What To Expect During Your First Pelvic Exam
March 25 2020 | Written by Madi Hanaka (She/Her)
I was 16 when I had my first transvaginal ultrasound; a procedure that requires a lubed metal scope to be inserted into the vaginal canal. At 18 I got my first Brazillian, requiring me to be spread eagle on a stiff table awaiting hot wax to be applied to my genitals. When I was 21, I had an IUD inserted for the first time; an invasive procedure where a t-shaped device is implanted inside the uterus. To be frank, I am no stranger to having strangers perform uncomfortable procedures down yonder. Three weeks ago, this pattern of routine intimate appointments continued as I visited my family doctor for one of the most basic procedures for vagina-owners: a physical.
In preparation for this appointment, I decided what better way to connect with our readers than to document the entire process from start to finish. This week, I am sharing intimate details of my experience, and through a blog/vlog combo, I am taking you all along for the ride!
Here you will find the full documented experience. Follow along as I take you through the process of my appointment and speak to common concerns regarding these types of exams!
What is a physical exam?
This exam, while commonly known as a “physical” is referred to by the medical community as a bimanual or pelvic examination. During this exam, your doctor will visually and physically examine your vulva, vagina, ovaries, cervix, uterus and fallopian tubes. This is not to be confused with a pap smear or pap test: this is a specific procedure that tests for cervical cancer by collecting cells from your cervix!
When and/or why should you book a physical?
There is not a one size fits all answer to this question, as it is somewhat subject to change depending on individual need. Typically, in Canada, it is suggested that you begin going for bimanual/pelvic exams once you turn 18, or become sexually active. However, if before you turn 18 or begin engaging in sexual activity you are experiencing pain or discomfort, you should always consult your doctor to see what is best for your personal health. Some potential reasons as to why you may have a bimanual exam sooner would be: pain in your pelvic region, extreme menstrual cramping, or abnormal vaginal discharge.
What types of devices are used during a physical?
The most notable - and most unsettling - part of this exam is arguably the speculum. A speculum is a metal or plastic device that resembles a duck’s beak. The bottom piece is hinged, allowing the device to open and close. During the exam, a speculum will be inserted into the vagina, allowing your doctor to get a better look inside as well as swab for any infections.
Fun fact: Yona Care - founded in 2017 - is a modern health company focussed on inclusivity and accessibility. Through their thoughtful work, they are redesigning this scary contraption and working to better serve patients!
As your doctor swabs for infections, the other obvious device is a cotton swab! These are long and stiff and will be used to collect cells from your cervix to test for infections like bacterial vaginosis, yeast, chlamydia and gonorrhoea.
What should I expect during a physical?
Upon entering the office, your doctor will likely ask you specific questions about your general health and menstrual cycle. They may take notes and ask you to describe any issues or concerns you have regarding your vaginal health.
After the verbal check-in, your doctor will leave the room and you will be instructed to remove your clothes - usually only from the waist down. They will provide you with a gown to wear and a sheet to lay over your lower body once you lie down on the table.
Once the doctor re-enters, they will instruct you on how to rest your feet in the stirrups. These are two arms that come out of the end of the table that allow you to position your feet and legs so that the doctor can easily examine you.
After your feet are in position, you’re all set! Your doctor will likely do the bimanual exam first, where they will insert gloved fingers into the vagina while also applying pressure to the outside of the lower abdomen. Here, they will feel around for any abnormalities (sores, swelling, etc.). This part should not be painful, though it might feel slightly uncomfortable. If you do experience any pain, do not hesitate to communicate this to your doctor!
Once the bimanual is complete, the speculum will be inserted. If the device is metal, sometimes - if you’re lucky - the doctor will run it under warm water to make it more comfortable. Once the speculum is inserted, your doctor will adjust the hinged piece to widen the vaginal opening. Again, this should not cause you any pain, though many people may feel discomfort and/or pressure. They will then shine a light inside the vagina to visually check for abnormalities (redness, discharge, etc.). Here, they will also insert the cotton swab to test for any infections. Then they will slowly remove the speculum, and the exam is complete!
Sometimes, you will be asked for a urine sample in which case you will be given a cup with a lid and shown to the bathroom. It’s always a good idea to refrain from emptying your bladder right before your appointment just in case this is something they request.
After all of these steps, your doctor will discuss their findings with you and/or time frames for receiving the results to any swabs they took during the exam. At this point, you are free to go!
How to prepare for a physical?
Unlike other medical exams/procedures, a pelvic exam is very relaxed in terms of preparation, in fact, you really don’t have to do anything to prepare! Personally, I like to take a shower beforehand as it makes me feel more comfortable and I also avoid wearing tight-fitted clothing. By far, the most important thing to do in preparation for this type of examination, is to relax. Though it can be easy to tense up when your doctor is poking down there, this will only make the process more uncomfortable as contracting your vagina will cause resistance against inserted fingers and/or devices. Remember to breathe through it, it will be over before you know it!