Pelvic Exam - Definition, Purpose,

Precautions, Description, Preparation,

Aftercare, Risks, Normal results,
Abnormal results
examination cervix examiner patient pap cervical genitalia lesions

A pelvic examination is a routine procedure used to assess the well being of the
female patients' lower genito-urinary tract. This is done as part of a usual health
screening and prevention tool, and is an element of the total health care for the
female patient.

During a pelvic
exam, cells from the cervix are scraped on a spatula and are tested for abnormalacies. (Illustration
by Argosy Inc.)
Purpose
Pelvic exams are useful as a screening tool for sexually transmitted diseases
such as gonorrhea, chlamydia, genital warts, herpes, and syphilis. In addition,
exams detect some forms of cancer that may affect the genitalia. By analyzing the
cervical region with a Papanicolaou or Pap smear, clinicians are able to look for signs
of cervical cancer. The American Cancer Society and The American College of
Obstetricians and Gynecologists recommend pelvic exams with Pap smears for
women starting at age 18. It is also recommended that exams start earlier if the
teenager requests oral contraception. Pap smears should continue once yearly for
three years and at the physicians discretion following this time. Various groups differ
in opinions on when to discontinue screening for cervical cancer, however, the
United States Preventative Services Task Force recommends screening continue until
age 65 if the patient has not had previous abnormal results. Women who have
undergone a total hysterectomy for reasons other than cervical cancer do not need
to be screened.

Precautions
Pelvic examinations are safe procedures, thus no precautions are necessary.

Description
The first part of the examination involves visual inspection and palpation of the
external genitalia. The examiner will note the characteristics of the labia majora,
labia minora, clitoris, urethral orifice, and the Skene's and Bartholin's glands. In
addition, the perineum and anus will be checked. The clinician will be examining
these areas for any indication of swelling, inflammation, abnormal discharge, polyps,
abnormal odor, or other lesions.

The next part involves examining the internal genitalia. The examiner will first insert
a gloved finger into the vagina in order to palpate the cervix—the vaginal walls. Next
an instrument called a speculum is inserted. This device is made of plastic or metal
and used to open the vaginal cavity in order for the examiner to be able to view the
vaginal walls and cervix. Any lesions, bleeding, or abnormal discharge can be
visualized with the speculum in place. If indicated, a Pap smear will then be
performed. With the speculum still in place, the examiner gently scrapes the patient's
cervix with a wooden or plastic spatula as well as a cylindrical-type brush. The
spatula collects cells from the outer surface of the cervix, while the brush is used to
collect cells from the inner-cervix. The collected cells are then spread on a glass slide,
sprayed with a fixative, and sent to a laboratory for analysis. The examiner may then
insert a cotton or Dacron swab into the cervix. This will be held in place for 10–30
seconds and when withdrawn spread on a plastic plate or into a tube containing a
reagent for the specimen. This procedure may be repeated again with the anus. Such
swab tests are used to check for gonorrhea and chlamydia, or bacterial vaginitis,
which is a bacterial infection resulting in inflammation of the vagina.
Following the Pap smear is the bimanual examination during which the examiner
will place an index and middle finger into the vagina to first examine the vaginal
walls for any irregularities or tenderness. The cervix will then be palpated in order to
note its shape, consistency, mobility, and any tenderness. The examiner will then
place his or her other hand on the abdomen and gently push down while pushing the
cervix up. This is done to assess the size and shape of the uterus, and also to note any
tenderness or abnormal lesions. During this time, the ovaries are also checked for
any masses, or tenderness.