As a woman, regular visits to the obstetrician/gynecologist are an important way to establish a long-term, trusting relationship with your clinician. They are also an opportunity to regularly review your medical history and evaluate your current health through various screenings, including a breast exam, mammogram or pelvic exam.

Despite recent headlines from the American College of Physicians (ACP), a screening pelvic exam as part of your well woman visit is important for women both with and without symptoms. While a pelvic exam and/or breast exam may be moderately uncomfortable or even embarrassing for some, its enormous possible health benefits make it an essential appointment for every woman.

A well woman visit does not consist solely of a pelvic exam or breast exam; instead these visits are an opportunity for women to have open conversations with their physicians and learn helpful information about their bodies and anatomy.  They can lead to the early detection of issues ranging from benign conditions like pelvic support and pain to sexually transmitted infection; ovarian, cervical, vaginal, skin and breast cancers; fibroids and more. 

Carl Buccellato, MD, Gynecologist at NorthShore, shares information about what you should expect from a yearly well woman visit:

• Open conversation. It’s important so come prepared to have a frank conversation about contraceptive and preconception counseling and safe sex practices with your doctor.
• Discussion about your state of health. Just like your yearly visit with your primary care physician, you will discuss any recent changes to your health, concerns from the last year and updates to your medical history.
• Medications. Bring a list of your current medications, including any birth control.
• Breast examination. A breast exam should happen at each of your yearly appointments starting at age 21. If you notice any changes to your breasts from self-examination, please inform your physician.
• Pelvic exam. A pelvic exam is typically performed at each annual visit, and will not always include a Pap smear. A pelvic exam consists of both an external and internal visual exam as well as an evaluation of your uterus and ovaries through a manual exam, which should take no more than 2-3 minutes. You may feel some pressure and mild discomfort during this exam but it should not be painful.
• Pap smear. You should consult with your physician on the best recommended schedule for this test. The timing of your Pap smear will depend on your age, health and medical history. We recommend you get your first Pap smear by age 21. It is commonly then performed every 3 years until you are 30, and every 3-5 years thereafter.

You should always be proactive about scheduling more frequent appointments and undergoing screenings if you have previously had abnormal test results from a Pap smear; family history of uterine or breast cancer; and/or any recent changes in health such as infection, pain or bleeding.

Studies performed by NorthShore researchers suggest a painful pelvic exam is one marker of chronic pain issues. It may be important to address this issue with your OB/GYN physician before chronic pain develops. This NIH-funded research study Chronic Pain Associated with Menstrual Pelvic Pain (CRAMPP) is being done by investigators Frank Tu, MD, and Kevin Hellman, PhD. 

While more research has yet to be conducted, a painful exam may not be entirely normal. If you experience pain and/or moderate-to-severe discomfort during your pelvic exam, please inform your OB/GYN physician.