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Well Women Exams

A well woman exam entails a routine pelvic examination and Pap testing. The American College of Obstetricians and Gynecologists (ACOG) recommends that all women have their first annual women's health exam after three years of onset of sexual activity or at age 21, whichever comes first.

Preparation for the Well Woman Exam

The well woman visit typically includes a pelvic exam, this can be a unnerving experience for many women, especially when it is the first exam. However, preparation for the exam and an understanding of the underlying health reasons behind the exam may help to lessen the anxiety.

If it is your first visit to us, the provider will start by taking a routine health history. Questions he will ask will include information about your health as well as any pertinent family medical history. He will ask about your menstrual cycles, if you are sexually active, and if your sexual relationships place you at any risk for pregnancy or sexually transmitted infections. Additionally, he will ask about any dietary, social, and violence related concerns which may place your health at risk. If you have any questions for her about your health, please do not hesitate to ask!

In preparation for the exam, the provider will give you a drape for your lap and will ask you to undress from the waist down. You will also be asked to unhook your bra in order to facilitate the breast examination. You may keep on your top/shirt during the exam.

The Breast Exam

The breast examination is an integral part of the well woman exam. The provider will inquire if you are doing a monthly breast self-examination (BSE) practices and will instruct you how to perform this exam. The best time during your menstrual cycle to perform BSE is the week after your period. The provider will examine your breasts for skin changes, lumps, nipple discharge and swollen lymph nodes. If you have any questions or concerns about performing BSE, please do not hesitate to ask them at this time.

The Pelvic Exam

The pelvic exam, in most cases, is actually a very short and simple procedure. In fact, it will probably take more time to read the following information than it will take to do the exam! At any rate, many women feel needlessly embarrassed and self conscious during the pelvic exam. Please try to remember that the provider performs routine pelvic examinations every day and understands your feelings. However, if you have had negative experiences in the past or have particular concerns, use this opportunity to discuss this with your provider before the exam. He may be able to help make the exam a more pleasant experience.

Before the exam, you should empty your bladder. You will be asked to bend your knees and place your heels in stirrups during the actual exam. The first part of the exam consists of a brief examination of the external area. The provider will look for any external signs of problems, including abnormal bumps or rashes. If you have noticed any bumps or rashes yourself, please alert the provider.

The Speculum Exam

A speculum will be used during the second part of the pelvic exam. A speculum is a metal or plastic instrument that is used to gently spread the vaginal walls allowing for better visualization of the cervix (the opening of the uterus). The speculum comes in several sizes, accommodating even virginal women. A warmed speculum will be inserted into the vagina. Most women describe the feeling "as having pressure". After inserting the speculum, the provider will visually examine the cervix and take a few cells for a Pap test. To do this, he will use small flexible plastic broomand a small cervical brush, which looks like a mascara brush. These cells will be sent to a pathology lab to look for any abnormalities. The Pap test is a screening test for abnormal cells that may become pre-cancerous cervical cells. Most results are back within two to three weeks. We will only contact you if your results are abnormal.

Screening for Sexually Transmitted Infections

The provider will examine the cervix and vaginal tissue for any abnormal discharge or bumps. Screening for sexually transmitted infections (STI), including gonorrhea and chlamydia, can be done. We encourage all sexually active women to be screened for STI if they have had a new sexual partner since their last exam or STI screen or are not in a monogamous sexual relationship. Screening for STI is simple and consists of taking a small amount of cervical discharge with a Dacron swab. Like the Pap test, this will also be sent to the laboratory for evaluation. Most results are back within 2-3 weeks. We will only contact you if your results are abnormal.

The Bimanual Exam

After the speculum is removed from the vagina, a bimanual (two-hands) examination of the uterus and ovaries will conclude the exam. The provider will insert one or two gloved fingers into the vagina and will locate the cervix with the tip of her finger. With his other hand, he will press firmly on the abdomen, right above the pubic bone. During this procedure, the provider is evaluating the size, shape, and consistency of the cervix, uterus, and ovaries. This can often feel like pressure to the woman. Any pain should be discussed with the provider.

Rectal Exam

Rectal exams are a routine part of a well woman exam. During the rectal exam, the provider will insert one lubricated gloved finger into the rectum.

After the Exam

After the exam, the provider will leave the room and ask you to get dressed. He will take the Pap test and any other tests to the lab. When he returns to the exam room, you will be given time to ask any additional questions about the exam findings. If any abnormalities were noted during your exam, the provider will use this time to discuss them with you. If any treatments are needed, the provider will provide them at this time and will instruct you on their use. Contraceptive options and medication refills may be discussed at this time as indicated.

You also will be given a handout about the Pap test and how to get your results as well as general information about the results. You should have a routine pelvic exam and Pap test every year unless your provider recommends more frequent exams.