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lisa fournace winn, dnp, aprn

Annual Exams – What are They Doing Down There??

Most women dread their annual exam at their OB/Gyn’s office. It is awkward for most and physically uncomfortable for some. You stare at the ceiling with your feet in the stir-ups and make small talk while the medical provider looks under your hood and checks out your lady parts. But what are they doing exactly?

Your OB/Gyn’s job is to care for your reproductive system: breasts, uterus, ovaries, cervix, vagina, and vulva. Did you know you had that many reproductive parts?

Women should see their OB/Gyn once a year. This visit will typically include a review of your medical history and menstrual history. It is a good time to discuss issues such as birth control, irregular periods, pain with intercourse, intent to start a family, bone health, or menopausal symptoms.

Your medical provider will most likely complete an exam that includes a clinical breast exam, a bimanual exam, and a Pap smear.

Breast Exam

During the breast exam, the medical provider will ask you to remove the top part of your gown and place your hands over your head. She will use her hands to feel the breast tissue to make sure there are no suspicious masses.

You can do this exam at home yourself in between yearly visits. This is called a self-breast exam.  A good time to do this exam is when you are in the shower.  Align the exam with your menstrual cycle, performing it about 1 week after your period starts.  If you no longer have a menstrual cycle, pick the same time each month to do the exam. Read more here about why I’m so passionate about self-breast exams.

Bimanual Exam

The bimanual exam allows your medical provider to assess your uterus and ovaries. The provider will insert two fingers into your vagina until she locates the cervix. She will use her other hand to press on your abdomen, isolating your uterus and ovaries between her two hands. This exam checks for pain or tenderness that may signal infection; size, position, and mobility of the uterus; and abnormal masses on your ovaries.

Pap Smear

A Pap smear is a test that screens for cervical cancer. It involves inserting a speculum into the vagina to visualize the cervix, and then gently scraping the cervix to obtain some cells. These cells are sent to a lab and analyzed for irregularities could lead to cancer of the cervix.

A Pap smear does not screen for ovarian cancer or uterine cancer. It does not test for sexually transmitted diseases.  

Your OB/Gyn provider may order an HPV test with your Pap Smear. HPV stands for Human Papillomavirus, a sexually transmitted disease responsible for most cervical cancers. Depending upon your age, your sexual history, and your Pap history/HPV status, your OB/Gyn may recommend you only have a Pap smear every 3 to 5 years if your HPV test is negative.

That does not mean that you get to go 3 to 5 years between Well Woman (aka Annual) Exams. It is still important for your provider to assess your breast and ovarian health every year and manage issues related to your reproductive and sexual health.

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