What does a pelvic exam entail?

Learn what to expect on your first trip to the gynecologist

By Heidi Borst | Oct. 12, 2023 Medically reviewed by Leslie Greenberg, MD

For women, staying on top of preventive care is essential. Screening tests can detect early signs of diseases and other health conditions and help to ensure your overall wellness. Just as breast exams and mammograms can detect breast cancer, pelvic exams and Pap smears can help identify problems with your reproductive organs.

If you’ve never had a pelvic examination, you may wonder what it involves: The exam evaluates your sexual and reproductive health with an external visual examination of the vulva and an internal vaginal exam using a speculum. Gloved fingers can be used to assess the cervix, uterus, and ovaries. When a pap smear is needed a brush or plastic spatula is used to collect cells to check for cancerous cells.

Read on to find out more about what a pelvic exam entails, how often it’s performed, and how to prepare.

RELATED: Questions to ask your gynecologist at your wellness exam

What is a pelvic exam?

A pelvic exam is a gynecologic test performed to assess a woman’s sexual and reproductive health. During a pelvic exam, a healthcare provider will visually inspect the external genital structures, insert a speculum to view the inside of the vagina and cervix, and then manually feel (or palpate) the uterus and ovaries to check for abnormalities.

During a pelvic exam, your provider will evaluate the following structures:

Vulva: the external genitalia, including the urethra, clitoris, labia, and vaginal opening
Anus: the opening of the rectum
Rectum: the end of the colon
Vagina: the muscular canal that connects to the vulva to the cervix and uterus
Cervix: the opening of the uterus
Uterus: a muscular organ in the female pelvis
Ovaries: the glands that hold your eggs
Fallopian tubes: the tubes that carry eggs from the ovaries to the uterus
Bladder: an organ that stores urine

What to expect during a pelvic exam

A routine pelvic exam takes about 10 minutes. You’ll start by laying on your back with your bottom scooted to the end of the table, your knees bent and open, and your feet placed in stirrups. Your provider will talk you through each part of the exam so that you know what to expect, but it typically consists of four parts: external, speculum, bimanual, and rectovaginal.

“While it can be uncomfortable for some women, a pelvic exam shouldn’t be painful,” says Rakhee Patel, MD, a board-certified OB-GYN and chief medical officer of Pinewood Family Care in Jersey City, New Jersey. If you experience pain at any of these stages, it’s essential to let your provider know.

1. External visual exam

During this part of a pelvic exam, your provider will visually inspect the vulva, vaginal opening, and other external genitalia for signs of redness, irritation, discharge, warts, or sores, explains Dr. Patel.

2. Speculum exam

At this stage, your provider will place a metal or plastic speculum (a tool shaped like a duck’s bill) in the vagina and open it gently they can see the inside of your vagina and the cervix, explains Kelly Culwell, MD, a board-certified OB-GYN and head of research and development in women’s health at Sebela Pharmaceuticals in San Diego, California.

The speculum is often lit so that the vaginal side walls and cervix can be well visualized. This part of the exam might cause some discomfort as the speculum places pressure on the vaginal wall, but it should be quick.

During this portion, your provider might conduct a Pap smear, says Dr. Culwell. (A pelvic exam is not the same as a Pap smear—but a Pap smear is part of the entire pelvic exam to look for precancerous changes in the cervix.) Using a brush or plastic spatula, they will take sample cells from the outer surface of the cervix to check for precancerous changes. The samples will be sent out to a lab and analyzed for changes that could indicate cervical cancer or precancerous conditions, explains Dr. Patel.

In women older than 30, a human papillomavirus (HPV) test is usually conducted with a Pap smear every three to five years to test for HPV, as certain virus strains increase the risk of cervical cancer. Patients may not know when an HPV test is added to their pap smear as it is taken with the same sample. Physicians now know that HPV often is the virus that can change the cervical cells from normal to cancer cells.

3. Bimanual exam

After removing the speculum, your healthcare provider will place one to two fingers inside the vagina while applying pressure with the other hand directly on top of the lower abdomen (above the bladder). The purpose of this physical exam is to check the size and shape of your uterus and ovaries and to check for areas of tenderness and any cysts or growths on the uterus, ovaries, or other pelvic organs that aren’t visible during the visual exam, Dr. Culwell explains.

4. Rectovaginal exam

Your provider may also perform a rectal exam by inserting one gloved finger into the rectum while another finger is in the vagina. This checks for abnormalities in the wall between the vagina and rectum, including tumors or tender areas.

When should I get my first pelvic exam?

The American College of Obstetricians and Gynecologists (ACOG) recommends adolescents have their first visit with an OB-GYN between the ages of 13 to 15 for a well-woman visit. However, most won’t require a pelvic exam, according to Dr. Patel.

At the first visit, a pelvic exam is not necessary unless the patient is experiencing symptoms such as pelvic or abdominal pain, abnormal vaginal bleeding, or abnormal discharge.

In the absence of symptoms, there is no reason to have a pelvic exam until the first Pap test, which is recommended at age 21, Dr. Culwell says. Pelvic examinations are vital because they help detect signs of conditions before they become more serious or symptomatic, such as:

Ovarian cysts
Fibroids
Infections like bacterial vaginosis or sexually transmitted infections (STIs)
Reproductive cancers

Pelvic exams are scheduled at various intervals based on a woman’s medical history, risk factors, and age. While some providers may recommend that women ages 21-65 have pelvic exams annually, others may advise having one every five years. Recommendations for the frequency of Pap smears vary depending on your age and medical history.

However, Dr. Culwell says a pelvic exam is necessary if any of the following symptoms occur:

Changes in vaginal discharge
Pelvic pain
Vulvar or vaginal pain or itching
Irregular periods or spotting
Painful urination
Bumps or sores on the external genitalia
Concern about exposure to sexual infections

How to prepare for a pelvic exam

A pelvic exam requires minimal preparation, according to Dr. Patel. She recommends you schedule the exam on a day when you’re not menstruating, mainly if you’re having a Pap smear. You can have a pelvic exam when you are menstruating, but the extra fluid may affect some lab results. Whether or not you shower before an exam is up to you, says Dr. Culwell, but your provider’s ability to do the exam will remain the same.

“Douching is not recommended,” Dr. Patel says, “as it can disturb the natural balance of vaginal bacteria.” It’s also best to avoid sexual intercourse or the use of vaginal medicines or spermicides for at least 24 hours before the test, especially if a Pap smear is part of the exam.

Additionally, for your comfort, emptying your bladder before the exam is a good idea.

After the exam

Once your examination is complete, Dr. Culwell says your provider will let you know if they saw or felt any abnormalities during the exam that require further evaluation or treatment. It’s essential to understand any follow-up recommendations or tests, adds Dr. Patel, so address any questions or concerns.

After that, you can go about your day normally, though you might have minor vaginal bleeding after a Pap smear, says Dr. Patel. She adds that if you experience any discomfort or symptoms post-exam, you should contact your healthcare provider.

If any testing was done (such as screening for STIs or a Pap test), your provider will let you know when to expect your results, says Dr. Culwell. These results are usually available within a few days to one to two weeks, depending on the test.