SEXUAL HEALTH

Pelvic Exams and Pap Testing

What is it and why do it?

A pelvic exam is an examination that a healthcare provider performs to assess the health of your external and internal reproductive organs. It can be part of a general health assessment or be done if you are experiencing symptoms that are of concern to you or your healthcare provider.

Here are a few reasons why a pelvic exam may be done:

To detect infections that can cause symptoms like unusual vaginal discharge or pelvic pain. Early Diagnosis can help with getting treatment before serious complications arise such as infertility.
To help detect early stages of some types of cervical cancers (via a ‘Pap’ test)
To assess the size, shape, and consistency of the uterus, fallopian tubes, and ovaries.

A pelvic exam can include:

Visually/physically examining external genitalia.
Inserting a speculum into the vagina to visually examine the vaginal walls and the cervix (at this time a ‘pap’ test may be done as well)
STI tests when requested (which may coincide with the latter two actions).
Bimanual examination where the healthcare provider inserts gloved fingers into the vagina and presses on the abdomen to assess internal reproductive organs.

What is a ‘pap’ test? How is it different from a pelvic exam?

A ‘pap’ test is also commonly referred to as a ‘pap smear.’ It is done to screen for cervical cancer. It can be done during a pelvic exam. During the test, the cells from the cervix are collected using a q-tip swab. That swab sample is later “smeared” onto a microscope slide to check that cervical cells are normal and healthy, and not showing signs of cancer. Cervical cancer can be caused by some strains of HPV. That being said, a pap test is not the same as an STI test (besides, there are multiple types of STI tests that check for different types of STIs - i.e., urine tests, blood tests, swab tests, and physical examinations). STI tests can be requested during your pelvic exam, however. HPV testing can be done on the swab sample taken during the pap test, but it can also be done on a separate sample that is collected the same way as a Pap test.

To learn more about STIs and STI testing, check out our section on STIs.

When do I need a pelvic exam?

Anyone with a cervix sexually active or who are 21 years of age or older should have an exam (and a pap test) every 3 years. Also, anyone with a cervix who is experiencing pelvic pain, unusual bleeding, or unusual discharge (basically anything that signals to you that something doesn’t feel right with your external or internal reproductive system) can ask a healthcare provider to perform a pelvic exam.

Breast Self-Examination

A breast self-exam (BSE) includes both looking and feeling over the entire breast and chest area to check for breast cancers. As a general rule, it should be performed once a month and the best time to conduct an exam is about a week after the beginning of menstruating when the breasts are at their least swollen and tender. If something doesn’t feel or look right (i.e., pain, lumps/bumps, etc.), you would then reach out to a healthcare provider.

How to do a manual inspection:

Stand upright or lie down on your back.
For each breast, move the pads of your middle three fingers around the breast in a pattern, making sure to cover the entire breast area. Try different patterns, such as vertical, circular, or “spokes of a wheel.”
Most breast cancers are found in the upper, outer portion of the breast or in the area behind the nipple, so pay particular attention to these areas.
Be sure to inspect the areas around your breasts, including the region from the armpit to the collarbone and below the breasts.
If you began by standing up, lie down and repeat the same procedure. If you began by lying down, stand up and repeat the same procedure.

How to do a visual inspection:

Stand in front of a mirror with your arms by your sides and check your breasts for any changes in size, shape, or position. Note any dimpling or puckering of the skin, pushed-in or misshapen nipples, redness, swelling, or other irregularities.
Repeat the inspection with your hands on your hips.
Raise your arms over or behind your head, and turn to each side to inspect your breasts in profile.

Testicular Self-Examination

The best time to conduct a monthly testicular self exam (TSE) is after a warm bath or shower, then the skin of the scrotum is relaxed.

Here’s how to do it:

Standing in front of a mirror, inspect the scrotum visually for swelling.
For each testicle, hold the testicle between the thumb and fingers of both hands and roll it gently between the fingers. Look out for any hard lumps or nodules or for any change in size, shape, or consistency.
Feel the epididymis, a cord-like structure on the top and back of each testicle, noting any changes.

Toxic Shock Syndrome (TSS)

The tampon, diaphragm, sponge, and IUD are all associated with a risk of Toxic Shock Syndrome (TSS), a very rare but life-threatening condition that develops as a result of bacteria entering the body and releasing various toxins. If you are using one of these and you experience two or more of the following symptoms, seek medical attention immediately:

a sudden high fever (sudden high body temperature)
vomiting
a sunburn-like rash
diarrhea
fainting or feeling faint
muscle aches
dizziness
confusion

If using a tampon, diaphragm, or sponge, remove it immediately. An IUD must be removed by a healthcare provider. Menstrual cups and disks are NOT associated with TSS.

10 Steps to Condom Use

Here at the SHRC we advise that when using a condom, one should follow the 10 steps to correct condom use (yes, there are 10 steps!):

Check expiration date.
Check for air bubbles (i.e., there should be a bubble of air in the condom package to indicate that the wrapping has not been punctured and that the condom inside is likely intact). If you can squish and feel your fingers through the package or the package has a hole, do not use the condom.
Open the package carefully - do not use teeth or fingernails - and watch out for sharp jewelry.
Blow into tip. To determine the correct way to roll it down: if the edges curl up like a sombrero, things can get HOT, and you’re “Good to go!”; if the edges are curled under like a toque (Brrr!), you should probably CHILL OUT and try again.
Pinch the tip to allow enough room for the ejaculate and to eliminate the air bubble, and place the condom on the head of the erect penis/phallus.
Unroll to the base of the erect penis/phallus.
Lubricate (with water-based or silicone-based lube) and enjoy.
Following ejaculation, hold the base of the condom during withdrawal, and point the condom and penis/phallus downwards as you remove the condom to avoid spillage.
Tie a knot with the condom to keep the contents from spilling.
Dispose of the condom properly, in a garbage can. Condoms cannot be flushed and they should not be thrown in places where animals could consume them, such as in the woods/bushes, etc.