By: Rachel Gelman
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.