Pelvic exam
An annual pelvic examination is recommended for all sexually active women. The best time to do a pelvic exam, and specifically the Pap test, is mid-cycle. The procedure takes place in an examining room and is done by a doctor/nurse.
The pelvic exam involves three steps:
- an external exam
- an internal exam with a speculum
- a bimanual examination
External exam
The external exam consists of a visual inspection of the genitalia, to ensure everything looks healthy (i.e., no signs of STIs or structural abnormalities).
Internal exam 
The internal examination involves opening the vagina with an instrument called a speculum. This holds the vaginal wall open so that the cervix can be seen clearly by the doctor/nurse and any necessary tests can be done.
PAP tests (Papincolaou Smear)
With a speculum in place to hold the walls of the vagina open, the doctor/nurse does the PAP test using a slender wooden spatula to gently remove cells from the surface of the cervix and cervical canal. Often, a small brush-like device is also used to get cells from the internal cervical canal. The sample is placed on a microscope slide and sent to a provincial lab for examination.
A PAP test is an excellent method of detecting changes in the cells of the cervix before cancer actually develops, and is recommended annually for all sexually active women. Women who are not sexually active are exempt from the PAP test but once sexually active, PAP exams should be initiated within a year of having sex. It may be recommended at longer intervals for women with a history of 2 or more negative PAP smears in a row. In OPT clinics PAPs are offered annually (or more frequently if indicated), and every client who has a PAP test done is also offered tests for gonorrhea and chlamydia. Other sexually transmitted infections can be tested for at the client's request.
Why are Pap tests important?
Because the cervix lies at the internal end of the vagina, it is vulnerable to infections caused by bacteria and viruses shared through intercourse. Infection may lead to a change in cell development on the surface of the cervix that could develop into cancer over time.
Factors that increase the chance of cervical cancer include:
- A history of more than one sexual partner (for a woman or her partner)
- Genital warts (HPV)
- Early age at first intercourse
- A weakened or compromised immune system
- Smoking
Tests for STIs are done at the same time. Specific swabs are used to take samples from the cervical opening and are placed in tubes sent to the BC Center for Disease Control (BCCDC).
These procedures are usually not uncomfortable, but may occasionally cause some cramping.
How long does it take to get the test results?
Test results for PAPs take about 6-8 weeks to return from the lab, while STD results can be back in approximately two weeks.
Bimanual Exam
The bimanual exam is done by the nurse/doctor and involves feeling the reproductive organs to ensure they are also healthy.
The physician introduces a gloved and lubricated finger into the vagina to locate the cervix and then lifts the cervix to bring the uterus closer to the abdominal wall. With the other hand placed on the client's abdomen, the doctor/nurse will feel for and locate the uterus, fallopian tubes and ovaries, checking for discomfort as well as the size, shape, and consistency of these structures.
