Before starting, the patient gets undressed and changes into a hospital gown. Then the patient lies on the table, putting her feet in the stirrups and bringing her bottom to the very end of the table. The examiner instructs the patient to get her in the best position for completing the exam. The examiner uses a bright light to assist in seeing all the necessary body parts. During this part of the examination, the doctor checks the outside of the vaginal area and anus for abnormalities. The examiner takes note of any swelling, lesions, inflammation, polyps, abnormal discharge or abnormal odor. These signs indicate treatment is necessary.
Internal Exam
The internal examination starts with the examiner palpating the cervix with a lubricated and gloved finger. Next, the examiner inserts a speculum into the vagina. A speculum is a plastic or metal device that opens the vaginal area so the examiner can see the vaginal walls and cervix. Next, the examiner scrapes the cervix gently with a plastic or wooden spatula, then with a cylindrical brush. The examiner places the cells that these instruments retrieve on a glass slide for analysis. Next, the examiner holds a cotton swab against the cervix for about 30 seconds and then sweeps it on a plate or mixes it into a liquid reagent. These tests go to a laboratory to check for STDs as well as cervical cancer.
Bimanual Exam
During the bimanual examination, the doctor inserts two gloved and lubricated fingers (the middle and index fingers) into the vagina, while pressing down on the outer abdomen with his other hand to check for problems. The purpose of the bimanual exam is to check for any abnormalities or tenderness of the vaginal walls, uterus or ovaries.
Recto-vaginal Exam
The examiner does not always perform a recto-vaginal exam during a pelvic exam, but on occasion it is necessary. During this part, the examiner inserts a gloved, lubricated index finger in the vagina, then a gloved, lubricated middle finger into the rectum via the anus. The patient may have the sensation of needing to have a bowel movement. However, this sensation passes quickly, and it doesn't occur. This examination allows the examiner to feel the uterus from another angle, and check any abnormalities further.
