Women today have gynaecological examinations not only in consultation about gynaecological symptoms but when they’re quite well, as part of having regular Pap smears taken and as a routine measure in antenatal and postnatal care. Most women don’t like it, especially the internal (pelvic or bimanual) examination. Even women who’ve had several pregnancies and numerous examinations can’t suppress a grimace when they hear ‘Can I examine you now?’ or a sigh of relief when it’s finished.
It’s not that the examination hurts (though parts of it can be a bit uncomfortable). Modesty and embarrassment make women dislike this procedure. It’s hard enough to have to bare your genitals and have them scrutinised under a spotlight, but when someone (even someone who has professional licence to do so) touches your sensitive genitals and feels and puts things into your vagina – that really is going against the most powerful taboos of most women’s upbringing!
If you know your anatomy and know how and why each part of the examination is done, I’m sure it will be less intimidating and more comfortable for you, even if you’ve had examinations before. Whether it’s done by a women’s health or family-planning nurse, a midwife, your family doctor or a gynaecologist, the usual routine for a gynaecological check is as follows.
1 Your general and reproductive health history is taken if you’re a new client. If you’re known to the practitioner, you’ll just be asked what’s been happening since your last visit and the reason for the present visit.
2 Your blood pressure and weight are measured. Sometimes a urine sample is tested.
3 You’ll be asked to undress and climb onto an examination couch. You’re given a sheet to cover yourself (in winter a warmed blanket let’s hope).
5 You’re asked to bend your knees and move your bottom as close as possible to the end of the bed (some couches have leg rests or stirrups). Some doctors prefer you to lie on your side for the rest of the examination. Your nurse or doctor then inspects your external genitals. It is usually necessary to separate the labia so that the vestibule and the urethral and vaginal openings can be seen.
6 The interior of your vagina is inspected next. Because the vagina is usually collapsed like an empty balloon, a speculum is used to hold its walls apart so that your vaginal walls and cervix can be seen. If you’re due for a Pap smear, it’s taken now.
7 After the speculum is taken out, an internal (bimanual) pelvic examination is done. Your nurse or doctor puts two fingers into your vagina to lift up your cervix and hold it steady. With the other hand on your lower abdomen, the condition of your uterus and ovaries can be felt between the two hands, as well as any other swellings or tender spots in your pelvis. Don’t be alarmed if your doctor closes her eyes at times during this step: she’s concentrating on what she’s feeling. We call this ’seeing with the tips of the fingers’.
That’s it – five to ten minutes at the most.
What if you’ve never had sex?
If it’s necessary, the examination can be done using a very narrow speculum and perhaps only one finger in the vagina. If the opening in the hymen is very small or the patient very nervous, the bimanual can be done with two fingers in the rectum (back passage). Rarely, it may be necessary to examine a woman or young girl under anaesthetic.
*11/31/5*
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