Ep. 71: Advocacy in the Dr.’s Office: Pelvic Exam

Welcome back to the Woven Well Podcast! 

Today we’re going to talk about pelvic exams: what they are, how they help, and how you can make it as comfortable of an experience as possible! 

This is a part of an ongoing series we offer called Advocacy in the Doctor’s Office. Last year we had an episode that focused on how to Ask Good Questions in the Doctor’s Office and earlier this year we released an episode about advocacy related to transvaginal ultrasounds. Both episodes were big hits, and I think I know why: Advocacy is incredibly important. We believe that at Woven Well. 

And here’s why it’s so important: You are an incredibly valuable human being, deserving of the utmost respect and care. Not because you’ve done anything amazing, or have a beautiful face, or an impressive job title. You are worthy of respect, because God deemed it so. You were made in God’s very image. And, as a child of God, you are infinitely (eternally!) valuable. 

Unfortunately, not everyone seems to understand this - and it can affect how they interact with us. It’s not always intentional, in fact, I’d say most of the time it’s totally unconscious - but missing that critical foundation that each human is worthy of respect because of God’s love for them can cause them to simply overlook someone, treat them roughly, doubt the importance of their words or experience, or prioritize being quick, instead of being kind.

Advocacy helps prevent these unintentional slights on our valuable personhood. 

How we advocate for ourselves can help us be treated with that dignity and care that we deserve. 

And so even though it can sometimes feel foreign to us to do that, it’s worth it!

Now, before we jump in, I’ll go ahead and mention that everything we go over today will be outlined in our printable resource on our website. You can also find our resources on asking good questions and transvaginal ultrasounds there, and all of these resources are totally free. We’ll link it in the show notes but you can find it at wovenfertility.com/resources. 

Ok let’s start with this basic question: What is a pelvic exam? 

A pelvic exam is a an exam that reveals any abnormalities of the vulva, vagina, cervix, ovaries, uterus and sometimes rectum. It’s done in a doctor’s office or health clinic and the only tools involved for the pelvic exam itself are a speculum, a light, and the medical provider’s hands. 

Although often completed at the same time, a pelvic exam is different than a pap smear. A pap smear checks the cervix for cancerous or pre cancerous cells by using a small tool to quickly scrape away some cells for testing. 

Pelvic exams and pap smears are a part of routine gynecological health care to help prevent larger issues from developing. Your doctor may also recommend a pelvic exam to help diagnose specific issues like ovarian cysts, STIs, uterine fibroids, and even cancer. If you have unusual spotting or pelvic pain, for instance, a pelvic exam may be suggested. 

Currently, pap smears are recommended every 3 years and pelvic exams every year - but keep in mind that often times that has more to do with when insurance companies will cover the exam than when the patient actually needs one. How often you get one should be based on medical and family history. But, keep in mind that it is preventative! So it’s okay to have them yearly, if need be. 

Now, many women think of these yearly exams as a real hassle. And I’m not here to say they’re necessarily “fun.” But I do think there are small things that can be done to make them a better experience, and we’re gonna talk about those today. Some are very practical and some are for those who are brand new to exams, more alert to the situation, or feeling nervous or anxious about the experience. 

I’m going to share them all, and if you find some that are helpful to you, great! Please make use of them! But you don’t have to use them all. Totally up to you. 

Okay, here we go! 

Let’s start with a common question: Can you get a pelvic exam done while on your period? Each medical provider may have a different preference, but pelvic exams generally can be done on period days. Ideally, it wouldn’t be a heavy day of your cycle, but you can call beforehand to find out your doctor’s preference about period flow.

When it comes to the exam, I think prepping for the best possible experience actually starts before you walk into the room. If at all possible, it will help if you’re not rushed, you have all the documents you need, and know what to expect as far as payments go. That’s because stress causes tension, and tension causes tense muscles. If there’s one thing that makes a pelvic exam uncomfortable, it’s tense pelvic floor muscles. So being as relaxed as possible as you arrive is the first step to helping everything go well from there! 

Confirming the medical provider you’ll see ahead of time also helps ensure the best pelvic exam experience. If you go to a practice that has more than one medical provider, it’s possible that they’ll have the NP, PA, or another OBGYN do the exam if your doctor isn’t available. You can decide beforehand if you’re comfortable with this or not. If you are, no worries. You can be flexible about whomever walks into the room. But I have many clients who prefer that exams only be done by the provider they’re familiar with, or by a provider of a preferred gender. You absolutely have the right to request that your doctor be a female, for instance. And if she walks in the room and has a male medical student in tow that you’re not comfortable with, let ‘em know. You get to decide who’s in the room with you. 

And that goes for someone you may choose to bring along, too. 

Many mothers choose not to bring their children. In fact, your office may not allow children in the exam rooms, because it can sometimes make it challenging to relax and focus on the questions when children are present. But you may choose to bring along your spouse, a family member, or someone else you trust. I’ve had women say before, “But won’t that seem weird to the nurses?” First, no, it won’t. But second, who cares? This is about making this experience the most comfortable for you. And if that means having your husband or mom or anyone else in the room, go for it!

Once you get in the room, the nurse will usually take some vitals, ask a few questions, and then ask you to change out of all clothing and cover yourself with a very thin, very breezy paper cover. It could be one or two pieces. If it’s two pieces, it’ll be a vest that you wear opening in the front, and a paper sheet to go across your legs. 

Now there are some clinics that do this differently! Bella Wellness, which is restorative health office in Denver CO, recently posted on Instagram about how their rooms all have robes in them for this time, and I was so impressed. All offices should consider something like this!! But, for most of us, it’s best to prepare to where a paper towel. If you’d like to have some article of clothing on, you can consider socks or possibly a loose skirt, if either make you feel more comfortable. 

You’ll sometimes be sitting in that paper towel for quite a while, so you may choose to bring along a book or something to keep you occupied and at ease until they come in. This is about the time you’ll be tempted to suddenly think about all the places that haven’t been shaved, but do not! They do not care. They’ve seen everything, everything before. They don’t give it a second thought. 

When the doctor comes in, let him/her know if you have any questions for after the exam. You totally have the right to ask your questions when fully clothed, if you prefer. 

If this is your first time meeting them, they’ll usually ask a question or two to get to know you. I think this is great! Ask any friendly questions you may have, too! 

As you get closer to the exam, it’s totally fair to ask that your provider let you know what’s happening every step along the way before it happens, even asking for permission before moving on to the next step. This is a small ask for these medical providers. They’re only doing a few things during the exam. It really takes mere minutes, and these requests add almost no time. But the difference it may make in your experience for you to know ahead of time and feel comfortable and relaxed may make a difference in how you feel about future exams to come. 

When it’s time for the exam, they’ll ask you to slide way down on the table, so that your backside is almost hanging off the end of the table. You’ll stick the heels of your feet in funny table arms called stirrups, and have the paper towel wrap covering your legs. 

Earlier I mentioned the tools involved in a pelvic exam: a speculum, hands for a manual exam, and oftentimes a light. A speculum is a tool used to open the walls of the vagina in order for the medical provider to get a clear view of the cervix. There are a lot of different types of speculums: they can be made of metal or plastic, and come in a variety of sizes. You can let them know if you prefer metal or plastic, or even a smaller size. They will even have pediatric sizes! It is totally fine for you to let them know your preference, and they can provide it for you. 

Remember how earlier we talked about keeping things loose? The less tense, the better? This is the point where that can really make a difference.  If you’re feeling nervous and tense, it can make it more difficult, but there are some tricks you can follow, too. Try taking deep breaths, and keeping your facial muscles relaxed. Relaxed facial muscles actually help your pelvic floor muscles relax, too. 

You can also gently push your backside against the table. This also helps prevent tension in those muscles. The more relaxed, the easier it will go. But to help even further, they’re gonna put a generous amount of lubricant like KY Jelly on the speculum to help things go smoothly. 

When the speculum is opened, it can feel like a mild pressure around the vaginal opening and internally in the vaginal canal. This is okay and normal. Take deep breaths if this sensation is new to you. The insertion of the speculum is really when the pelvic exam gets real, but unless you’re doing a pap smear, it’s also a pretty quick process. 

If you are having a pap smear, this is when they’ll insert a thin tool to scrape a few cells from the cervix. Some women feel nothing, others feel a mild cramping. This should not be a really painful experience! Otherwise, they’ll usually just take a look at the cervix with the light to makes sure all looks normal, the speculum will then be removed, and they’ll move on to the manual part of the exam. 

Remember, it’s totally your right to ask that they let you know when they’re moving from one thing to the next, that they tell you what they are about to do next, or even that they ask for your permission before doing the next step. If you’d like to take a few deep breaths before any step, you can. You are not inconveniencing them. 

At this point, they’ll move on the manual part of the exam. The medical provider will use two fingers internally and their other hand externally to feel the size of reproductive organs like your uterus and ovaries. This should not hurt or cause discomfort, so if you feel tenderness or pain, let them know. Tenderness could be a helpful symptom for diagnosis. 

Some doctors will then repeat this process in the rectum to feel for any growths or abnormalities. You can ask your doctor ahead of time if this will be done, but they usually give you a heads up about this one. Just like the others, this should not be painful at all. 

Then, congrats! The pelvic exam is done! The entire thing may only take 5-10 minutes. And if at any point in the process, you want to stop - You can tell them, and they will. 

Pelvic exams can feel intimidating. The first time you have one, it can be a nerve wracking experience because it’s so new and unknown. 

If you’ve had a negative experience, it may make them feel especially scary or overwhelming. We hope that these tips can provide some support in whatever scenario you find yourself in, so that you can feel prepared, equipped, and able to advocate for your comfort. 

Remember that if you’d like a written form of all these tips, we’ve already got it ready for you! We have that available as a free resource on our website at wovenfertility.com/resources. I invite you to check it out. 

We’ll be posting about it on our Instagram page, as well @wovenfertility.

You are so incredibly valuable. Who you are as a person and a woman can never be replicated. You are intimately known and loved by God, who designed you with beauty and intention. 

Your body matters. Your experience matters. Your comfort matters. 

I hope you feel these things deeply today. 

As always, thanks for listening as we continue to explore together what it means to be woven well.