Pelvic Exams And Pap Smears

What to expect during a gyn visit.
We know, getting the most intimate part of your body inspected can be feel like an awkward ordeal. But an annual pelvic exam is essential for keeping your reproductive system healthy and spotting trouble early. R. Scott Thornton, M.D., practicing gynecologist and co-author of Everything You Always Wanted To Ask Your Gynecologist tells all about what to expect during a gyn visit:

Who should go for a Pap smear?

A woman should have regular GYN exams when she becomes sexually active. If you haven't had sexual vaginal intercourse, you probably don't need a Pap smear but even if you do have a Pap smear, it will not cause you to lose your virginity.

What to expect during a gyn visit?

1. External examination

During the pelvic exam, the doctor will usually inspect the external genitalia, the urethral opening and the perianal region for any unusual change in color, thickness or texture of the skin in these areas, and also check for the presence of any skin lesions such as warts, cysts and ulcerations.

2. Vaginal examination using speculum

A speculum, which is a long and narrow device, is then inserted into the vagina. Opinions concerning this instrument range from "uncomfortable" to "instrument of torture", but if you learn to relax your pelvic and buttock muscles, the exam will be much easier.

At this point, the doctor also obtains a Pap smear. The Papanicolaou (named after the man who introduced the technique) or "Pap" smear is a procedure whereby the gynecologist collects a sample of cervical cells and places them on a slide for analysis.

The specimen is taken while the speculum is open inside the vagina. A brush, small spatula, or cotton-tipped applicator is used to obtain it and it is usually painless, but it may feel unusual.

The cervical cells collected are analyzed under a microscope to find precancerous or cancerous changes of the cervix. The Pap smear screens women for cervical cancer only and does not reveal endometrial, ovarian or vulvar cancer.

A separate smear of the vagina is required to detect vaginal cancer but this procedure is not as frequently requested as the Pap smear, since vaginal cancer is relatively uncommon.

3. Manual examination

Your gynecologist will also perform a manual examination, where he or she places one or two fingers into the vagina while the other hand is placed on your lower abdomen. The doctor can then feel the size, shape and mobility of the internal organs using mild to moderate pressure.

If you experience pain during the exam, don't worry about it: The ovaries just don't like being pushed around. Remember, concentrate on relaxing and the examination will be more comfortable.

At this point, your doctor may also perform a rectal or recto-vaginal (one finger in the rectum and one in the vagina) exam for a better assessment of the posterior part of the pelvis. A rectal exam is recommended for women over age 50 as a screening for rectal cancer.

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