Your health care provider will ask you to undress and put on a paper or cloth gown. Next, you will be asked to lie down on the exam table and put your feet on footrests at the end of the table. (Some tables have knee rests instead.)
Slide your hips down to the edge of the table. Let your knees spread out wide. Relax as much as possible. Relax your buttocks and your stomach and vaginal muscles. This will make you more comfortable. The exam will be more complete, too. You can cover your lower abdomen and thighs with a sheet to feel less exposed.
There are usually four parts to the pelvic exam:
1. The External Exam — Your health care provider will look at the folds of your vulva and the opening of your vagina. This part of the pelvic exam checks for signs of cysts, discharge, genital warts, irritation, or other conditions.
2. The Speculum Exam — Your health care provider will gently insert a lubricated speculum into your vagina. Made of metal or plastic, the speculum separates the walls of the vagina when it opens. This may feel uncomfortable but not painful. Let your health care provider know if it is. She may be able to adjust the size or position of the speculum. If you would like to see your cervix, just say so. You may be able to see it using a mirror.
The provider will then use a tiny spatula or small brush to take a small sample of cells from your cervix. This sample will be given a Pap test to see if there is any precancer or cancer in the cervix.
If you think you may be at risk of having a sexually transmitted infection, tell your health care provider. Your health care provider can use a cotton swab to take a sample of the discharge from your cervix. This sample will be tested for sexually transmitted infections.
3. The Bimanual Exam — During this part of the exam, your health care provider will insert one or two gloved and lubricated fingers into your vagina while gently pressing on your lower abdomen with the other hand. This is a way to check for
- the size, shape, and position of the uterus — which could affect your fertility and birth control choices
- an enlarged uterus — which could mean pregnancy or fibroids
- tenderness or pain — which might mean infection or other conditions
- swelling of the fallopian tubes — which might mean an ectopic pregnancy
- enlarged ovaries, cysts, or tumors
4. The Rectovaginal Exam — Your health care provider may put a gloved finger into your rectum. This checks the muscles between your vagina and your anus. This also checks to see if there are tumors behind the uterus, on the lower wall of the vagina, or in the rectum. Some health care providers put another finger in the vagina, too. This lets them examine the tissue in between more thoroughly.
You may feel like you need to have a bowel movement during this part of the exam. This is normal and only lasts a few seconds.