Are you guys ready to get awkward? I’m ready to go there. Today’s post is all about vaginas.
Yup. You read that right. Vaginas.
I want to share with you MY experience, not as a patient but as a nurse who assists with pelvic exams on a regular basis. I have friends and coworkers who are nurses who are trained to complete pelvic exams as well. They are called SANE nurses (sexual assault nurse examiner).
Before we begin, I’m all for education and I’ll break this down into basic terms as much as possible.
A pelvic exam is when a physician, nurse practitioner, physician assistant or a SANE nurse examine your bottom, external genitals or in proper terms, your vulva, cervix, ovaries, uterus, and Fallopian tubes. The women’s legs are up in stirrups and there is usually another nurse in the room assisting the provider. They may collect swabs and they will insert a tool called a speculum into the vagina as well. To palpate your your reproductive organs, the provider will insert 2 fingers into your vagina after the speculum exam is over.
(Fun fact, Carver is learning all about body parts and the difference between boys and girls. He calls the vulva the LAVA)
There is a lot of anxiety and fear and embarrassment associated with a pelvic exam which I am a FIRM believer that education replaces fear. So you’re about to get educated.
First of all, when preparing for your exam – you don’t need to prepare for your exam. Bring your genitalia as they are. Using a bunch of perfume or douching before your exam can mask signs or symptoms that need to be addressed/observed by your provider.
When you arrive at the office, you’ll visit with the provider before the exam. NOW IS YOUR CHANCE. Do you itch? Do you stink? Do you have discharge? Is sex painful? How are your periods? Do you have a new sexual partner? Would you like to be tested for STDs?
Tell them everything and anything that you are concerned with. There are certain swabs we can collect to diagnosis and help relieve your symptoms. There are certain signs to look for that can lead to a diagnosis. If we don’t know there is a problem, how can we look for it? Chances are, you only get this exam every year or so. Don’t wait. Speak up.
As women get older and go through menopause, there aren’t as many hormones in your body. Your vagina may not be as lubricated as it used to be, which can be uncomfortable or lead to painful intercourse. TELL YOUR DOCTOR.
Don’t be embarrassed. When we say we have seen it all and heard it all, we mean it. You would be hard pressed to bring up a concern or ask a question that hasn’t been asked before.
The provider will step out and allow you to get dressed into a gown or remove your bottoms. Take off your underwear! So many times I come back into the room after directing them to get undressed completely and they still have their underwear on and a tampon in. Take it all off/out.
The care team will return when you are dressed. There are always two people present when helping with a pelvic exam. There are several reasons for this. One to make sure that there are no accusations, misinterpretations, or maltreatment, or inappropriate comments, like a witness. Another reason is to assist. Swabs need to be handed to them in a certain order, they need to be placed in certain fluid after collected, the doctor may be doing a sterile exam and unable to touch certain instruments, etc.
This is a speculum. It is hooked up to a light source so we can see. There are different sizes, small medium and large for well small medium and large women!
The most IMPORTANT part of a pelvic exam – more comfortable for you AND easier for the doctor is to RELAX. We don’t just tell you that to calm you down, your vagina is a muscle and the more relaxed the muscle is, the easier it is to insert the speculum/fingers to assess what we need to.
The pelvic exam may be UNCOMFORTABLE feeling but it should not be PAINFUL. Big difference. If you feel PAIN during any part of the examination you MUST SPEAK UP!
This next chunk I stole word for word from Planned Parenthood’s website. You can find that link here: https://www.plannedparenthood.org/learn/health-and-wellness/wellness-visit/what-pelvic-exam
There are usually 3 or 4 parts to a pelvic exam:
1. The external exam — Your doctor or nurse will look at your vulva and the opening of your vagina. They’re checking for signs of cysts, abnormal discharge, genital warts, irritation, or other issues.
2. The speculum exam — Your doctor will gently slide a speculum into your vagina. The speculum is made of metal or plastic. It separates the walls of your vagina when it opens. This may feel uncomfortable or weird, but it shouldn’t hurt. Let your doctor know if it does hurt, because they may be able to fix the size or position of the speculum. If you’d like to see your cervix, just ask. You may be able to see it using a mirror.
Your doctor will then use a tiny spatula or brush to wipe a small sample of cells from your cervix. This sample will be sent to a lab for a Pap test to see if there is any pre-cancer or cancer in your cervix.
If your doctor or nurse is testing you for STDs (like chlamydia or gonorrhea) or other infections, they’ll use a cotton swab to take a sample of the discharge from your cervix. This sample will be tested.
(this is Kalissa now)
I don’t love that Planned Parenthood just brushed past “other infections.” There are infections that need treatment that are not labeled as STDs.
The vagina is an organ and is susceptible to bacteria just like any other body part. There are many infections like gardnerella, vaginitis, trichomoniasis, vaginal candidiasis that may or may not be sexually transmitted. It is just bacteria that made its way into your vagina and may or may not be causing problems.
Just because they are testing for bacteria, doesn’t mean that they think you have an STD which would be transmitted through sex and it DOESN’T mean you got it from someone else other than your husband/partner or that your husband/partner gave it to you.
(okay back to Planned Parenthood)
3. The bimanual exam — During this part of the exam, your doctor or nurse will put 1 or 2 gloved and lubricated fingers into your vagina while gently pressing on your lower abdomen with their other hand. This is a way to check for:
the size, shape, and position of your uterus
tenderness or pain — which might mean infection or another condition
enlarged ovaries, fallopian tubes, ovarian cysts, or tumors
4. The rectovaginal exam — Your doctor or nurse may also put a gloved finger into your rectum. This checks the muscles between your vagina and your anus. This also checks for tumors behind your uterus, on the lower wall of your vagina, or in your rectum. Some doctors put another finger in your vagina while they do this. This lets them examine the tissue in between more thoroughly.
You may feel like you need to poop during this part of the exam. Don’t worry, you won’t. This is totally normal and only lasts a few seconds.
To conclude this blog post, I’d like to share some final thoughts.
- We do NOT care how much hair you have.
- We do NOT care if you have an odor other than for diagnostic purposes.
- We WANT you to ask questions and bring up concerns.
- The more you relax, the more we relax.
- The more you talk, the more we talk.
- They might also do a breast exam.
- You can ask for a panty liner, pad, wipes, or new underwear – we have it! That lubrication we use on the speculum can get sticky/messy.
- ASK us to explain what we are doing! We try to but sometimes we forget! This is a very personal procedure and we want you to feel as comfortable as possible.
- I have seen dozens of bottoms in my life and when I say I truly don’t judge, I truly don’t judge. You see one, you see them all.
There you have it ladies (or men I guess…do men read my blog??)
Okay – had to check my analytics – about 20 men read my blog every day! HEY GUYS! Now you know what we go through when we got our lady exams!
Thank you for the education and the personal straightforwardness. Very informative.
I love this! As a OB nurse I find my myself saying the same things! I always tell my patients I know it’s uncomfortable but I promise I won’t remember what your bottom or breast look like. I also get mommas that I ask to take everything off and put on the gown and come back and they have their bra and panties on….we can’t have a baby wearing undies. ☺️ And we can’t do skin to skin per your birth plan if we have a bra on. I realize it’s a comfort thing but I also realize people knew as nurses we really don’t judge and we really won’t remember because we really see it all in nursing. Good topic!!
Thank you – most of us don’t get that kind of info from doctors or P.A.s Much appreciated.
Love and prayers
Like mother, like daughter! Love your frankness and honesty. Very informative. You will probably never know how many people you may have helped with this great post! Thank you.
I chuckled about LAVA. When my daughter was little, I asked her if she remembered the correct word for that part of her anatomy, and she beamed, “Yep – CHINA!”
Thanks Kalissa! Very well written and explained. Years and years ago I had a co-worker who, before every doctor’s appointment, would leave early from work, go home and take a bath so she wouldn’t feel embarrassed by “smell”. We used to laugh at her! She went on to have 3 more children and i doubt (at least hoped) she didn’t continued to do that! We are all different!
Thank you. It is important that women know this.
Having been a nurse in a busy OB GYN clinic in the inner city, I have to say this was very well written even if you took large parts of it from Planned Parenthood. I’ve had to walk many a young pt and older woman thought this. The older ones, may have been avoiding it due to history of rape and abuse. Good job!
Well written explanation–wish I knew all this when I was a youngster!
Do you guys get Pap smears every couple of years in the US? Here in Australia we do (it’s about to change to 5 yearly due to newer and better tests apparently). This is all covered during those exams and if you get them from about 18yo like most, pelvic exams aren’t really that unusual or taboo.
Excellent educational blog! As a retired nurse Kalissa is right we have seen it/ heard it all and we don’t judge. Please bring up any concerns and/or questions to your medical team. Remember the only “dumb” question is the one that is not asked.
Interesting to see what I used to have!! Since I had a complete hysterectomy at 40, I shouldn’t have any “inner” lady parts except my vagina. My NP told me I didn’t need a pelvic exam any more because there wasn’t anything there to check. Works for me!! It was never the highlight of my year to have my yearly exams and pap smears, but my doctor always made it comfortable for me. Love your bluntness…I wish every doctor/nurse would be just as blunt.
When my son was young, I wanted him to use the appropriate words for body parts. He pronounced vagina as Jonathan! I told him all ladies had them so the next time he saw his grandmother, he asked her if she had a Jonathan. She didn’t know what he wanted…lol! I finally had to explain it to her.
Great post! Very informative.
I don’t care if you see it, or if you’re going to forget about it. I will not forget. I do not want to be TOUCHED, I do not want to be invaded. I don’t want fingers or tools up there, I don’t care if you’re “just a doctor”. Just thinking about getting an exam causes me mental stress. Also not getting an exam causes me mental stress. But- No matter how much research and convincing I try to do for myself, I absolutely cannot. Will not.
It makes me feel extremely frustrated.
Why can’t I do it myself?
Why is there really no other way?
Why has this not advanced?