Hesperian Health Guides
The pelvic exam
HealthWiki > A Health Handbook for Women with Disabilities > Chapter 6: Health Exams > The pelvic exam
- you have any lumps, swelling, or sores, around your genitals. Some of these could be dangerous and may need treatment.
- you are pregnant.
- you have an infection in your womb, tubes, ovaries or vagina. Untreated infections are dangerous.
- you have cancer of the cervix, ovaries, or womb.
- you have other problems in the womb or the ovaries, such as fibroid tumors, endometriosis, or cysts that are not caused by cancer.
Contents
If you limp when you walk, or use a cane, crutch, or a wheelchair
If you have difficulty moving your body, you will know best how to move from one position to another. Ask your friend or the health worker to help. Before the pelvic exam begins, make sure you are well-balanced and feel safe and comfortable. (See “Positions for a pelvic exam” for some ideas.)
Before the exam, try to pass as much urine and stool as you can. The pelvic exam can easily make the muscles relax and cause urine and stool to come out. If you wear a catheter all the time, you do not need to remove it. It will not affect the exam. If you have a urine bag tied to your leg, remove it and place it either beside you or across your belly. Make sure the tube does not bend, and that it continues to drain properly.
Steps of the pelvic exam:
- The health worker will look at your outer genitals for any swelling, bumps, sores, or changes in color.
- Usually, the health worker will put a speculum into your vagina. A speculum is a small metal or plastic tool that holds the inside of the vagina open. She can then examine the walls of the vagina and the cervix for swelling, bumps, sores, or discharge. You may feel slight pressure or discomfort with the speculum inside, but it should not hurt. The exam is more comfortable if your muscles are relaxed and your bladder is empty.
- If the clinic has laboratory services, the health worker should do a Pap test for cancer and, if needed, tests for STIs. To do a Pap test, the health worker uses a small, rounded stick to scrape a bit of tissue off the cervix. This is not painful. You should feel only a little pressure. The sample of tissue is sent to a laboratory where it is checked for signs of cancer. If cancer of the cervix is found and treated early, it can almost always be cured.
- After the health worker removes the speculum, she will put on a clean plastic glove and put two fingers of one hand into your vagina. She will press her other hand on your lower belly. In this way she can feel the size, shape, and location of your womb, tubes, and ovaries. This part of the exam should not be painful. If it is, tell her. It may mean something is wrong.
- For some problems, the health worker may need to do a rectal exam. She will put one finger into your anus and one finger into your vagina. This exam can give the health worker more information about possible problems of the vagina, and of the womb, tubes, and ovaries. The rectal exam will be easier if you push against the health worker’s finger when it first touches your anus—as if you are passing stool. This will relax the muscles around your rectum so the exam is less uncomfortable.
To the health worker:
In many clinics and hospitals, exam tables are high and hard to use for women who have difficulty moving their legs or holding them in place.
Tables closer to the ground are best for most women with disabilities. But you do not need to use a special table to do a pelvic exam. A health worker can do this exam on any clean, firm surface—even on a clean cloth on a clean floor.
To examine someone on the floor, turn the handle of the speculum so it faces up when you put it into the woman’s vagina. Otherwise the speculum will be hard to open. To make sure the speculum does not touch the floor, put some folded cloth under the woman’s hips to lift them a little.
Many women are frightened when they first see a speculum. They imagine that it must hurt them when it is put inside their vagina. When you examine a woman who has never had a pelvic exam before, show her a very small speculum, even if you plan to use a larger one. Make sure she is relaxed, touch her gently, and always explain what you are about to do. When the exam is finished, thank her for making it so easy for you to do the exam.
See more suggestions about making exams easier for women with different disabilities.
Take precautions to prevent dysreflexia (sudden high blood pressure with pounding headache)
Dysreflexia is common in people with spinal cord injuries. It is the body’s reaction to something that would normally cause pain or discomfort, but which the person does not feel because of the injury. During a woman’s pelvic exam, dysreflexia can be caused by:
- a woman’s body touching a hard exam table or surface (even if she cannot feel it).
- pressure in the vagina or rectum from the hands of the person doing the exam or from an instrument (such as a speculum), especially if it is cold.
- cold temperature in the clinic where the exam is being done.
- a urine tube (catheter) that has become bent or twisted.
Positions for a pelvic exam
If you cannot separate your legs easily, this does not mean you cannot have the exam. Talk to the health worker about different positions that will work for your body.
Here are some positions many women with physical disabilities use:
If you have stiff or tight muscles
Muscles can suddenly get tight and stiff during an exam. This happens mainly to women with a spinal cord injury or cerebral palsy. Sudden muscle spasms can happen when:
- you move onto an exam table.
- you are in an uncomfortable position.
- an instrument such as a speculum is put into the vagina.
- a health worker puts her fingers in the vagina or anus, as with a ‘bimanual’
or rectal exam.
If you have tight muscles, ask the health worker to go slowly so you have more time to relax. If a spasm happens during the exam, ask the health worker to stop and wait until your muscles are relaxed or soft again. Do not pull or push directly against the tight muscles. This will make the spasm worse. A friend can gently hold or support the affected place until the muscle is soft again.
The exam will be easier if you can find a comfortable position where you can relax and do not have to make your muscles tight to hold yourself in place. Or ask a friend or family member to help hold your body during the exam. If this is not possible, you can roll up blankets and put them underneath your knees.