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What is a pelvic exam and Pap test?
A pelvic exam and Pap test are cancer prevention screenings performed during a visit to your gynecologist to check for abnormalities or gynecological cancers. These tests are important to have done, as they can detect issues early — when they're most treatable.
Previously, gynecologists recommended getting a pelvic exam and Pap test once per year. However, since cervical cancer typically develops slowly, these guidelines have changed. Now, doctors recommend getting these tests done every 3 to 5 years, depending on your age.
Pelvic exams and Pap smear tests are typically performed during an annual well-woman exam. Pelvic exams are done to diagnose or detect signs of different gynecological conditions, including:
- Precancerous cervical changes
- Pelvic inflammatory disease
- Sexually transmitted diseases
- Gynecologic cancers
- Cysts such as ovarian cysts
- Uterine fibroids (these are typically benign tumors that develop in the uterus)
- Polyps (fingerlike growths in the cervical canal that are easy to remove)
While some conditions may be diagnosed during your pelvic exam, most will require additional testing for a specific diagnosis.
What happens during a pelvic exam?
During a pelvic exam, you'll go through three separate exams:
- External Exam: Your doctor will look at your vulva and the opening of your vagina for any discharge, irritation, warts, or cysts.
- Speculum Exam: A tool called a speculum is inserted into your vagina. When the speculum opens, it separates the walls of your vagina. If you’re getting a Pap smear or HPV test, your doctor will wipe a small sample of your cervical cells and send the sample to a lab for testing.
- Bimanual exam: Your doctor will put gloved and lubricated finger(s) into your vagina while pressing on your lower abdomen. This allows them to check the shape, size, and position of your uterus and for possible enlarged organs, tumors, or any tenderness or pain.
After your pelvic exam, your doctor will talk to you about any abnormalities they found. If you have a Pap test, your results won’t be available for a few days. If abnormal cell growth is detected, your doctor may recommend additional testing and you may need to have more frequent Pap tests in the future.
When should you have a pelvic exam and Pap smear?
A pelvic exam examines the vulva, vagina, uterus, cervix, pelvis, ovaries, and rectum. A Pap smear looks for abnormal cells that may develop into cancer.
How often you should have a pelvic exam and Pap test depends on your medical history and age. Doctors may also perform an HPV test. HPV is a sexually transmitted infection spread by oral, vaginal, and anal sex. While it can sometimes go away on its own, some HPV types can cause cancer.
Most doctors recommend the following:
- Age 21 to 29: A Pap test should be done every 3 years.
- Age 30 to 65: Both a Pap test and HPV test can be done every 5 years. Or you can have a Pap test alone every 3 years.
- Age 65+: You can stop getting these tests if you haven’t had abnormal cervical cells or cervical cancer and have had several negative test results in a row.
When do I need more frequent pelvic exams or Pap smear tests?
You may need more frequent pelvic exams or Pap tests if you:
- Have a history of abnormal Pap test results
- Have a family history of sexual health problems or cancer
- Have a history of cervical cancer
- Are HIV positive
- Have a weakened immune system
- Have a sexually transmitted disease (STD)
Do pregnant or menopausal women need to have pelvic tests and Pap smears?
Older women still need a well-woman exam and screening tests. Once you turn 65, you'll still need a pelvic exam, but likely won’t need a Pap test, unless you:
- Had a total hysterectomy to treat a precancerous condition or cervical cancer
- Had a serious cervical precancerous condition in the last 20 years
- Are high risk for developing cervical cancer because you have a weakened immune system
Pregnant women still have pelvic exams throughout their pregnancy. A Pap smear is usually done at the first prenatal visit to look for any cervical cell changes. This test poses no risk to the fetus. If an abnormal Pap test is detected, your doctor will discuss treatment options that are safe for both you and your baby. Additional Pap smears may be done throughout pregnancy if needed.
When to see a doctor
Whether or not you are due for a pelvic exam or Pap test, you should still see your gynecologist once a year. This routine visit is a good time to talk about any concerns you have about your period, menopause, sex, birth control, or any pain you’re having.