Pelvic Exam and Menopause

A pelvic exam is a way for doctors to look for signs of illness in organs in a woman's body before, during, and after menopause. The word "pelvic" refers to the pelvis. The exam is used to look at a woman's:

• Uterus (the womb)
• Vagina (the muscular canal which extends from the cervix to the labia)
• Cervix (opening from the uterus to the vagina)
• Fallopian tubes (tubes that carry eggs to the womb)
• Ovaries (glands that produce eggs)
• Bladder (the sac that holds urine)
• Rectum (the chamber that connects the colon to the anus)

A woman's body size determines the sensitivity of the pelvic exam to identify an abnormality. Unfortunately, it is more difficult to examine patients who are heavier. Sometimes a doctor may order an ultrasound to confirm the findings on a pelvic exam.

Why Do Menopausal Women Need Pelvic Exams?

Because the risk of cancer increases with age, having regular pelvic exams may help in early detection of certain cancers in both menopausal and postmenopausal women.

How Often Should Menopausal Women Get a Pap Test?

The U.S.Preventive ServicesTask Force recommends that women between the ages of 21 and 65 have a Pap test every three years, or a human papillomavirus (HPV) test or a combination of a PAP and HPV test every five years, starting at age 30.

Women over age 65 can stop getting screened if they’ve had at least three consecutive negative Pap tests or at least two negative HPV tests within the previous 10 years, according to the guidelines. But women who have a history of a more advanced precancer diagnosis should continue to be screened for at least 20 years.

And women of any age who’ve had a hysterectomy with removal of the cervix and no history of cervical cancer or advanced precancerous abnormalities do not need to be screened, according to the guidelines.

Still, even though you may not need a Pap test every year, you should still have an annual gynecological exam to protect your health.

Do I Need to Do Anything to Prepare for a Pelvic Exam?

You do not have to do anything special to get ready for a pelvic exam. When you arrive at the office, your doctor may ask if you need to use the bathroom. This question is asked so that you can stay comfortable during the exam. Sometimes, a urine sample is requested.

What Can I Expect During the Pelvic Exam?

You can expect to feel a little discomfort, but you should not feel pain during a pelvic exam. The exam itself takes about 10 minutes. If you have any questions during the exam, be sure to ask your doctor.

How Is the Pelvic Exam Performed?

During a typical pelvic exam, your doctor or nurse will:

1. Ask you to take off your clothes in private. (You will be given a gown or other covering.)
2. Talk to you about any health concerns.
3. Ask you to lie on your back and relax.
4. Press down on areas of the lower stomach to feel the organs from the outside.
5. Help you get in position for the speculum exam. (You may be asked to slide down to the end of the table.)
6. Ask you to bend your knees and to place your feet in holders called stirrups.
7. Perform the speculum exam. During the exam, a device called a speculum will be inserted into the vagina. The speculum is opened to widen the vagina so that the vagina and cervix can be seen.
8. Perform a Pap smear if indicated. Your provider will use a plastic or wooden spatula and small brush to take a sample of cells from the cervix. A sample of fluid may also be taken from the vagina to test for infection.
9. Remove the speculum.
10. Perform a manual exam with their fingers. Your provider will typically place two fingers inside the vagina and use the other hand to gently press down on the area they are feeling. Your doctor is noting if the organs have changed in size or shape.
11. Sometimes a rectal exam is performed. Your doctor inserts a gloved finger into the rectum to detect any tumors or other abnormalities.
12. Finally, your doctor will talk to you about the exam. (You may be asked to return to get test results.)

What Tests Are Taken During the Pelvic Exam?

As mentioned above, during a pelvic exam, a sample of cells may be taken as part of a regular test called a Pap smear, or Pap test, to screen for cervical cancer or cells that look like they might lead to cancer. This sample may also be screened for HPV as well. The sample is placed in a solution and sent to a lab where it is examined. Tests also may be taken to screen for sexually transmitted diseases or other infections.

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