Pelvic Exam
Posted on Sunday, May 01 @ 17:59:39 EDT by vetta |
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The American College of Obstetricians and Gynecologists recommends that all women age 18 or older need annual gynecologic examinations, including a pelvic examination, as do sexually active adolescents younger than age 18.
The American College of Obstetricians and Gynecologists recommends that all
women age 18 or older need annual gynecologic examinations, including a pelvic
examination, as do sexually active adolescents younger than age 18. The well-woman
visit is a key part of preventive care; it includes a discussion of the patient's
health history and reproductive health care needs, a physical examination,
including a weight and blood pressure check, a clinical breast examination, and
various tests depending on a woman's age and risk factors for disease.
Some women feel embarrassed by the exposure involved in a pelvic exam. Others
view the pelvic exam as an indignity to their bodies.
Actually, these feelings, although understandable, must be overcome. Few
examinations are as important to your health and well-being. Just as periodic
examinations of your breasts can detect early lumps or thickening, the pelvic
exam is essential for the early detection of genital cancer, infection or other
abnormalities. As with breast cancer, genital cancer is best managed if found
early. And early detection and treatment of other problems can often head them
off before they become serious.
As a patient, the best way to approach the pelvic exam is as a routine
examination that happens to take place in the gynecologic area. It should be no
more embarrassing than your annual overall physical checkup, and the steps
involved are no more difficult than having your blood pressure recorded.
PRE-EXAM CONSULTATION
Before beginning the pelvic exam, you and your clinician will discuss
your particular requirements as a patient: Are you currently in a relationship?
Are you needing birth control? Do you have a history of vaginal infection? All
of these factors will be taken into consideration.
The examination usually involves two steps:
- vaginal examination with a speculum
- vaginal examination with the hands and fingers (digital exam). Your
doctor may also want to perform a rectal checkup during the digital phase of
the examination.
SPECULUM
EXAMINATION
Preparation: Usually with the aid of the nurse, your body is
draped with a sheet and your feet are placed in stirrups. After routinely
examining the breasts, abdomen and groin, your clinician inspects the outer
genitals. Because good light is important, a lamp may be used during this
inspection. Generally, the examiner will place an arm or elbow on your leg or
thigh before touching the outer genitals. This is to avoid startling you--in
which case your genital muscles might involuntarily contract and interfere with
the examination.
Inserting the Speculum: A speculum is an instrument which
enlarges the vaginal opening and spreads the vaginal walls so that your
clinician can "see what is going on" inside the vagina. Your clinician will
carefully insert the speculum into the vaginal entrance with one hand, while
using the other hand to gently spread the labia. The type or size of the
speculum depends on whether the patient is sexually active, uses tampons, has
had children, or is post-menopausal. To avoid discomfort, the speculum is
inserted slowly and at an angle. But if you feel any distress—which is extremely
rare—your clinician will adjust the speculum to make you feel more comfortable.
Inspecting the Cervix: As it is gradually rotated, the speculum
can be opened to expose the cervix--the "neck" of the lower uterus that connects
it with the vagina. Again, this is done with very little discomfort to the
patient. By manipulating the speculum, the doctor obtains a clear view of the
cervix and can examine it for cysts, tears or other abnormalities.
The Pap Smear: Named for its developer, Dr. George N.
Papanicolau, the Pap test is a simple procedure which detects precancerous cells.
In other words, the Pap test can warn of cancer even before clinical signs of
disease are apparent.
You've probably been instructed not to use douches, vaginal creams or
medications for at least 48 hours prior to your pelvic exam. This is important
because these substances can distort the appearance of the cells to be studied
in the Pap smear.
While the cervix is still exposed by the speculum, cells are taken from the
cervix and vagina with a scraper or cotton-tipped applicator. The cells are then
rinsed into a vial and sent to a laboratory for analysis.
With the speculum still in place, your physician may also take appropriate
smears to determine the presence or absence of vaginal infection.
DIGITAL
EXAMINATION
After gradually withdrawing the speculum, the examiner will
carry out the digital examination. This is just what it sounds like: an
examination with the fingers or "digits." It is also a "bimanual" examination
because both hands are used--one internally and one externally on the abdomen.
Wearing a glove, your clinician inserts the index and/or middle finger of one
hand into the vagina. In this way, the cervix can be palpated or "felt" for
consistency, shape and position. The cervix may be moved from side to side to
determine if it is tender to the touch. And the upper vagina is explored for
masses, tenderness, or distortion.
During the digital exam, your clinician will also examine the uterus and ovaries.
While the finger (or fingers) within the vagina elevate the cervix and uterus,
the other hand is gently placed on the abdomen. By "grasping" the upper portion
of the uterus between the vaginal fingers and the abdominal hand, the examiner
can determine its size, its mobility and the presence or absence of tenderness.
The ovaries also can often be located and felt.
RECTAL CHECKUP
In order to completely rule out abnormality, your clinician
may include a rectal checkup as part of the digital examination. Just stay
relaxed, and you'll feel nothing more than perhaps a brief sensation of a full
bowel.
The rectal examination follows naturally from the digital exam. Still wearing a
glove, your clinician again inserts the index finger into the vagina. The middle
finger--which has been well lubricated--is gently and slowly inserted into the
anal canal. This is done to determine whether there is any mass in the anal
canal or lower rectum. By reaching further into the rectal canal, the examiner
can also palpate the cervix and uterus.
POST-EXAM
CONSULTATION
After the pelvic exam, you'll be asked to return to the
consulting room, where you and your clinician will discuss the findings of the
examination. You'll be told when to expect the results of your Pap smear. If
birth control is your primary concern, a contraceptive program will be tailored
to your individual needs.
Your physician will also tell you when to come in for your next pelvic exam and
Pap smear, generally within six months to a year. You may get a reminder in the
mail--but don't wait to be reminded! Now that you know about this all-important
method of detecting genital cancer and infection, you'll probably want to have a
pelvic exam and Pap smear at least once every year.
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