Well Woman Exams
Women's Health provides routine pelvic examinations and cervical cancer screenings (Pap
tests). As of May 2012 new guidelines for Pap tests were issued by the American Society for
Colposcopy and Cervical Pathology (ASCCP), decreasing the number of Pap tests a woman may
have to have in her lifetime. Even though Pap tests are no longer needed yearly, it is still
recommended that women schedule pelvic exams, breast exams and STI screening
annually.
The 2012 Pap test guidelines state that:
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Cervical cancer screening (Pap test) should begin at age 21 years.
Screening before age 21 should be avoided because it may lead to unnecessary and
harmful evaluation and treatment in women at very low risk of cancer.
Cervical cytology screening (Pap testing) is recommended every 3 years for women
between the ages of 21 years and 29 years who have not had abnormal Pap tests.
Women aged 30 years and older who have not had abnormal Pap tests should have Pap
and virus testing every 5 years.
Sexually active adolescents (females younger than age 21 years) should be counseled and
tested for sexually transmitted infections, and should be counseled regarding safer sex
and contraception. These measures may be carried out without a Pap test.
Besides routine check-ups or to obtain contraception, you are welcome to schedule an
appointment if you have any of the following symptoms:
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Abnormal or heavy vaginal discharge that itches, burns, has an odor, or causes you
discomfort
Heavy vaginal bleeding, missed periods or irregular menstrual cycles
Bleeding between periods, also known as spotting or break through bleeding
Painful intercourse
Menstrual cramps that cause you to miss school or work
Any signs of pregnancy
Side effects or problems from your birth control method
Breast pain, lump, or discharge from the nipple
Preparation for the Well Woman Exam
The well woman visit, which typically includes a pelvic exam, can be a unnerving experience for
many women, especially when it is the first exam. However, preparation for the exam and an
understanding of the underlying health reasons behind the exam may help to lessen the anxiety.
Important: In order to ensure accurate results, we ask all women who are scheduled for a well
woman exam to have nothing in the vagina at least 48 hours prior to the examination. This
includes abstaining from intercourse, tampon use, creams, douching, etc. If you are actively
bleeding or are on your menstrual period at the time of a scheduled well woman exam, we will
ask that you reschedule your appointment.
If it is your first visit to Women's Health, the provider will start by taking a routine health
history. Questions she will ask will include information about your health as well as any
pertinent family medical history. She will ask about your menstrual cycles, if you are sexually
active, and if your sexual relationships place you at any risk for pregnancy or sexually
transmitted infections. Additionally, she will ask about any dietary, social, and violence related
concerns which may place your health at risk. If you have any questions for her about your
health, please do not hesitate to ask!
In preparation for the exam, you will be given a gown to wear and a drape for your lap. You will
be asked to undress for an annual exam. If you prefer, you may keep on your top/shirt during the
exam ( if so, you will also be asked to unhook your bra in order to facilitate the breast
examination).
The Breast Exam
The Women's Health Division of Student Health Services at the University of Pennsylvania
currently follows the National Comprehensive Cancer Network (NCCN)'s recommendations
regarding women's self breast exam. We no-longer suggest a monthly self breast exam for
women. At this time, we recommend that women be familiar with their breasts and report any
changes or problems to their health care provider as soon as possible. The NCCN's term for
women's familiarity with their breasts is called "breast awareness." Breast awareness includes
consistent periodic self breast exams and being aware of what your breast tissue normally looks
and feels like.
When performing a self breast exam women should be aware of "red flags," which warrant
prompt attention from a women's healthcare provider. These red flags include:
§ A lump that has not been evaluated
§ A change in a breast lump, such as size
§ Red, swollen, or flaky skin on any area of the breast
§ A nipple that is painful or becomes inverted
§ Any fluid that is leaking from the nipples (if not breastfeeding)
§ Any skin dimpling
§ A lump or changes in skin under the arm.
The Pelvic Exam
The pelvic exam, in most cases, is actually a very short and simple procedure. In fact, it will
probably take more time to read the following information than it will take to do the exam! At
any rate, many women feel needlessly embarrassed and self conscious during the pelvic exam.
Please try to remember that the provider performs routine pelvic examinations every day and
understands your feelings. Additionally, she also goes regularly for her own examinations!
However, if you have had negative experiences in the past or have particular concerns, use this
opportunity to discuss this with your provider before the exam. She may be able to help make the
exam a more pleasant experience.
Before the exam, you should empty your bladder. You will be asked to bend your knees and
place your feet in footrests during the actual exam. The first part of the exam consists of a brief
examination of the external area. The provider will look for any external signs of problems,
including abnormal bumps or rashes. If you have noticed any bumps or rashes yourself, please
alert the provider.
The Speculum Exam
A speculum will be used during the second part of the pelvic exam. A speculum is a metal or
plastic instrument that is used to gently seperate the vaginal walls allowing for better
visualization of the cervix (the opening of the uterus). The speculum comes in several sizes,
accommodating even virginal women. A warmed speculum will be inserted into the vagina.
Most women describe the feeling as "having pressure". After inserting the speculum, the
provider will visually examine the cervix and take a few cells for a Pap test. To do this, she will
use small flexible plastic broom and a small cervical brush, which looks like a mascara brush.
The Pap test is a screening test for abnormal cells that may become pre-cancerous cervical cells.
Follow-up and treatment for abnormal Pap tests is done at Women's Health. Most results are
back within two to three weeks.
Screening for Sexually Transmitted Infections
The provider will examine the cervix and vaginal tissue for any abnormal discharge or bumps.
Screening for sexually transmitted infections (STI), including gonorrhea and chlamydia, can be
done. We encourage all sexually active women to be screened for STI if they have had a new
sexual partner since their last exam or are not in a monogamous sexual relationship. Screening
for STI is simple and consists of taking a small amount of cervical discharge with a swab. Like
the Pap test, this will also be sent to the laboratory for evaluation. Most results are back within 23 weeks. Women's Health will contact you if your results are normal or abnormal. Please
contact your provider if you do not hear from Women's Health within 3 weeks of your testing.
The Bimanual Exam
After the speculum is removed from the vagina, a bimanual (two-hands) examination of the
uterus and ovaries will conclude the exam. The provider will insert one or two gloved fingers
into the vagina and will locate the cervix with the tip of her finger. With her other hand, she will
press firmly on the abdomen, right above the pubic bone. During this procedure, the provider is
evaluating the size, shape, and consistency of the cervix, uterus, and ovaries. This can often feel
like pressure to the woman. Any pain should be discussed with the provider.
Rectal Exam
Rectal exams are not a routine part of a well woman exam in women under the age of 50.
Evaluation of certain pelvic problems, such as endometriosis, may require a rectal exam in
addition to a bimanual exam. The provider will tell you if she needs to do a rectal exam. During
the rectal exam, the provider will insert one lubricated, gloved finger into the rectum.
After the exam, the provider will leave the room and ask you to get dressed. When she returns to
the exam room, you will be given time to ask any additional questions about the exam findings.
If any abnormalities were noted during your exam, the provider will use this time to discuss them
with you. If any treatments are needed, the provider will provide them at this time and will
instruct you on their use. Contraceptive options and medication refills may be discussed at this
time as indicated.
You also will be given a handout about the Pap test and how to get your results as well as general
information about the results.