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You hate them, but know you need them. Making a pelvic exam more tolerable

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You might cringe while setting up the appointment for your next pelvic exam, which probably includes a Pap test. The Pap test and pelvic exam is the most accurate way to screen for cervical cancer and human papillomavirus (HPV), which can cause genital warts and certain types of cancer.

What to consider before you go:

  • If you have concerns about sexually transmitted infections (STIs), pelvic pain or vaginal discharge, mention them up front to your health care provider. Many of the tests for STIs can be collected at the time of your pelvic exam and Pap test.
  • You don’t need to reschedule if you have your period on the day of the test – particularly if your bleeding is not very heavy. But if you’re uncomfortable with the idea of that, go ahead and reschedule. Many women get bleeding after a Pap test or internal pelvic exam, so consider bring a pantyliner with you to the appointment.
  • Two days before your Pap test, avoid intercourse, vaginal creams, suppositories, medicines and douches. These can make it difficult for the pathologist to see abnormal cells or cause reactive changes in the cells that are read as abnormal.
  • If you normally shave, no need to stop. It’s important for you to feel comfortable.
  • Remember – your provider isn’t judging how your body looks. Everyone is different, and all women need these exams.

How to prepare mentally:

  • Use relaxation techniques or distract yourself. Deep breathing, guided imagery and mindfulness can help. It may also help to listen to music, watch a video or talk during the process.
  • If you’re nervous, let your provider know. Ask as many questions as you need to. If you’re uncomfortable, the provider may be able to make adjustments.
  • If you have posttraumatic stress disorder or have experienced sexual violence, or if you suffer from health anxiety, fear of the unknown or body dysmorphia, let your provider know before the exam begins.
  • Say “stop” if you’re in pain. You’re in control during your exam. You can ask your provider to stop at any time.

Remind yourself of the steps for the exam:

  • You or your provider may request a chaperone to be present. You will fully undress and put on a hospital gown.
  • Your provider or her staff will likely set up equipment and label your specimen bottle.
  • Next – the dreaded position. Called the lithotomy position, having your feet in the stirrups attached to the table allows your provider to visualize the genital area. The provider will then gently insert a speculum into your vagina. It is used to widen the vagina slightly so the provider can inspect the internal vagina and collect a sample of cells from your cervix for the Pap test. The Pap test is collected with 1 or 2 devices that swipe the surface of the cervix and pick up cells
  • You may feel mild pressure or discomfort, and you may feel pressure in your abdomen or vagina. However, it should never hurt. During this time, it’s important to breathe and stay relaxed.
  • The bimanual exam is next. Your provider will insert two lubricated, gloved fingers into your vagina and press on your lower abdomen to check your uterus and ovaries.
  • At times, a final step is a rectal exam. Your provider should indicate whether this is part of the process for you.
  • Afterward, you will be able to sit up as the provider or her staff spin the collection tools in a small jar of fluid that is sent to the pathologist for review.
  • Collecting the specimen from your cervix may cause bleeding — which can be perfectly normal.

Your healthcare team will let you know the results of the Pap test after it has been reviewed by the lab. This typically takes several days to a week.

Based on your medical history and Pap test history, your provider will indicate how frequently Pap tests and pelvic exams need to be repeated.

Bridget Glomski, M.D.

Dr. Glomski is a resident physician in Family Medicine at Mayo Clinic Health System in Eau Claire, Wisconsin.

Hannah Miller, M.D.

Dr. Miller is a resident physician in Family Medicine at Mayo Clinic Health System in Eau Claire, Wisconsin.

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