What To Expect During a Well Woman Exam
A monthly self-breast exam is no longer suggested, but young women should be familiar with the tissue of their breasts (breast awareness) and immediately report any changes or problems to their health care provider. Breast awareness involves periodic and consistent self-breast exams and maintaining an awareness of how your breast tissue normally looks and feels.
When performing a self-breast exam, be aware of “red flags.” The following conditions warrant prompt attention from your health care provider:
- A lump that has not been evaluated
- Changes in a breast lump, such as size
- Red, swollen or flaky skin on any area of the breast
- A nipple that is painful or becomes inverted
- Any fluid that is leaking from the nipples (if not breastfeeding)
- Any skin dimpling
- A lump or changes in skin under the arm
Pelvic, Speculum & Bimanual Exams
The Pelvic Exam
The pelvic exam is actually a short and simple procedure. Apprehension is understandable, but there is no need for embarrassment or self-consciousness during this exam. Remember that the clinic’s health care providers are women and health care professionals who perform these routine pelvic examinations on a regular basis and understand your feelings. Please feel free to discuss any concerns with your provider before and during the exam. Your provider will work to make the exam a more pleasant experience.
Before the exam, please do your best to empty your bladder. As the actual exam proceeds, you will be asked to bend your knees and place your feet in footrests. The first part of the exam involves a brief examination of the external area. The provider will look for any external signs of problems, including abnormal bumps or rashes. Please make the provider aware of any bumps or rashes that you have recently noticed.
The Speculum Exam
As the examination continues to the second part of the pelvic exam, a speculum will be used. A speculum is used to gently separate the vaginal walls allowing for better visualization of the cervix (the opening of the uterus). The speculum comes in several sizes to accommodate the different sizes of vaginal openings (even the virginal). The provider will insert a warmed speculum into the vagina, causing a feeling described as one of pressure.
During this insertion of the speculum, the provider will visually examine the cervix and take a few cells for a Pap test. To do this, she will use a small, flexible plastic broom and a small cervical brush (like a mascara brush).
The Pap test screens for abnormal cells that may become pre-cancerous cervical cells. Most results are back within one or two weeks. For abnormal Pap tests, you may be scheduled for follow up and treatment with a gynecologist.
The Bimanual Exam
After the speculum is removed from the vagina, examination of the uterus and ovaries complete the exam. The provider will insert one or two lubricated, gloved fingers into the vagina and will locate the cervix with the tip of her finger(s). Using her other hand, she will press firmly on the abdomen, right above the pubic bone. During this procedure, known as a bimanual exam, the provider is determining the size, shape and consistency of the cervix, uterus and ovaries. As with the insertion of the speculum, this can also feel like pressure. Please notify the provider of any pain experienced during the exam.
After Your Exam
After the exam, you will be given privacy to get dressed. The provider will come back and give you time to ask any additional questions about the exam findings. Any abnormalities noted during your exam and any possible treatments/referrals will be reviewed with you. The provider may prescribe medication(s) at this time, and will instruct you on their use. Contraceptive options and medication refills may also be discussed.
A follow-up appointment will be scheduled so that your results can be reviewed and possible options for further follow up/referrals discussed.
Note: Rectal exams are not a routine part of a well woman exam in women younger than 50. The provider will discuss any further examination that might need to be performed.
Regarding Abnormal Results:
- Patients with findings of Atypical Squamous Cells of Undetermined Significance (ASC-US) will be counseled to have repeat Pap tests in six months and 12 months. If either of the follow-up tests is positive, the patient will be referred to gynecology.
- Patients with findings of Low-grade Squamous Intraepithelial Lesion (LSIL) or High-grade Squamous Intraepithelial Lesion (HSIL) will be referred to gynecology.
- Patients with findings of Atypical Glandular Cells (ACG) will be referred to gynecology.
- Patients with positive HPV DNA testing will be referred to gynecology.