Medical Content Created by the Faculty of the
Harvard Medical School
You'll have a pelvic examination. The doctor uses a cotton swab to collect a sample of the fluid that moistens the lining of the vagina. This swab is rubbed against two glass slides, and a small drop of fluid is placed on each slide to mix with the vaginal fluid. If your doctor is testing for infection with gonorrhea or chlamydia, he or she might use a second cotton swab to take a sample of mucus from the middle of the cervix.
Your doctor or a technician examines the slides under a microscope for signs of infection with yeast, a tiny parasite called Trichomonas, or a bacterium called Gardnerella (which causes an infection called bacterial vaginosis). If a second cotton swab was used, the doctor sends it to a laboratory for gonorrhea or chlamydia testing.
A pelvic examination assesses the health of your vagina, uterus, fallopian tubes, and ovaries. This exam may be done in conjunction with a diagnostic or screening test. You lie on your back on an examining table with your knees bent and your feet in footrests. The doctor or the doctor's assistant asks you to spread your knees apart. The exam has two parts: a speculum examination and a bimanual examination. The speculum examination allows the doctor to see inside you, and the bimanual examination allows him or her to feel inside you.
During the first part of the examination, the doctor inserts a speculum, a device used to separate the walls of your vagina (normally the walls are touching each other) so that he or she can see inside. You will feel some pressure when the doctor inserts the speculum. As it is inserted, the doctor also shines a light inside you, and can see the walls of your vagina as well as the cervix-the outermost part of your uterus. If you have a vaginal infection, an abnormal discharge may be visible in the vagina. The doctor can take a sample of that discharge and study it under a microscope to diagnose what kind of infection you have.
In the center of the cervix is a channel called the cervical os that leads to the interior of your uterus. If there is bleeding in the uterus, bloody material may be seen coming out through the cervical os. If there is an infection in the uterus, pus can be seen coming out through the os. With certain infections, the outer surface of the cervix can appear irritated, or may have tiny areas of bleeding.
Even if everything looks normal, the doctor may do a routine screening test such as a Pap smear or a diagnostic test such as an endometrial biopsy or colposcopy. These techniques identify various diseases or conditions that cannot be seen with the naked eye.
During the bimanual examination, the doctor determines the size and shape of your uterus. He or she presses inside your vagina with one or two fingers while pressing on your lower abdomen with the other hand. In this way, the uterus is lifted up toward your abdominal wall, making it easier to feel between the two hands. The doctor can feel if the uterus is enlarged, or whether it is lumpy from fibroids (very common but benign growths on or in the wall of the uterus). The doctor also sometimes can feel the ovaries and any masses in the fallopian tubes (the tubes that carry eggs from the ovaries into the uterus). Sometimes he or she will insert another finger into your rectum, to better feel the area between the uterus and rectum. That finger can also feel for any lumps in the wall of the rectum, and can obtain a sample of stool to be tested for any sign of bleeding.