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Sexual Health

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First Pelvic Exam

 

FACT: The scariest part about a pelvic exam is not knowing what to expect. 

Scared about your first pelvic exam? Try these tips:

  • Do your homework:  A pelvic exam is a lot like any other exam – if you want to breeze through it, you’ve got to do your homework.  There are lots of good websites, brochures, and other resources out there to give you an idea what you can expect. Knowing what the exam is all about is the best way to put your mind at ease.
  • Talk to someone who’s been there:  Why not ask a family member what the test is like?  Mothers, aunts, older sisters, cousins can all give you the first-hand scoop about what to expect. Or, ask a friend who has had the test before or a teacher or school nurse.
  • Let your doctor know that you’re nervous:  If it’s your first time getting a pelvic exam, your doctor knows it can be a bit scary.  Let them know that you’re a bit nervous about the exam.  They can go through the exam with you step-by-step so there are no surprises.
  • If all else fails:   So… you’ve gotten all the information, you’ve spoken with people and you know exactly what to expect…but YOU’RE STILL SCARED.  Relax – even if you know exactly what to expect, it’s normal to be a bit scared.  Once you’re there, chances are it won’t be nearly as scary as you may think.  And, if all else fails, remember that the embarrassing part of the exam doesn’t last that long, and once you’ve had it once, it gets a whole lot easier the next time.

What is a pelvic exam?

A pelvic exam is an examination that your doctor or a nurse performs to make sure that your reproductive organs are healthy.

Here are a few reasons why a pelvic exam is a good idea:

  • They make sure that your pelvic organs (uterus, fallopian tubes and ovaries) are normal.
  • They can detect infections that can cause vaginal discharge, pelvic pain or infertility.  If you have one of these infections, a regular pelvic exam can help make sure that it’s detected early, so you can get treatment before any serious damage is done.
  • Probably the best reason to get a pelvic exam is that it includes a “Pap” test that can detect early stages of some types of cancers.  Spotting these early signs of cancer could even save your life.

“Pelvic exam”, “Pap test” or “Pap Smear”?

During a Pap smear, the cells from the cervix are “smeared” onto a microscope slide using a q-tip. You may have wondered before if there is a difference between a “pelvic exam”, a “Pap test” and a “Pap smear”.  A “Pap test” and “Pap smear” are the same thing – they are a test that involves collecting cells from your cervix and then looking at them through a microscope to make sure they are normal and healthy.  It is sometimes called a “smear” because the cells from the cervix are “smeared” onto a microscope slide.  A pelvic exam is a little different – it refers to the entire exam of your reproductive organs, part of which is the collection of cells for the Pap test.  Some people think that a Pap test is a screening test for all sexually transmitted diseases, this is not true.

pap smear diagram

When do I need a pelvic exam?

If you are sexually active, or if you’re 21 or older, your family doctor or health care giver will discuss the necessity of a  pelvic exam.  Sometimes, a pelvic exam might also be necessary if you have unusual discharge or bleeding from your vagina, or unexplained pain in your pelvic area.   A pelvic exam can sometimes help identify the cause of these problems.

It’s very important for women to have regular pelvic exams.  After your first visit, ask your doctor or nurse when you should schedule your next visit. Typically, you will be asked to schedule your next exam a year later.   After you’ve had two or three yearly exams, your doctor may suggest that you can reduce your exam frequency to once every two or three years.

You should also speak to your healthcare provider about how often you should be having pelvic exams.

According to Statistics Canada, more than five million Pap tests are performed annually in Canada.

My Story

  •  “I was a little bit nervous during my first pelvic exam, since I didn’t really know what to expect. Mostly, I think I was just feeling shy and embarrassed. But once the test got started, my doctor was very nice and professional, and she helped guide me through it.  She helped me relax a bit and I definitely felt a lot more comfortable after she explained all of the steps to me – that I would need to undress, and that she would do a breast exam, press on my organs, insert the speculum, remove a sample, etc….
    The exam itself didn’t hurt, and in the end I’d say the whole thing went very well. I can’t say that I particularly ‘enjoyed’ having the exam done, but it felt nice to know that I was taking good care of myself and being active about my health.”
    - Isabelle
  • I remember that going to my first Pap test was quite stressful and nerve-racking.  I wasn’t really sure what to expect or if it was going to hurt – and I don’t exactly have what you would call a “high threshold” for pain. By the time I got there, I was getting pretty nervous.
    Lucky for me, I have a really great relationship with my family doctor.  She knew exactly what my concerns where, and talked me through everything.  At every step in the exam, she told me what she was doing and what I would be feeling while she was doing it.  I was even told that if the exam was too painful she could stop and we could do it at another visit. She also told me how to position myself so it would be easier for her and more comfortable for me. I was pretty relieved once the procedure was over - it went a whole lot better than I imagined it would!  The exam was a bit uncomfortable and a bit embarrassing, but I’m certainly not scared to go for my regular Pap anymore.
    - Melissa

Preparing for your exam

Call your local clinic or family doctor to book an appointment.  Be sure to book your appointment at a time when you won’t be on your period, because blood can affect the results of your Pap test. 

Before your appointment, you may want to prepare some of the questions you’d like to ask your doctor.  If you have any questions about your menstrual cycle, contraception, sexually transmitted infections, etc… you may want to write them down so you remember to ask your doctor at your appointment.  In particular, be sure to ask your doctor about any concerns you might be having about your reproductive health.

On the day of your exam, it might be a good idea to wear comfortable clothing that is easy to change in and out of.  If you’d like, you can bring a friend to come with you to the exam.  You’ll need to bring your health card with you and you may want to show up a little bit early for the appointment.

When you arrive at your appointment, let the staff know that you are there.  They will likely ask you to wait for a few minutes and you may have to fill out some quick Paperwork before the doctor sees you.  Next, you will be shown into an examining room and asked to change into a gown for the examination. Sometimes, a nurse may take your weight and blood pressure before the doctor arrives for the exam. 

Do my parents need to know?

By 21 years old regular pelvic exams are an important part of staying healthy for every woman.   However, if you are sexually active, then it is important to get your first pelvic exam a little earlier.  

Some young women may be afraid to tell their parents about getting a pelvic exam because they don’t want their parents to know that they are sexually active. While it is important to have an open relationship with your parents (and they may be happy to know that you are being responsible about your health), you do not need a parent’s permission to have a pelvic exam.  You can arrange the exam yourself directly through your local clinic or family doctor. Remember that what you tell your doctor is just between the two of you.

During the Exam

Pelvic exams can be a bit embarrassing, especially the first time.  It’s perfectly normal to be embarrassed, but remember that your doctor is a professional who performs Pap tests all of the time, and there’s really nothing to be afraid of. 

If you’d like, you can have someone stay with you in the room during the exam.  It could be a parent or another family member, or a friend who will sit with you through the exam.  Or, if it makes you more comfortable, you can ask that another staff member at the doctor’s office stay in the room.  It’s totally up to you, just let your doctor know what you’d prefer.

Here’s what you can expect:

(1) After you’ve had a chance to change, your doctor may start the exam by asking you some questions.  If you have any concerns about your reproductive health, now is the time to ask. Also, if you think you might be pregnant, let your doctor or the nurse know and you may be offered a pregnancy test to be sure.

(2) Don’t worry about being shy or nervous about asking your doctor questions.  This is your doctor’s job, there is probably nothing that you can ask them that they haven’t been asked before!

(3) You and your doctor may talk about:

  • Your menstrual cycle (a.k.a. your periods) – If you’ve been having any spotting, pain, or unusual bleeding, be sure to let your doctor know.   Your doctor may also ask you for the date that your most recent period first began, how long your periods usually lasts, and when you first got your period. 
  • Whether you are sexually active or not - Your doctor will ask you if you’ve ever had sex, and may ask some questions about your sex life.  Be honest.  Remember, except for some rare cases (if you are being abused or if your doctor feels that you are in danger, for example), what you and your doctor talk about is just between the two of you.  Your doctor will not speak to your parents or anyone else about the exam or anything you talk about. 
  • Discharge, pain or other problems - You may be asked if you’ve had any unusual vaginal discharge, pain or other symptoms that could be a sign of an infection or other problems.  You should also inform your doctor if you think that you may be pregnant.
  • If you are using birth control – If you have any question about birth control, or if you’re having any concerns about the birth control method you’re using, be sure to ask your doctor. 

Check-up and Breast Exam

After you’ve had a chance to ask and answer questions, or possibly at the same time, your doctor may perform a general check-up exam, which may include a breast exam.

The check-up part of the exam tests your general health, much like other check-ups you may have had with your doctor.

If you’ve never had a breast exam before, you might be a little embarrassed.  Don’t be.  Breast exams are really important because they can find any lumps or changes in your breasts, which can help your doctor spot any potential problems early.  During this exam, your doctor will press down lightly on your breasts, feeling for any lumps or anything that feels unusual. 

REMEMBER! Most breast lumps, especially those in younger women, are not related to breast cancer.  If you think you feel a lump in your breast, ask your doctor about it, but remember – breast cancer is extremely rare in young women! Most often, any lumps are just part of normal breast development.

If you’ve noticed any unusual changes to your breasts recently or if you’ve been having any pain in your breasts, this would be a good time to ask your doctor about it.

The Pelvic Exam and Pap test


speculum diagram

This special instrument called a speculum is used to gently spread open the inside walls of your vagina

speculum inside diagramswab & speculum inside diagram

With the speculum fitted in the vagina, the doctor collects cells from the surface of your cervix to be used in a Pap test

 
If this is your first pelvic exam, this might be the part where things start to get a bit embarrassing.

First, your doctor will ask you to lie down in a comfortable position on the examination table, with your knees bent and your legs spread apart. Your can rest your legs on special “stirrups” to make you more comfortable during the exam.

Your doctor will examine your vulva (the outer lips of your vagina).  Next, your doctor will look at the inside walls of your vagina and at your cervix.  (Your cervix is the entrance to your uterus, located at the back of your vagina).  To do this, a special instrument called a speculum is used to gently spread open the inside walls of your vagina.  The speculum is made of plastic or smooth metal and looks a little bit like a duck’s bill.

You may feel some discomfort when your doctor gently slides the speculum into your vagina, but it shouldn’t hurt.  Do your best to relax your stomach muscles and the muscles around your vagina so that the speculum can slide in easily.  If you tense up your muscles, it is more difficult for your doctor to insert the speculum, so you may feel some discomfort.  That’s why it’s really important to relax as much as you can.  Try taking deep breaths.  If you’re really tense, it might help to try looking at any posters or pictures on the walls to take your mind off the exam. 

If you do feel any pain or discomfort, be sure to let your doctor know.  If it is too uncomfortable it is always possible to do the exam at another visit.

Once the speculum is in place, your doctor can see the walls of your vagina and your cervix to make sure that everything looks right.  Then, your doctor will collect some cells from the surface of your cervix to be used in a Pap test. Your doctor will collect these cells, and later they will be examined by a specially trained professional who will look at the cells under a microscope.  Looking at the cells under a microscope allows the specialist to ensure that they are normal and healthy. 

The Pap test is very important, because it can detect microscopic changes to cells.  In some cases, these changes might be early stages of serious diseases like cervical cancer.  Cervical cancer is dangerous, but it progresses very slowly.  By catching these changes early, doctors are able to treat and prevent cervical cancer from progressing.

Before the speculum is removed, your doctor may perform another test to look for infections such as chlamydia or gonorrhoea.  This test is performed by rubbing a long cotton swab (it looks like a long Q-Tip™) against your cervix.  The swab sample is then tested to help detect these infections.
Like the Pap test and cervical cancer, detecting these infections early makes all the difference.  Chlamydia and gonorrhoea can usually be treated very easily with antibiotics, but if an infection goes untreated for a long period of time, it can cause serious problems including infertility.

It’s important to note that this particular test is not always performed during a pelvic exam, and that you should not rely on a pelvic exam to detect sexually transmitted infections. If you are interested in getting tested for sexually transmitted infections, speak with your doctor or your local sexual health clinic. 

After these tests are performed, the doctor will gently remove the speculum.  It shouldn’t hurt while it is removed. 

Now, your doctor will perform the final part of the pelvic exam.  Wearing gloves, your doctor will place two fingers inside your vagina to feel your reproductive organs.  They may use a slippery lubricant during this test to help make you more comfortable. By pressing down on your abdomen with the other hand, while feeling inside with his or her fingers, your doctor will be able to feel your reproductive organs.  This allows them to check the size, shape and position of your ovaries, fallopian tubes, and uterus.    You shouldn’t feel any pain during this procedure, but you will feel pressure as your doctor feels your organs. 

After the Exam

After your exam, your doctor will send your Pap smear to a lab where a specialist will look at these cells under a microscope to make sure that the cells look healthy and normal.  Before you leave your exam, make sure to ask your doctor about how you can get your results and how long it should take.  It may take a few weeks before the results are available.

My doctor tells me my Pap smear was abnormal – what does that mean?

The most important first thing to know is that an abnormal Pap smear does not mean that you have cancer. Pap smears are a highly effective screening tool for changes on the cervix that can (over time) lead to cancers, which is why we do them – we want to catch any problems in the very early stages to prevent them from progressing. Depending on the result, your doctor may recommend a follow-up Pap smear in six months or may ask you to see a gynaecologist in a colposcopy clinic.

Colposcopy is a special type of pelvic examination where a magnifying lens (the colposcope) is used to look more closely at the cervix. Just like with a Pap smear, a speculum is placed in the vagina first, so that the cervix can be seen. Your doctor may wash the cervix with special liquids or stains to make any abnormal areas become more obvious. If there are abnormal areas, they will be looked at more closely - this can sometimes tell us about what type of abnormality it is, and what further management should be. A biopsy (sample of the cells) may be necessary for further diagnosis.

In summary

In summary, Pap smears are a simple, inexpensive and highly effective way to screen for changes that could lead to cancers of the cervix. When abnormalities are found on a Pap smear, it is extremely important that they get followed up appropriately, whether that is by having another Pap smear in six months to see if the changes have resolved, or whether it is by having a special examination in the colposcopy clinic. Most of the time, no treatment is needed, but it is important to have the follow up Pap smear to make sure the changes have resolved.