WHAT TO EXPECT
The exam will include a complete pelvic exam and breast exam and can also include a more general physical exam depending on age and whether the patient has other physicians, such as an internist, family, or general practitioner. A Pap smear may be collected if it is due. A comprehensive history will also be taken or updated, including family history and evaluation for hereditary cancer and other diseases. Counseling can be performed on healthy life choices as well as contraceptive needs and family planning.
An exam will begin with the patient undressing, putting on an exam gown, and laying on the examination table. Once on the table, the patient’s legs will be elevated, and her feet will be placed into stirrups. A helpful tip: be sure to wear socks to the examination, as they will help to keep the feet warm during the process. A sheet is then draped over the patient’s lap, and the doctor performs a pelvic exam.
In the pelvic exam, the doctor examines the patient’s reproductive organs. This is first done with a physical and visual examination of the vulva. The doctor is looking for any abnormalities on the surface, including irregular signs, like irritation, swelling, growths, cysts, and/or pigmented moles. Next, a metal instrument, known as a speculum, is inserted into the vagina in order to visualize the vagina and cervix. If a Pap smear is due at the time of the exam, it will be collected, and additional tests can be ordered on the Pap smear collection, such as screens for sexually transmitted diseases, like Chlamydia and Gonorrhea. The speculum is then removed.
The next step is a bimanual exam, in which the uterus and adjacent tissue (the adnexa which includes the ovaries) is manually examined by the health professional. Two digits of the examiner are inserted into the vagina using a water-based lubricant, and the pelvic organs are felt (palpated) through the lower abdomen. The purpose of this process is to tactilely search for abnormal growths, like fibroids, within the uterus or cysts/ growths on the ovaries, which would otherwise go unnoticed. Depending on the circumstances and patient’s age, a rectal exam may also be performed. A transvaginal ultrasound is sometimes performed as well, depending on the exam findings or patient history.
A Breast exam will be performed to search for any lumps or abnormalities that might be present or have been missed on a mammogram. The doctor can instruct the patient on how to perform self-exams as well. Additional physical examinations, lab tests, and urine analyses are often performed, depending on the circumstances. Further screening tests are also often recommended (i.e. colonoscopy screening for colorectal cancer in patients over 50 years of age).
The routine Gynecological exam can help prevent disease or provide early detection and should be a part of a healthy lifestyle.