The Pelvic Exam: What Happens and Why

A pelvic exam usually takes just a few minutes, but many people feel anxious beforehand, especially the first time. Knowing what happens, and why, can make it much easier. You stay in control throughout.

When is a pelvic exam needed?

A pelvic exam isn’t automatically part of every gynecologist visit. The American College of Obstetricians and Gynecologists (ACOG) recommends exams when your symptoms or medical history call for one, and a shared decision between you and your clinician when you have no symptoms. The US Preventive Services Task Force has found insufficient evidence to recommend routine screening pelvic exams for people without symptoms.

Common reasons for an exam include:

• Unusual bleeding, discharge, itching or odor
• Pelvic pain or pain during sex
• Collecting a sample for a Pap or HPV test, which needs only the speculum part
• Inserting an IUD or fitting a diaphragm
• Checking on a known condition, such as fibroids or prolapse

You don’t need a pelvic exam to start the pill, patch, ring, shot or implant. Our birth control guide compares those options.

What happens, step by step

You’ll undress from the waist down in private and be given a sheet or gown. You’ll lie on your back with your feet in footrests, or with your knees bent and relaxed apart.

1. External exam

The clinician looks at the vulva for irritation, sores, cysts or other changes.

2. Speculum exam

A speculum, a smooth instrument made of metal or plastic, is gently inserted into the vagina and opened so the clinician can see the vaginal walls and cervix. If you’re due for screening, they use a small brush or swab to take a sample from the cervix. Most people feel pressure rather than pain. The speculum part usually takes a minute or two.

3. Bimanual exam

The clinician places one or two gloved, lubricated fingers in the vagina and presses gently on your lower abdomen with the other hand. This lets them feel the size and position of the uterus and ovaries and check for tenderness. Occasionally, a rectovaginal exam is also needed.

Making it more comfortable

• Empty your bladder before the exam.
• Ask for a smaller speculum, or ask whether you can insert it yourself.
• Ask them to explain each step before they do it.
• Breathe slowly and let your knees fall apart; tensed muscles make exams more uncomfortable.
• Ask for a chaperone, or bring a support person.
• Agree on a stop signal. You can pause or end the exam at any time.

Your rights during the exam

You have the right to know what’s being done and why, to say who is in the room, including students, and to withdraw consent at any point. A good clinician will welcome your questions. If you’re looking for someone new, our guide to choosing a gynecologist explains what to look for.

Frequently asked questions

Does a pelvic exam test for STIs?

Not by itself. STI testing uses swabs, urine or blood tests, which may be collected during the exam. Ask if you want testing.

Can I have a pelvic exam during my period?

Usually, yes, though heavy bleeding can affect some test samples. Call the clinic to ask whether to reschedule.

How often do I need one?

Only when there’s a reason. Your yearly visit doesn’t have to include one; see how often to see a gynecologist.