Time to Cram for those Pap and Pelvic Exams!

In Pelvic Floor Physical Therapy by pelv_admin2 Comments

Pelvic floor dysfunction can lead to symptoms like pain with sex or urinary incontinence, which can have a negative impact on someone’s quality of life. Many patients seen at The Pelvic Health and Rehabilitation Center report pain with gynecological visits, primarily pelvic exams and pap smears. While few people jump for joy at the idea of spending their lunch break in stirrups, this examination is important for vaginal and reproductive health. Yet, even though most of us know it’s important, how many of us can actually say what this examination is for? Or what is going on once that speculum is in? This post will break it all down so that you can ace your next annual examination!

A pelvic examination usually has three parts. First, the provider will look at the vulva externally. (If you are asking yourself, what the heck is a vulva? Please check out this post on female anatomy.) A provider will also perform a bimanual examination where they insert two fingers into the patient’s vagina and at the same time, the provider may apply pressure on the patient’s lower abdomen with their other hand in order to assess the reproductive organs. At some point during a pelvic examination, the clinician may insert everyone’s favorite medical instrument, the speculum, to visually assess the cervix and the vaginal canal. If a pap exam is going to be performed, it will often happen at this time. However, a pap test is not always performed during a pelvic exam.

Fun fact, the technical medical term for a pap exam is Papanicolaou test, which for obvious reasons was shortened to Pap Test or Pap Smear–not like Noah’s Bagels, but because the cells that are being tested are literally smeared onto a microscope slide–more on that later. The test is named after Dr. Papanicolaou, although Romanian physician Dr. Aurel Babeș had been studying cervical cytopathology in women around the same time, yet somehow Babeș was left out of the name. Although, if you are ever in Romania they do refer to it as Methode Babeş-Papanicolaou. (Deep thought: I personally believe the exam would have better PR if it was called the Babes Test).

A Pap smear is an important test to assess if any precancerous or cancerous cells are present. The doctor may also screen for certain strains of the Human Papilloma Virus (HPV), which can lead to certain types of cancer. If you are unsure what tests the doctor is going to do, just ask. Typically, STD/STI testing is not a standard part of a pelvic or pap exam. Therefore, it is important to talk to your healthcare provider if you want additional testing, which may require a blood and/or urine sample. Ideally, your provider will ask if you want these tests performed, but if they haven’t brought it up, just ask. If you don’t feel comfortable asking your provider or want to know places to go, this site can help you out.

But let’s rewind. A pap exam is an important way to screen for cervical cancer. How does that happen? First, that fun and shiny speculum is used to open the vagina which allows the healthcare provider to have a clear view of the cervix. Then the provider uses a sampling instrument, which may look like a small brush, to remove cells from the cervix. The cells are sent to a lab for testing. According to the American College of Obstetrics and Gynecology (ACOG), it can take 3-7 years for cervical cell changes to become cancer, which is why testing is so important to allow for early detection.

Ok, so how do I know if I need this test or how often to get it? According to US Preventative Services Task Force (USPSTF), if you are between the ages of 21-29, you should have a pap exam every three years. If you are 30 to 65 years of age they recommend either: screening every three years with a pap exam alone,  every 5 years with HPV testing alone  or every five years with a pap exam and HPV testing (co-testing)  . Anyone over 65 years of age may not need a pap exam if they have had either three negative Pap test results in a row or two negative co-test results in a row within the past 10 years. A person still needs to be screened even if they received the HPV vaccine and/or they had a hysterectomy but still have a cervix. A person may need more frequent testing if they have a weakened immune system, a history of cervical cancer or other comorbidities. If you are unsure if you need a pap exam, ask your healthcare provider.

Even if you are not due for a pap exam, an annual well woman examination is still recommended by ACOG. During the visit you can discuss birth control options, preconception planning, vaccinations and other issues relating to your reproductive health. This appointment would also be a good opportunity to talk to a provider if you are experiencing any issues relating to urinary or bowel function, pelvic pain or sexual dysfunction, such as pain with sex. It can sometimes help to go to these appointments with any questions or concerns written down.

Again, these examinations are an important part of managing one’s health. While a pelvic examination and pap test may not be what some consider a fun time, it shouldn’t be painful. If you experience pain or discomfort with the examination,  are unable to have the exam or avoid having it due to pain, talk to your healthcare provider. Pelvic floor dysfunction may be a contributing factor, and your provider may recommend pelvic floor physical therapy as a treatment option so that you are able to get this essential exam.













What are pelvic floor muscles?

The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.

What is pelvic floor physical therapy?

Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.

What happens at pelvic floor therapy?

During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.

What is pudendal neuralgia and how is it treated?

Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.

Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.

What is interstitial cystitis and how is it treated?

Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.

Who is the Pelvic Health and Rehabilitation Team?

The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.

How many years of experience do we have?

Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.

Why PHRC versus anyone else?

PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.

Do we treat men for pelvic floor therapy?

The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.

Do I need pelvic floor therapy forever?

The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.


  1. Hi Rachel,

    I’m reaching out about your blog post, “Time to Cram for those Pap and Pelvic Exams!” which mentioned the U.S. Preventive Services Task Force’s recommendation on screening for cervical cancer.

    The post stated that the Task Force recommends that women 30-65 years of age are screened “every three years with a pap exam alone or every five years with a pap exam and HPV testing (co=testing).”

    I wanted to clarify that there are actually three different options for this age group, including: every 3 years with a Pap test alone, OR every 5 years with HPV testing alone, OR every 5 years with HPV testing in combination with a Pap test (cotesting).

    Given the above, would you be willing to update the recommendation in the blog post, so readers have a clear understanding of the different options? Please let me know if you have any questions or would like to discuss.

    Thank you!
    Lauren Bauer
    USPSTF Media Contact

    1. Author Rachel Gelman says:

      Thank you for your feedback, the blog was meant to be a summary of the recommendations, hence why the link to the full recommendations was included. However, I went ahead and added in the third recommendation to ensure clarity for our readers. Thank you for reaching out and taking the time to read the post!

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