the uterus and makes it easier to feel the uterus and ovaries in women who have a tipped (retroverted) uterus. It also helps detect rectal lesions, and tests the tone of the rectal sphincter muscles. Blood in the rectum is sometimes an early sign of colon cancer. A stool test for blood at the time of the rectal exam was used in the past, although a single test at an exam is now considered inadequate compared with a three-day home test or other screening options like colonoscopy.
Some women find the rectovaginal exam unpleasant; others don't mind it. You may feel as if you are having a bowel movement as the practitioner withdraws his or her finger from your rectum. Don't worryâyou won't, although sometimes a little stool will leak out. The rectal exam is usually the last part of the exam.
If you came in for a method of birth control that was not prescribed earlier or was not inserted yet, or for any vaccines, your provider will now address those issues and offer general health advice, either in the exam room or in a private consultation. Findings from your exam will also be discussed.
Many tests, such as Pap and STI tests, do not yield immediate results. If you have had any tests done, your provider should let you know when the results will be ready and how you will be contacted. When you filled out your medical history and office paperwork, you should have been asked whether it's okay for the office to contact you by email or phone. Check this with your provider if you're concerned about who will see or hear the messages.
Hopefully your experience with your provider was positive. But if you don't feel that your concerns were addressed, or if the provider was uncaring or unresponsive to your concerns or questions, ask your friends or family members for recommendations of other providers. Also consider sending an email or a letter to the provider describing your observations and concernsâsometimes clinicians need to be taught by their patients.
Some of us have specific physical needs or experiences that can make gynecological exams challenging. Some providers are committed to serving all populations; others are not as educated or sensitive, so the onus can be on us to ask for inclusion or adaptations, understanding that we are entitled to the same care as anyone else.
If you're not certain about a provider's willingness or ability to accommodate you, ask questions when calling to make an appointment, or consider scheduling an appointment to visit the office and meet with the provider in person, prior to an exam. Also contact groups that advocate for your specific needs; some may keep informal or formal lists of recommended health-care providers. Ask for referrals from friends, and look online for reviews.
Many women who have experienced sexual abuse find that pelvic exams, like other kinds of genital contact, can be difficult. You may feel as though you don't have control, and parts of the exam may trigger body memories of sexual abuse and/or assault. You do not have to tell a health-care provider that you have been abused if you don't want to, but disclosing it may help your provider to understand your fears and take extra measures to make you feel comfortable and safe.
SHARE YOUR CONCERNS
Some people with food allergies keep a card handy to give to servers at restaurants to eliminate confusion about what they can and can't eat. You can create a card to share when seeing a new provider that states what you needâsuch as slower, clearer speech; a written record of everything covered during the exam; or language/words that make you uncomfortable or that you prefer. Also, giving your provider a list of any allergies to medications you have and any medications you take (and their dose) will make your health care safer.