Most women will have a pelvic exam during their annual check-up or if they are having a problem involving the female reproductive system. So what exactly is your doctor looking for during this exam? There are two parts to the exam: a visual and a physical exam.
The visual part of the exam involves inspecting the mons pubis, the vulva (which includes the labia minora and majora, and the clitoris), the vagina, the perineum and the anus (see diagram).
Doctors look at the external genitalia and hair distribution and for any rashes, bumps, ulcers, irritation, or unusual vaginal discharge. From there, they will separate the labia majora and look at the labia minora (smaller vaginal lips), the clitoris, urethra (the hole you urinate from), the vaginal opening called the introitus, and hymen.
Once finished looking at the external genitalia, they will use a speculum to visualize the inside of the vagina. The vagina should appear pink, rugate, and moist. The vagina is about 4 centimeters in length and at the end of the vagina is the cervix. The cervix should look like a smooth pink doughnut. The provider will also look at the bladder and rectum to see if they are well supported and not protruding out into the vagina. Depending on the reason for your visit, your gyno could do a pap smear (a screening test for cervical cancer), take a sample of abnormal discharge you may be experiencing, or swab the cervix for sexually transmitted infections.
The physical part of the exam follows the visual part of the exam. This includes a bimanual exam in which the doctor will place two fingers inside the vagina and the cervix will be moved from side to side. If this elicits any pain, called cervical motion tenderness then this may be a sign of enlarged ovaries due to a cyst, or ovarian mass. Another reason for pain could be an infection in fallopian tubes and ovaries called pelvic inflammatory disease or tubo-ovarian abscess. This is commonly caused by sexually transmitted diseases like gonorrhea and chlamydia but Bacteroides and other less common bacteria can be the culprit. From there, the top of the uterus is then palpated. The doctor will then feel for the size, mobility, and if it is irregularly shaped, keeping in mind that the normal size of a uterus is 6-8cm. An irregular or enlarged uterus may be due to fibroids or adenomyosis. Fibroids are caused by encapsulated smooth muscle that can grow inside or on the outside of the uterus. Adenomyosis is where the inner lining of the uterus grows into the muscle portion of the uterus called the myometrium. This is more common in women in their 40s and can cause painful periods, bloating, and heavy periods. The uterus could also be fixed or retroverted meaning tilted toward the spine which can be a normal finding but could also be due to endometriosis and cause pain during intercourse.
There is a lot of information your doctor can get from a pelvic exam which is such an important part of the women's wellness exam. If the exam reveals anything unusual, your doctor will discuss any tests, treatments, and additional follow-up appointments that you need.
Getting familiar with your vaginal anatomy is so important and shouldn't be scary! Embrace the body that you're in and get to know your lady parts.
Dr. Jodie Horton