A cervical exam is a medical procedure used to assess the cervix, which is the lower, narrow part of the uterus that opens into the vagina. This examination is a common and quick part of gynecological and obstetric care. The purpose and method of the exam change significantly depending on whether it is performed for routine preventative health screening or during pregnancy and labor. Understanding these different contexts can help demystify the procedure and reduce anxiety.
Cervical Exams in Routine Health Screening
Cervical exams performed during routine gynecological visits focus on preventative care and screening for cellular abnormalities. The most recognized aspect is the Papanicolaou test, or Pap test, which screens for precancerous changes or cervical cancer. This screening is often performed alongside a test for human papillomavirus (HPV), since most cervical cancers are linked to this common infection.
To conduct the Pap test, a speculum is inserted into the vagina to hold the walls apart, allowing a clear view of the cervix. The speculum may be made of plastic or metal and can cause a feeling of pressure in the pelvis once it is opened. A small sample of cells is then collected from the surface of the cervix and the endocervical canal using a soft brush and sometimes a scraping device.
The cell sample is preserved in a liquid medium and sent to a lab to be examined under a microscope for abnormal cell growth. This collection process is quick and generally takes only a few minutes, though some people may experience a mild, brief cramping sensation. The Pap test is a highly effective tool that has helped reduce the incidence and mortality rates associated with cervical cancer by identifying changes before they become cancerous.
Cervical Exams During Pregnancy and Labor
The purpose of a cervical exam changes when performed during late pregnancy or active labor, shifting from a screening tool to an assessment of readiness for birth. This examination is typically performed digitally, where the provider inserts two gloved fingers into the vagina to manually feel the cervix, rather than using a speculum. These checks usually begin in the final weeks of pregnancy or upon admission to labor and delivery, and are used to gauge the progress of labor.
A manual cervical check assesses three distinct measurements to evaluate how far the body has progressed toward delivery. The first is Dilation, which describes how open the cervix has become, measured in centimeters from zero (closed) to ten (fully open). The second measurement is Effacement, which refers to the thinning or shortening of the cervix, expressed as a percentage from zero percent (thick) to 100 percent (paper-thin).
The third factor assessed is Fetal Station, which indicates how far the baby’s head has descended into the pelvis in relation to bony landmarks called the ischial spines. Fetal station is measured in numbers ranging from negative five (high in the pelvis) to positive five (crowning or visible at the opening). A station of zero means the baby’s head is level with the ischial spines, indicating that the head is engaged.
These three measurements—dilation, effacement, and station—provide a snapshot of the labor process but do not reliably predict when birth will occur. During active labor, these digital exams may be performed every few hours to monitor the progression of the cervix. The information gathered, sometimes combined into a Bishop score, helps the medical team make informed decisions about intervention, such as recommending inducing labor.
Preparing for the Exam and Managing Discomfort
Preparation for a routine cervical exam involves steps to ensure the accuracy of the Pap test results. It is recommended to avoid scheduling the appointment during your menstrual period, as blood can interfere with the cell analysis. To prevent washing away or hiding potentially abnormal cells, you may be advised to avoid douching, using vaginal medicines, or having intercourse for two days before the procedure.
The physical sensation during a routine exam using a speculum is often described as pressure, which can sometimes be accompanied by mild cramping when the cell sample is collected. Patients can ask for a smaller-sized speculum or a plastic one, which is often warmer and may feel less intrusive than a metal instrument. Emptying your bladder right before the exam can also help relax the pelvic muscles and reduce discomfort caused by pressure.
For both routine and labor-related exams, managing anxiety and discomfort involves communication with your provider. You should not hesitate to request that the provider stop or pause the procedure at any point if you are experiencing pain. Focusing on slow, deep breathing helps to relax the muscles of the pelvic floor, which can make the examination smoother.
A technique some people find helpful is to cough or bear down, as if having a bowel movement, during speculum insertion or cell collection, which can serve as a distraction from the pressure. After any type of cervical exam, it is normal to experience some light spotting for up to 24 hours due to the manipulation of the cervical tissue.