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There is a lot of confusion about when to get a pelvic exam and what happens when you do. Hopefully this short video clears that up.

 Introduction (0:00)


Today I'm getting a pelvic exam. Dr Blake gave us permission to film the whole thing, so that you know how to prepare, what to expect and when to come back.

In 2014, the American College of Physicians determined that annual (once a year) pelvic exams were doing more harm than good. Their vote was appointments as needed, as in if the person was pregnant or experiencing symptoms of a problem.

Whereas the American Congress of Gynecologists and Obstetricians insist that gynecology appointments are important, because it allows them to connect to patients, on sexual challenges, STIs, birth control, gender identity and sexual orientation.

[Dr Blake] Okay Lindsey, we're ready for ya.

 Preparation/The Appointment (0:41)


[Dr Blake] So you're here for your pelvic exam today.

[Dr Doe] Yes.

[Dr Blake] So normally I would get a sexual history, past medical history, that sort of thing, but I know you're just here for the exam, so why don't we just go ahead and move on into that.

[Dr Doe] 'kay.

[Dr Blake] So I'm going to give you a gown, I'll have you undress, gown opens to the back...

[Dr Doe] Okay.

[Dr Blake] and then there is a sheet right here, you can just unfold it and drape it across your lap, have a seat on the table and I'll be back in a couple minutes.

[Dr Doe] Awesome! 

I prepared for this, here's how you would do it. Shower, groom depending on preference, preferably schedule it when you're not menstruating, put nothing in the vagina - no products, penises, toys, et cetera for 24 hours prior to the appointment, bring a list of questions to ask and a friend or relative for moral support.

One more thing you can do before the appointment is to masturbate. You can also touch yourself during it, just don't jostle things about - this is going to open up the vagina, create more lubrication and relax you.

 The Table (1:33)


[Dr Blake] You ready?

[Dr Doe] Ready.

[Dr Blake] Right, so feet there,

[Dr Doe] Stirrups in.

[Dr Blake] Which, by the way, I don't like to call them stirrups, because you're not a horse.

[Dr Doe] Oh. What do you like to call them?

[Dr Blake] I call them foot-holders.

[Dr Doe] Okay, so you don't call them stirrups, you call them foot-holders, because I'm not a horse.

[Dr Blake] I do. Yes, lots of people call them stirrups. I will occasionally probably slip up and say that, but I try not to.

[Dr Doe] That's so nice of you!

[Dr Blake] Go ahead and lay down.

[Dr Doe] Scoot all the way down.

[Dr Blake] Scoot all the way down until it feels like you're falling off the table.

[Dr Doe] Success! Okay.

[Dr Blake] I'm gonna raise you up a little bit, so I don't want you to get off the table quickly, 'cause you will be higher than you think you are.

[Dr Doe] Okay. Haha hoohoohoo!

 The Exam (2:15)


[Dr Blake] All right, so I've got the speculum here, a little light that goes inside of it.

[Dr Doe] Sweet.

[Dr Blake] Then I'll put a little bit of water-based lubricant on it. This does not mess up Pap results, some people may say otherwise, but it's okay.

[Dr Doe] Okay.

[Dr Blake] Just to make things more comfortable for ya, so go ahead and lay on down, and slide your knees out to the side and you'll feel me touch.

[Dr Doe] His hand is going down my thigh, and now it's on...

[Dr Blake] Right, so I'm gonna look at the outside here, and you'll just feel some pressure and some cold - this is the speculum.

[Dr Doe] Ahh...

[Dr Blake] Doing okay?

[Dr Doe] Yeah. It's like somebody is flicking me, my vagina, and it's a little tiny bit cold and there's like a tiny little pinch, like somebody is pulling on a leg hair or something like that.

[Dr Blake] So I can see your cervix, it looks healthy and normal. So this is our Pap brush, and we basically use it to scrape a few cells off your cervix, to see if there are any abnormalities.

[Dr Doe] Okay.

[Dr Blake] Sometimes it feels a little crampy.

[Dr Doe] Okay.

[Dr Blake] Ready?

[Dr Doe] Crampy...

[Dr Blake] Is it feeling crampy?

[Dr Doe] Yeah.

[Dr Blake] Doing okay?

[Dr Doe] Uh-huh. So that feels like... a menstrual cramp.

[Dr Blake] Yeah. But not super painful.

[Dr Doe] No. Very localized.

[Dr Blake] And that's it.

[Dr Doe] Okay.

[Dr Blake] So then what I do is I stick it over here, knock all the cells off, and then we send that to the lab.

[Dr Doe] Okay.

[Dr Blake] And that's it. So then...

[Dr Doe] The exam is over!

[Dr Blake] The exam is over. And this comes out... Sometimes a little crampy, and you can go ahead and push yourself up. Don't get off the table.

[Dr Doe] That was so fast.

 Final Discussion (4:19)


[Dr Blake] And we can talk about this more in a little bit, but again, the other thing that potentially could happen is the bimanual exam, which is two fingers in the vagina, pushing on the abdomen. I don't routinely do that.

[Dr Doe] Because?

[Dr Blake] Because it depends on who you talk to, but the American Academy of Family Physicians, and I'm a family physician, says that there's not really any benefit for just a routine screening - it's not very sensitive, in terms of finding abnormalities, and it's uncomfortable and invasive. So, why do it if it's not gonna help us?

Now, if you're having symptoms of, you know, abnormal menstrual cycles, pain, then it may be worthwhile to do, 'cause then you're actually looking - is there something wrong with the uterus? Is there a cyst on the ovary? But just as part of the routine screening, it's not something I usually do.

The other thing I would tell you is, when we scrape your cervix, sometimes there is a tiny bit of bleeding, so you may have a little bit of spotting, but it should be very small.

[Dr Doe] 'kay.

[Dr Blake] I will step out and let you get dressed.

[Dr Doe] Awesome.

The next episode, I ask Dr Blake a lot of your questions, so stay curious.

 Extra (5:24)


[Dr Blake] You're very small, so I'm using the small speculum.

[Dr Doe] What if my vagina is big, though?

[Dr Blake] Then I'll... go get a different size. It's been known to happen.

[Dr Doe] (laughter) Okay, note: small person, potentially small vagina.