A pelvic examination, also known as a pelvic exam or vaginal exam, is a physical examination of the female pelvic organs. Broadly, it can be divided into external examination and internal examination and it is also called bimanual exam when two hands are used and manual uterine palpation. It is frequently used in gynecology, examination of anatomy skin lesion palpation of stomach area Use of a speculum to locate the external cervical os. Examination for foreign bodies and cervical swabs are taken at this point in the exam and these swabs of the epithelium layer of the cervix are known as a Pap smear. Other vaginal swabs can be taken at this time to test for sexually transmitted diseases, two fingers are inserted into the vagina until they isolate the cervix. Then the health care professional tests for cervical motion tenderness, as seen in pelvic inflammatory disease. The examiner presses down on the abdomen with the hand, to locate the fundus of the uterus. The exam should not be uncomfortable, but a woman with a vaginal infection or vaginismus may feel pain when the speculum is inserted. Using the smallest available speculum may help, a woman with an untreated imperforate hymen may find it impossible to be examined. During the bimanual exam, the palpating of the ovaries may be painful, the pap smear may cause some cramping as well. For educational purposes, trainee doctors have performed pelvic exams on unconscious women, the subjects are those undergoing surgery for unrelated causes, and they were rarely informed the examination had occurred. This practice is forbidden in the United States, New Zealand, and the United Kingdom, the practice still continues in Canada according to a study published in the Journal of Obstetrics and Gynecology. In July 2014, the American College of Physicians issued a guideline recommending against performing this examination to screen for conditions in asymptomatic, nonpregnant, adult women. The ACP said that there was no evidence of benefit in support of the examination and this was a strong recommendation, based on moderate-quality evidence. The American College of Obstetricians and Gynecologists disagreed, while they acknowledged that a routine annual pelvic exam was not supported by scientific evidence, it was supported by clinical experiences of gynecologists treating their patients. Pelvic exams are an occasion for gynecologists to recognize issues like incontinence and sexual dysfunction, and discuss patient concerns generally, ACOG said
Image: Pelvic exam nci vol 1786 300
An image that shows the introitus (the opening of the vagina) in relation to its surrounding structures, when the labia are displaced by a gloved finger.
A speculum exam showing the ectocervix of a postmenarchal, nulliparous woman.