How Doctors Evaluate the Pelvic Floor
During a pelvic examination, a doctor inspects the vulva, vaginal opening, cervix, ovaries, uterus, and rectum for any signs of cervical cancer, and may administer a Pap test to further confirm a diagnosis. To test for weak pelvic floor muscles, a healthcare provider might insert a finger or two into the vaginal, urethral, and anal openings, asking the patient to squeeze gently, then let go and rest for three to eight seconds.
External and Internal Visual Exams
An external visual exam allows the doctor to detect abnormalities in the vulva, vagina, cervix, uterus, ovaries, rectum, and pelvis, often as part of a routine checkup, and it may include a Pap smear if it's been a while since the last one, or if the patient is at risk for certain sexually transmitted infections. A speculum is used to open the vagina so the vulva and cervix can be seen clearly. A doctor may also perform a bimanual exam, inserting two fingers into the vagina while using the other hand to feel the lower abdomen for changes in the size or position of organs, and a rectal exam to check for tumors or other anomalies. Because pelvic exams can be invasive and uncomfortable, a good provider explains each step and stays open to any concerns the patient raises.
An internal visual exam inspects the vulva, cervix, and fallopian tubes for abnormalities or swelling using a lubricated speculum. While the pressure can be uncomfortable, it shouldn't cause pain. This part of the exam can reveal cysts or other signs of infection not visible externally, and it can also help detect cancerous growths in the fallopian tubes. Both OB-GYNs and pelvic floor physical therapists (PFPTs) perform pelvic exams to evaluate reproductive health and will review findings and next steps with the patient afterward.
The Physical Examination
A physical examination checks the pelvic floor, vulva, vagina, cervix, uterus, fallopian tubes, and ovaries for potential gynecological issues such as abnormal bleeding, sores, or cysts. The provider first inspects the vulva for signs of inflammation such as redness, swelling, or sores, then inserts a speculum to widen the vagina and take a cell sample for a Pap test. The provider may then palpate the pelvic floor muscles with one or two gloved fingers to feel for pain, tenderness, elasticity, and tone, sometimes using lotion to reduce discomfort.
What a Pap Smear Detects
A Pap smear tests for precancerous cells in the cervix and can help detect cervical cancer at an early stage. It can also detect other sexually transmitted infections, such as human papillomavirus (HPV); for women 30 and older, an HPV test may be substituted for a Pap smear. Scheduling a Pap smear about five days after menstruation ends is recommended, since heavy flow can make it harder to obtain an accurate cell sample. The doctor uses a speculum to open the vagina and examine the cervix, then collects cells with a brush or spatula, most women feel some pressure or irritation during scraping, and mild bleeding or cramping can occur afterward.