A vaginal or pelvic exam is a routine medical check used to assess the health of a person’s reproductive organs, including the vulva, vagina, cervix, uterus, and ovaries. This examination is performed as part of a general wellness check or to investigate specific symptoms like pelvic pain, unusual bleeding, or discharge. Understanding the position, preparation, and steps involved helps make the process more comfortable and less intimidating. Open communication with the healthcare provider about any anxiety or concerns ensures a positive experience.
Preparing for the Pelvic Exam
Before the examination begins, a patient is typically asked to undress from the waist down and put on a gown. A large sheet or drape is provided for privacy until the provider is ready to begin the exam. It is standard practice for a medical assistant or chaperone to be present in the room to support the patient and the healthcare provider.
The provider usually encourages the patient to empty their bladder right before the exam, which significantly improves comfort during the internal portion. An empty bladder allows the internal organs to be felt more easily and prevents unnecessary pressure. The patient should use this time to voice any concerns directly to the provider. This open dialogue ensures the provider can adjust their approach to accommodate the patient’s needs.
Understanding the Standard Examination Position
The standard posture used for a vaginal or pelvic exam is known as the dorsal lithotomy position. This position requires the patient to lie flat on their back on the examination table. The hips are positioned near the edge, and the knees are bent and spread apart.
The patient’s feet are typically placed into specialized supports called stirrups, which hold the legs in a flexed and abducted position. Stirrups may be simple footrests or boot-like supports that hold the entire calf. This arrangement is designed to provide the clinician with maximum visibility and direct access to the vulva and vaginal canal. The position allows the provider to conduct both the visual inspection and the internal checks efficiently.
The degree of hip flexion is usually around 90 degrees, with the legs abducted, or spread apart, at an angle of 30 to 45 degrees from the midline. Proper positioning ensures the vaginal opening is optimally aligned for the insertion of instruments. For improved relaxation, the patient’s head is often elevated slightly, which facilitates communication between the patient and provider during the examination.
Necessary Modifications and Alternatives
The traditional dorsal lithotomy position is not suitable for every patient, and alternative positioning options are frequently used to ensure comfort and accessibility. Patients with physical disabilities, severe arthritis, or limited hip and knee mobility may find the standard position painful or impossible to achieve. The healthcare provider should always inquire about a patient’s mobility limitations before beginning the exam.
Alternatives to the standard position include variations like the M position or the diamond position, which do not require the use of stirrups. The M position involves the patient lying on their back with feet flat on the table and knees bent. The diamond position involves the patient lying on their back with the soles of their feet together and knees dropped to the side. For patients who cannot lie on their back, the lateral recumbent position, or Sims position, may be used, where the patient lies on their side with one knee drawn toward the chest.
Specialized examination tables that can be lowered or have supportive obstetrical stirrups are available to accommodate patients with mobility challenges. These stirrups offer more support than traditional footrests, holding the entire leg in position. The goal is always to modify the position to maintain patient comfort while providing the provider with adequate access for a thorough exam.
The Procedural Steps of the Exam
Once the patient is correctly positioned, the examination begins with an external visual inspection of the vulva, checking the external genitalia for signs of irritation, lesions, or swelling. The provider then moves to the speculum exam, which is used to visualize the internal structures. A lubricated speculum, a hinged instrument, is gently inserted into the vagina, directed downward toward the patient’s lower back to follow the natural curve of the vaginal canal.
The speculum is carefully opened to separate the vaginal walls, allowing the provider to see the cervix at the end of the vaginal canal. The provider visually inspects the cervix and vaginal walls for abnormalities. If screening is needed, samples for a Pap test are collected using a small brush or spatula to gather cells from the cervix. Once visualization and collection are complete, the speculum is gently closed and removed.
The final phase is the bimanual examination, which involves the provider inserting two lubricated, gloved fingers into the vagina while placing the other hand on the patient’s lower abdomen. By pressing down with the external hand and pushing up with the internal fingers, the provider can palpate the size, shape, and position of the uterus and ovaries. This two-handed technique allows the provider to assess the internal organs for any tenderness, masses, or unusual size variations.