Hesperian Health Guides

The pelvic exam

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HealthWiki > A Health Handbook for Women with Disabilities > Chapter 6: Health Exams > The pelvic exam

A pelvic exam can help you know if:

  • 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.

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.

To the health worker:

WWD Ch6 Page 132-1.png

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.

a woman speaking.
A health worker at the clinic told me she could not do the exam because I could not get onto the table. So I asked her to do the exam on the floor.
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A speculum can be used upside down to examine someone on the 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.

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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.

IMPORTANT! If you examine a woman with a spinal cord injury, watch for signs of dysreflexia and be prepared to stop the exam. Dysreflexia is a medical emergency. The high blood pressure can cause seizures or bleeding inside the brain. Do not leave a person with dysreflexia alone.

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:

a woman on her back with her knees up and feet apart.
Women who have trouble with their hips may find this position easier. This position is good if there is no one to hold your feet, because many women can keep their legs in this position without tightening their muscles.

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Some exam tables have places for a woman's feet to rest. Many women with disabilities do not use these footrests.
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Some women use the footrests for support under their knees if they are unable to hold their knees up themselves.
a woman on her back with the soles of her feet together and knees bent apart; a health worker holds her legs.
This position works well for women who cannot move their legs on their own. It can also be good for women who have trouble bending their knees.
a woman on her side with one knee closer to her chest.
This position is more comfortable for women who have trouble separating their legs.

If you have stiff or tight muscles

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A friend or family member can support your legs during the exam. Then you can relax your muscles, which makes the exam easier.

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.
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You can also roll up a blanket or use pillows to support your legs.

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.

IMPORTANT! Do not massage or rub spastic muscles. Massage will make the muscles tighter.