Annual Exam: Part 2

What to Expect

Any discomfort that women anticipate is related to the pelvic exam portion of the appointment. In reality, this part takes only a short time.  But if it brings up feelings of anxiety, remember that you are in control of what happens during the exam. You can ask to take a "time out" if you need one. Taking deep breaths to relax the body also helps. And communicating your concerns or questions to your provider is important. They will do their best to make you comfortable.

When the nurse brings you into the exam room, you will be asked to undress, put on a gown and cover your legs with a paper sheet. 

To begin the exam, the clinician will ask you to lie back on the exam table, "scoot down" toward the end, put your feet in the stirrups, and relax your knees. This will allow the clinician to examine your outer genitals for any changes or abnormalities, and (when you are ready) to gently insert an instrument called a speculum (see second diagram below) into your vagina. Breathing deeply and focusing on relaxing your pelvic muscles will increase your comfort during this part of the exam. As the speculum opens, it will create a sensation of "fullness", but it should not be painful. Please let your clinician know if you experience any discomfort.

Once the speculum is open, the clinician can see your cervix. You can see it too, if you want; just ask your clinician to position the hand mirror so you can see. The cervix (see diagram below) is the "neck" of your uterus and is located at the far end of your vagina. (It looks like a small donut and feels like the end of your nose when you touch it.)

For women aged 21 or older, your clinician will check to see if you are due for a Pap smear. As of November 2009, it is recommended that women aged 21 or older get this cervical cancer screening every two years. The screening process means that your clinician will use a small brush to take a sample of cells from both inside and outside the cervix. The sample will be sent to a laboratory to be examined for any abnormal cell growth. Such growth may be caused by precancerous or cancerous cells on the cervix. Early detection is key to the treatment or management of such conditions. Getting a Pap smear is not painful, but you may feel some slight cramping.

After the speculum is removed, the health care provider will insert gloved fingers into your vagina and place his/her other hand on your abdomen, applying slight pressure. This examination is done to determine the size, shape, and position of your uterus and ovaries. Following this, a gloved finger may be inserted into your rectum to detect any abnormalities of the rectum, and to feel the back of the uterus and the ovaries.

Although this exam sounds complicated, rest assured; the pelvic exam takes only five (5) minutes or so to complete and by now, you hopefully understand its importance.

Kegel exercises are recommended for women to feel more in control of their bodies and to help them relax during the pelvic portion of the gynecological exam.

Please remember that the annual exam (and the Pap smear) are not testing you for sexually transmitted infections (STIs). When you check in for your annual, you will routinely be asked if you would like an HIV antibody test. If you want to be tested for other STIs, you will need to make that request as well. Then, your clinician will know to take the appropriate samples (samples may include cervical cells, vaginal discharge, blood, or urine).

Without symptoms, testing for STI's will not be covered by most health insurance policies. Still, a clinician may recommend testing for diseases that are often asymptomatic (such as chlamydia and gonorrhea) if she/he believes there may have been a risk of exposure. Left undiagnosed and untreated, these diseases can lead to infertility.

If you are sexually active with men (even if just occasionally), you may want to consider purchasing Emergency Contraception at the Gannett Pharmacy before you leave, to have on hand in case of a future contraceptive failure or unplanned sex.

What is the pap smear?

A thin prep pap involves collecting a small sample of cells from the cervix, the part of the uterus that extends into the vagina. The cells obtained are filtered, placed on a slide and analyzed. Analysis usually includes initial computer screening and occasional slide review by trained personnel. Thin prep Paps screen for cervical cancer or pre-cancerous changes.

Unless your menstrual flow is heavy, you can still have a pap smear if you have your period the day of your appointment. However, you should avoid intercourse, douches, vaginal medications and lubricants for at least 48 hours prior to your visit.

The pap is first checked to see that all cell types from the cervix are found in adequate amounts. If they are not, the thin prep pap is deemed sub optimal. In this case, your practitioner may recommend a repeat pap or may wait until the next regularly scheduled interval. In rare situations,  the thin prep pap is deemed unsatisfactory because very few cells are present. In these cases, unsatisfactory thin prep pap tests are repeated promptly.

Even under the best of circumstances, a very small number of abnormal paps may be read as normal (false negative). As in all screening tests, sometimes an abnormal result will be recorded when no disease is present (false positive). For these reasons, all women should have the recommended cervical cancer screening every two years if aged 21-29, every three years if 30 or older.

And Pap smears are still important screening tools, regardless of whether you received the HPV vaccine (Gardasil). The vaccine protects against the two most common HPV types that can cause cervical cancer, but not all.