Women's Health Exam
Why is the Women's Health Exam Important?
The women's health exam is one of the most essential routine medical exams for women. All women should have this exam beginning at age 21. The main component of the women's health exam is the pelvic exam, which allows a clinician to assess the health of the reproductive system. The women's health exam gives the patient a chance to ask questions or voice any health concerns that she might be having as well as to learn about the practices that promote her reproductive and sexual health. The exam also provides an opportunity to check, change, or update one's method of contraception (birth control).
Pelvic exams help protect women's health. They are critical in the diagnosis and treatment of several types of diseases including cancer and sexually transmitted infections. If one is sexually active, getting tested for sexually transmitted infections is important to ensure that prompt treatment can occur if one has a positive test. During the women's health exam, the provider can provide information about reducing one's risk for contracting an STD. For women of all ages routine pelvic exams are crucial in the early detection of certain types of cancer.
Although pelvic exams play a significant role in the health and reproductive life of women, the personal nature of the procedure and the information discussed in the exam can make it an uncomfortable or embarrassing experience for some women. Knowing in advance the details of the procedures and why they are important may help make the pelvic exam a positive learning experience and a routine part of good health care.
What Happens during a Women's Health Exam?
The exam includes several steps. First, a clinician reviews your medical history, focusing on the reason for the exam, and information about the onset of menstrual periods, the regularity of periods, and the symptoms experienced during the menstrual cycle. Since so many elements of your sexual, emotional and dietary life can affect your reproductive system, you may also be asked about dating, sexual intercourse, eating habits, and athletic activity. The clinician may listen to your heart beat and to your lungs while you breathe in and out normally or as requested.
Breast examination is an important part of the exam. The clinician examines each breast to feel for any lumps or abnormalities. The clinician will also teach you how to do the breast self-exam monthly, so you can detect any changes that may occur in your breasts.
The next step is to examine the abdomen externally to check if there are any abnormalities, including swelling or pain. The clinician then examines the external genitalia to check for any lesions, bumps or lumps, which could indicate a problem.
The Pelvic Exam
Since the reproductive organs of a woman are on the inside of the body, it is important for the clinician to perform a pelvic exam. The pelvic exam can include a speculum exam, cervical cancer screening (pap smear), and a bi-manual vaginal exam.
The Speculum Exam
Since the walls of the vagina rest very close together, the clinician must hold open the two sides of the vagina in order to see the reproductive organs. This is done with an instrument called a speculum. The clinician inserts the closed speculum gently into the vagina. Once the speculum is in place, the clinician opens it and is then able to get a good view of the cervix (the opening to the uterus), and the walls of the vagina. Putting in a speculum is not painful, but can be uncomfortable if you are nervous or tense.
The clinician looks for abnormalities in the vagina, such as redness, inflammation, or discharge, which can be a sign of infection. They will also check for abnormalities on the cervix, such as lumps, bumps, discoloration, or discharge which may signal an infection.
If testing for sexually transmitted diseases is requested or indicated, the clinician will use a long q-tip to take a swab of mucous from the walls of the vagina and/or cervix. This sample is then sent to the lab for analysis.
Cervical Cancer Screening (If ordered, an additional charge applies)
To perform cervical cancer screening (also called the pap smear), the clinician will take a long, thin plastic or wooden spatula-like instrument and gently swab some cells from the cervix. The sample is then sent to an outside laboratory (at cost) to determine if there are any abnormal cells present. You will be notified within a few weeks if any abnormalities appear in your test. An abnormal pap smear does NOT mean that you have cancer. The clinician will give you further instructions on what to do if your result is abnormal. Getting a pap smear is generally not painful, but can involve some discomfort.
Women should get their first pap smear at 21. Discuss with your practitioner the timeline for subsequent pap smears. The best time of the month to see your clinician for your pap smear is 10 to 20 days after the first day of your period. It is also best to refrain from sexual activity for 24 hours prior to your appointment.
After the pap smear, the clinician removes the speculum from the vagina.
The Bi-Manual Vaginal Exam
The clinician will put a thin rubber glove on one hand and lubricate one or two fingers of that hand with lubricating jelly. Gently, they will insert the finger or fingers into your vagina while placing the other hand on your lower abdomen. This allows the clinician to feel the size, shape, and position of your uterus, ovaries, and fallopian tubes, and to check for tenderness, growths, or other abnormalities. This exam can involve a sensation of pressure, but it usually does not hurt (Ask the clinician to explain what they are feeling). Be sure to let the clinician know if you experience discomfort.
I had a vaginal exam at my last doctor appointment. Does that mean I had a pap smear?
Not necessarily. Having a vaginal exam does not always include a pap smear. Always ask your clinician for the specifics of your exam.
I had a pap smear at my last pelvic exam, does that mean I had STD testing as well?
The pap smear and STD testing are not the same! You and your clinician should discuss whether STD testing is right for you. Don't assume that you had STD testing at your pap smear visit. Again, ask your clinician to explain exactly what she/he is doing during your exam.