Understanding Pelvic Exams: What to Expect

Having your junk checked out can be painful, uncomfortable, scary and weird, but if you know what to expect, it can be a little less confronting. Here’s what to expect from a pelvic exam.

Reasons for a gynaecological evaluation and a pelvic exam

You may need a specific issue looked into more closely, like pelvic pain, or unusual vaginal bleeding or discharge. Regular gynaecological examinations are a great way to keep in touch with what’s going on in your vagina, having someone there to ask questions of and check into anything that you’ve been feeling is a bit off.

These pelvic exams don’t need to be done by a gynaecologist, since doctors are also trained in pelvic exams, though it’s wise to see someone who knows what they’re looking at.

How often should I have a pelvic exam?

You should have a pelvic exam every year if you are a sexually active women over the age of 18. If you were or are sexually active at a younger age, it’s smart to see if you can get a pelvic exam earlier.

The ‘age of consent’ problems mean that you have to have your parents input in many places to simply be examined, which isn’t what many of us want to chat to our folks about, or make them pay for.

Find your local sexual health clinic who can help you for free or low cost. If you are pregnant, you need specialist care from an obstetrician and to be seen by a doctor.

Your gynaecological history

It’s important to keep records of things that happen to your body, including your periods. Get a period tracker app or a calendar you mark the start of each period on. This means you not only can estimate when your next period will arrive, but you can also tell if things go awry.

Missing, painful, too frequent or strange periods/lack of periods may need your attention, and having a good record can make all the difference. Your doctor will ask you what’s wrong, when it started, and what your symptoms are, taking a menstrual history from you, along with a sexual history.

Having it all written down is a great start and can make your appointments use less precious time on taking a comprehensive history and more about starting to devise a treatment strategy.

Keep good records of your past vaginal or other problems, treatments, and always get a copy of your medical records and any tests done from your doctor. They are obliged to make a copy if you request it.

Before a pelvic exam, keep records of:

Pain – location, duration, character, quality, triggering and relieving factors
Abnormal and normal vaginal bleeding – quantity of blood, duration of bleeding, how it relates to your menstrual cycle
Discharge – colour, consistency, odours, irritation that comes at the same time You will probably be asked about pregnancy symptoms (nausea, breast tenderness, skipped periods).

What your menstrual history consists of

First period (onset of menarche)
Length of your cycle – that is, how many days between Day 1 of your period and Day 1 of your next period
Number of days you bleed for, and how heavy or light the bleeding is on each day
Regularity of cycles – skipped periods, double periods, etc.
Start date of your last period
Dates of previous periods
Colour and volume of bleeding – they may ask how many tampons or pads you go through per day
Any other associated symptoms – cramping, bowel interruptions (diarrhoea, loose stools), PMS

What’s normal for a period?

A normal menstrual period is medium to dark red, with flow of between 13-80mls lasting for about five days. A normal cycle is between 21 and 35 days long (from Day 1 of your period).

The second day is usually the heaviest bleeding, with a saturated pad or tampon containing between 5-15ml of blood. Cramping is most common during the day prior to and day of bleeding.

Tampon absorbency ratings and blood flow estimates

30mls of blood = 1 fl.oz = a small bottle of perfume
Light tampon = 6mls about a teaspoon
Ultra tampons = 15-18mls just under 4 teaspoons

Obstetric (pregnancy and birth) history

Your doctor will want to know of any pregnancies, miscarriages, abortions, ectopic or molar pregnancies, and births, including dates and outcomes.

Sexual history

Don’t be shy here – it matters that your doctor knows the truth so they can accurately assess you.

How often you have sex
How many sexual partners you have had
Contraception use and outcomes (like bad reactions to hormones or allergies to condoms)
Unsafe sexual practices
How sex works for you – do you orgasm? feel pleasure? pain?

Gynaecological history

You will need to explain any pain, bleeding, discharge, and any other diagnoses that have been previously made and any conditions you suffer from, or have suffered from.

Make sure you take your full medical history to the doctor, from other doctors, tests, hospitals, etc. The more information they have, the better off you are.

Your physical exam

A proper physical examination of your body, including your vagina, pelvis and abdomen should be done. Your doctor should first explain what they are doing and why. Talk to them while they’re doing it and ask questions. It’s interesting!

Find out what they are doing to you, what they are looking for, and what you should be looking out for while going about your regular business (for example home breast checks).

Your pelvic exam will mean you are up with your legs in stirrups, with a towel draped across you so you can’t see yourself. If you want, someone else can be in the room with you while this happens, and with anyone under 18, another person present is required by law.

Pubic hair examination

Your pubic hair and mound area will be examined for any lesions, inflammation, and pubic lice.

Perineum examination

Your perineum will be inspected for redness, swelling, abnormalities in pigmentation or skin, and any ulcers, blisters, warts, tumours or nodules. If you have anatomical abnormalities, these may be discovered for the first time during this inspection.

Any malformations or injuries (including some ‘at-home’ surgeries like female genital mutilation) will be observed here.

The vaginal opening (introitus) and labia examination

The introitus will be checked for any lumps and bumps, including Bartholin gland cysts or abscesses. The labia will be spread, and you will be asked to perhaps breathe in deeply or bear down so that your vaginal tissue pushes out a bit so it can be inspected more easily. A prolapse of the uterus can be more easily observed here.

Next, it’s the speculum

The speculum can be heated up with a heating pad/hot water, and should be lubricated before insertion. A Pap test and STI tests may be taken, or any other tests that are deemed appropriate – your doctor will discuss those with you.

A gloved, lubricated finger will be inserted into your vagina to see where your cervix is positioned, and the doctor will open the speculum to view the cervix.

A normal cervix is pink and shiny without discharge. Anatomical abnormalities can be found here too, which may make the rest of the examination difficult, though these are uncommon.

The speculum will be gently removed, and the doctor will use their middle and index fingers to insert into the vagina to just below the cervix, with their other hand placed just above the pubic bone. This is to check the location of the uterus and possibly the ovaries.

If the doctor touches your ovaries, it can make you feel nauseous and they may feel tender. The uterus should be movable and smooth.

The next move by your doctor is a rectal exam. The septum that separates the vagina and rectum is felt by – you guessed it – a gloved finger up the butt and the other finger inside the vagina. Thankfully this is usually a short part of the procedure.

Examining children

Children need more care when undergoing examinations since the inside of the vagina is usually off-limits for inspection. A rinse may be used to obtain discharge from the vagina. Only a paediatric gynaecologist should perform these examinations.

See the parents’ section for more information.