Gynecological Exams for Women

November 07, 2009

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Gynecological Exams for Women

by Marjorie Greenfield, M.D.
reviewed by Marjorie Greenfield, M.D.

The American College of Obstetrics and Gynecology recommends annual pelvic examination and Pap test for all women starting at age 21 (sooner if they have started having sexual intercourse). Women who are at low risk for cervical cancer may be able to have their Pap tests at less frequent intervals after having normal test results for two years in a row. If you think this may apply to you, talk to your doctor about your individual situation.

Recommendations about annual breast examinations vary--from not starting until the age of 40, to including them in the annual examination as soon as Pap tests are being done. Mammograms are not recommended for most women until the age of 40.

Internists, family doctors, nurse practitioners, midwives, and obstetrician-gynecologists all provide gynecological care for adult women.

The steps of the annual pelvic examination

External genital examination--The doctor looks over the outer genitalia for inflammation or lesions.

Speculum examination--A speculum is an instrument, sometimes described as looking like the bills of a duck, with two blunt, slightly rounded pieces of plastic or metal that, when closed, can be inserted into the vagina. The two parts are then gently separated to open up the vaginal walls so that the practitioner can see into the vagina and the cervix. Once the speculum is in place, the practitioner will collect cells from the cervix for a Pap test, using what looks like a narrow tongue depressor and a tiny bottlebrush. A lab technician then views those cells under a microscope, looking for precancerous changes.

If you have signs or symptoms of vaginitis, tests can be done on vaginal secretions. Cervical testing is obtained for chlamydia and perhaps gonorrhea if you have a new sexual partner, have other risk factors or concerns about STDs, or show symptoms that might be indicative of infection.

The speculum examination can be uncomfortable but should not hurt. If you experience pain, tell your practitioner. There are ways of modifying the exam to make it more comfortable.

The bimanual examination--Wearing gloves and using a water-based lubricant, the practitioner puts two fingers into the vagina while pressing down on the lower abdomen with the other hand so that the ovaries and uterus can be felt between the two hands. This allows the examiner to check the size, shape and tenderness of the pelvic organs. Be sure to tell your practitioner if you feel any pain. Emptying your bladder before the exam makes it more comfortable and more accurate.

The rectal exam--Similar to the bimanual exam, the doctor puts a lubricated, gloved finger into the rectum to feel for tenderness and masses. Sometimes retrieved stool is checked for blood. This type of examination should not be painful, since a finger is smaller than a stool, but it may feel odd, as if the bowels are moving. Some practitioners include a rectal as part of the routine exam, while others do this procedure only in specific cases.

STD screening
Other goals of routine gynecological examination include testing for sexually transmitted infection, identifying menstrual problems, discussing birth control, and educating the patient about the prevention of STDs.

New studies have shown that the incidence of chlamydia is highest in girls and women between the ages of 15 and 24. Sexually active women in this age group should probably be tested twice a year, especially those who are at high risk because they have had multiple sexual partners or a past history of sexually transmitted infection.


RELATED INFORMATION

			Five Causes of Vaginitis
			Gonorrhea and Chlamydia
			The Pap Test
			Menstrual Issues
			Sexually Transmitted Diseases (STDs)
			Gynecology

	Birth Control and Getting Pregnant
	Tests and Procedures

Created July 26, 2001
Reviewed April 01, 2003

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