Purpose, Preparation, Risks, and Results

A pelvic exam, also called an internal exam, is an exam of your pelvic region, which includes your vulva, vagina, uterus, cervix, ovaries, and rectum. A gynecologist, OB-GYN, or certified midwife performs this test to check the health of your reproductive organs. They may also perform this test during routine gynecological procedures, such as pap smears.

Pelvic exams are tools that can be used as part of gynecological care. Not everyone needs a pelvic exam every time they visit their provider. However, these exams can be useful in certain circumstances and can help diagnose certain symptoms and conditions, including:

• Abnormal bleeding
• Abnormal discharge
• Pelvic pain
• Painful intercourse
• Abnormal masses, both benign (non-cancerous) and malignant (cancerous)
• Cysts
• Polyps
• Fibroids
• Anatomical differences
• Pelvic infections

While pelvic exams can help diagnose many issues, there are certain instances where a pelvic exam is not necessary. For example, you don’t need a pelvic exam to screen for sexually transmitted infections (STIs) or get most forms of birth control.

Experts recommend against adolescents getting pelvic exams during their first gynecological visit unless they have a symptom that needs to be examined. People who are not pregnant or are not having health concerns also do not need routine pelvic exams.

Pelvic exams usually take place in your healthcare provider’s office. This is an outpatient procedure and usually only lasts a few minutes. You don’t have to dress in any particular manner for your appointment, but wearing clothes you can easily remove can be helpful, as you will have to change out of your clothes and into a hospital gown or sheet.

You don’t have to eat differently before a pelvic exam or avoid medications. A full bladder during the exam can be uncomfortable, so peeing beforehand can help. Many people prefer not to have this exam during the heavy days of their period. However, you can still get a pelvic exam while on your period.

Bring your insurance card, ID, and any other information your provider requests to your appointment.

Support

If you are uncomfortable doing the exam alone, you can bring a friend, partner, or family member with you during the procedure. This may be especially important for people who are survivors of sexual abuse or sexual violence. You may also want to consider telling your provider beforehand if you have this history and may find the exam triggering.

Some people with gender dysphoria, or psychological distress from their assigned sex at birth not matching their gender identity, may also find the exam triggering. If you have gender dysphoria, consider writing down your pronouns and which terms you prefer to describe your body to discuss with the provider. For example, some people prefer the term “bottom exam.”

If you have any concerns about the exam, you can discuss them beforehand with your provider. They can describe how the exam will proceed and what to expect. Consider bringing a list of questions with you to the appointment. You can request that your provider tell you before they perform each step of the exam and that they ask permission before touching you.

Pelvic exams are brief procedures. They usually occur during your gynecological visit, especially if your provider performs tests like pap smears. In addition to a pelvic exam, your provider may ask about your medical history, your menstrual cycle, and other symptoms you are having. They may also perform a breast or chest exam, test for STIs, and discuss birth control options.

During the Test

To begin your pelvic exam, your provider will ask you to lie on the exam table and put your feet in stirrups. This will keep your feet lifted and help you stay in position during the exam.

You can expect the following during your pelvic exam:

• Your provider will start by examining your vulva and other external genitalia.
• Using lubrication, they will insert a tool called a speculum inside of your vagina, which keeps the vaginal walls open.
• While the speculum is in place, your provider may use a small light to see the sides of your vagina and cervix.
• If you are getting a pap smear or human papillomavirus (HPV) test, the provider will use a brush tool to remove cells from your cervix for examination. This may feel moderately uncomfortable. Your provider may take samples of your discharge to check for infections.
• After removing the speculum, your provider may do a digital (finger) pelvis exam. They will insert a gloved finger or two inside your vagina to briefly examine your pelvic area. They may push their gloved fingers upward toward your cervix while their other hand gently presses on your belly to examine your uterus and ovaries.
• Less commonly, your provider may need to examine your rectum as part of a pelvic exam. This involves inserting one gloved finger in your vagina and another finger in your rectum (the lowest part of your small intestine, just above your anus).

You can ask your provider to explain each step as they move through the procedure. If you feel discomfort, let them know.

After the Test 

After your pelvic exam, your provider may discuss anything they observed during the exam and will discuss the next steps with you if any are needed. You will be free to go home after the exam. It’s common sometimes to have light bleeding after a pap smear, but this should end soon after. You may also need to clean up any lubrication applied during the exam.

Pelvic exams don’t have many physical risks. You might experience slight pain and discomfort after the pap smear portion of a pelvic exam, but this is temporary and not harmful. You may feel discomfort when the speculum is inserted or during the digital portion of the exam. However, this should not be painful. If it is, alert your provider right away.

A common concern about pelvic exams is that they can cause stress, anxiety, and embarrassment. This may be especially true for your first exam or if you aren’t comfortable with your provider. People who have a history of sexual abuse may find pelvic exams triggering. If you ever feel uncomfortable during an exam, you can ask your provider to stop at any point.

It’s important to find a provider you feel comfortable with and to discuss your feelings about the exam as honestly as possible.

Your provider will usually be able to tell you right away if they found any concerns during your pelvic exam, such as anatomical abnormalities, masses, fibroids, cysts, polyps, or signs of infections.

However, if they took samples to test, you likely won’t know the results at your appointment. It can take about 1-2 weeks to get the results of a pap smear.

Interpreting Your Results

If your provider has any concerns about what they observed during your pelvic exam, they may recommend that you seek further testing, such as an ultrasound or biopsy. They may also take a sample of your vaginal discharge for testing.

Pap smears and HPV testing results will return in a few weeks, and you will be alerted about them.

You will typically receive one of the below pap smear results:

• Normal: This result indicates no abnormal cell changes on your cervix.
• Unclear: This result means there are possible signs of abnormal cells, but it’s unclear if these are related to standard changes like pregnancy or menopause, if they are a sign of an infection, or if they indicate an HPV infection.
• Abnormal: This result means that abnormal cell changes were found on your cervix, which may have been caused by HPV. These changes may or may not develop into cancer.

If you are under the age of 30 and your pap smear results come back as unclear or abnormal, your provider will likely recommend getting an HPV test. If you are over the age of 30, experts typically recommend getting an HPV test along with a pap smear before waiting for pap results. HPV tests look for signs of an HPV infection. Test results can be either:

• Negative: You don’t have an HPV infection.
• Positive: You have an HPV infection, which may increase your risk of cervical cancer.

Pelvic exams are tests that a healthcare provider, such as an OB-GYN or midwife, may perform as part of a gynecological exam. Pelvic exams are used to assess the health of your reproductive system and are used when you need to get a pap smear. Not everyone needs a pelvic exam as part of their gynecological visit.

Pelvic exams can be stressful or uncomfortable. This is common and normal, and you should feel empowered to discuss your questions and concerns with your healthcare provider.