from a physical exam?
Does the exam show whether you’re a virgin? Whether you’ve given birth, or had a miscarriage or an abortion? If you’ve had an STD? If you’re sexually active?
What do they see when they look “up there”?
It’s embarrassing to be 63 years old with four kids and having probably 30 pelvic exams and not know this, but I’m asking anyway.
Brings to mind an article I read about Princess Diana. Before she married Charles, she had to submit to a check up and be certified as fresh.
That suggests there is at least some science available for making such a call. Also, in a abuse case reported in the paper not too long ago, I read of a child who had a marital vagina. I assume I understand what that might be.
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They can tell if the hymen is present or not (though that is notoriously not definitively probative of virginity).
I suspect they can also ballpark the degree of “activity.” Two ex-GFs who had had essentially none told me they had to request a small speculum and, in one case, encountered comments from the tech performing a pelvic ultrasound (which uses a probe, which is just what it sounds like) to the effect that she would go slow because obviously things were kind of tight.
Several things happen during a pelvic examination.
First, the doctor is going to look at the vulva, major labia and minor labia. If the patient has a sexually transmitted disease with active symptoms, those symptoms often show up here. Sores from herpes, gonorrhea, and syphillis, as well as genital warts, will be apparent. However, a lack of these does not indicate there is no disease.
The doctor will check to see if there is any redness, tenderness, or swelling that might indicate an infection or trauma. Even relaxed, happy sex can cause some trauma to the vagina - small tears or bruises. Significant trauma, especially considering circumstances of the patient, can indicate sexual assault or early sexual activity.
The hymen, a membrane stretched across the mouth of the vagina, is often taken as an assurance that the patient has not had penetrative vaginal sex. However, this is not necessarily true. The hymen can stretch or partially tear, allowing penetration, without being completely destroyed. If the hymen is present and intact, then the doctor will check for any possible complications, like an occlusion that might prevent menstruation. This is very rare.
Next, the doctor usually palpates the pelvic organs by placing one or more fingers in the vagina and her other hand above the pelvic bone. She will check placement and size of the uterus and ovaries. Palpation can be uncomfortable, but an unusually guarded or painful reaction from the patient can indicate cysts, infection, or other complications.
Using the speculum, the doctor will then inspect the walls of the vagina and the cervix. Again, there may be signs of a sexually transmitted disease, such as lesions or warts, or trauma such as abrasions or tearing. The doctor can spray a dilute solution of acetic acid (vinegar) into the vagina, and any genital warts become prominent. White, grey, yellow, or green secretions, especially if there is an unpleasant smell, indicate bacterial vaginosis.
The cervix - the opening of the uterus into the vagina - can give a great deal of information. During ovulation, it softens and opens very slightly and usually has a specific type of mucus that aids semen transport. If the woman has had part of her cervix removed due to pre-cancerous tissue or cervical cancer, there will be scarring present. If she has cervical cancer, and it has progress beyond Stage I, it may be visible as a lesion or tumor on the cervix.
The opening of the cervix in women who’ve never given vaginal birth appears as a pinpoint. In women who’ve given vaginal birth, it appears more as a flattened dash. A pregnant woman with an incompetent cervix may have several sutures taken to keep the cervix closed while she carries her child.
That’s about all a doctor can tell by a visual inspection. Diagnosis of any lesions or other tissue must be done by smear, staining, and microscopy. A Pap smear is necessary for the diagnosis of cervical cell changes that indicate cervical cancer.
A doctor cannot tell during a pelvic exam if the patient has ever had an abortion, if they have a sexually transmitted disease, if the patient has ever been pregnant or had a miscarriage, or if the patient has ever had penetrative vaginal intercourse. While some things may indicate one thing or another, there is no certainty.
I’ve heard that alot too, but wouldn’t alot of the horse riding that upper class women seem so fond of render that “test” useless?
…or a yeast infection or STD (BV is NOT an STD).
**phuoka **has it pretty much right.
Except gonorrhoea doesn’t have skin lesions, and women rarely have purulent urethral discharge.
A normal nulliparous (never had children) cervical opening is a bit bigger than a pinpoint, but it is round. A truly pinpoint os usually indicates a previous cone biopsy or laser treatment. If you have had babies the cervical opening can be bigger and more open, and it is often possible to get a fingertip into it.
The changes to the cervix from pregnancy require that a pregnancy has advanced and that the cervix has been dilated by labour - women who have never been in labour might not have these changes to the cervix, even if they have had several children.
It’s impossible to tell if someone has had first trimester terminations or miscarriages unless there was scarring to the cervix at the time (unlikely). Second or third trimester terminations or stillbirths may cause the cervix to change in appearance to one of someone who has had children, but may not.
If you’ve had an episiotomy or anterior or posterior repair operations, the doctor will be able to see the scars. If you’ve had a hysterectomy the doctor will notice that the cervix is missing, or if the cervix is still present (a partial hysterectomy) they will notice that the rest of the uterus is missing when they try to palpate it.
Huerta88 Your suspicions are unfounded. When people are nervous, embarassed or scared their muscles tense. ALL their muscles. When they are happy, calm and relaxed, their muscles relax too. I’ve had to use the smallest size of speculums on mothers of several kids because they were tense and scared. Some people have really good pelvic floor tone, some don’t. That’s all you can usually say and it’s unwise to make assumptions based on that observation.
I absolutely wouldn’t use a speculum on anyone with an intact hymen unless she had assured me she wasn’t a virgin. There really wouldn’t be any need to use a speculum in a virgin unless you had reason to believe there was a problem with the cervix. It would be much kinder to do a digital examination and an ultrasound or arrange an examination under anaesthesia (where you get knocked out). Even the virgin size of speculum is bigger than would be comfortable (I have small hands and it’s about the size of 2 of my fingers).
Wow, Phouka, I had no idea that so much was going on when they poke around down there.
A question about the hymen: If you’ve had a speculum used on you or had any other kind of penetration, could you still have an intact hymen? I thought not, but something a friend of mine said has made me wonder.
Most hymens have holes in them, and it’s conceivable (no pun intended) that you could have “penetration” with an object and not fully break the hymen. Tampons are notorious for this - there used to be a portion of the 5th grade menstruation filmstrip that reassured girls we would still be virgins if we used tampons. :rolleyes: Some of us have (had) holes large enough to slip a tampon through without breaking the hymen. Others tear the hymen with the first tampon, or discover that their hymens tore years ago in gymnastics or climbing fences or just being active kids.
A FOAF actually had painful intercourse a couple of times before her first gyn exam, and the doctor discovered that there was still a band of hymen intact. He snipped it for her and sex was much more comfortable after that.
I’ve known about the changes in the cervix after labor.
However, I was once told I had a beautiful cervix. Here’s a question for you pros, what the hell makes a cervix beautiful? And can I put that on my resume?
When I was a 15-year-old virgin, I had some pretty bad abdominal pain. Hurt worse when I walked.
My mom made an appointment for me to go to the doctor. She didn’t tell me that he was going to do a pelvic. I’d never had one before.
He asked me in front of my mother if I’d ever had sex. I said no. He said, "Can you answer that question honestly in front of your mother? "
Mom leaves the exam room. Doctor proceeds to tell me to put my feet in these here stirrups and begins his exam.
Remember, I’d never had one before. No one gave me any indication what they were going to do. Talk about a nervous patient! You want me to WHAT???
Anyway, he proceeds to … well… jam what feels like his whole arm up to his elbow up my vagina. Yeah, I tense up because this hurts like a … well, you know.
He yells (!!) at me that if I don’t relax, he won’t be able to examine me. I don’t think he used a speculum, just a manual exam. I swear he said something about checking my fallopian tubes. Felt like he’d gone all the way up past my cervix into my uterus and was poking around my fallopian tube with his fist. :eek:
He supposedly takes some kind of swab. He brings my mother back in.
About a half an hour later, he comes back in and snidely announces that I have PID.
“But since you’re a virgin,” he snidely remarks, “I don’t know *where *you got it.”
Gives me a script for something. I don’t remember. Driving back home I have to explain to my mother what PID is.
So, to this day, I don’t think I had PID. And I don’t know what caused that pain. Several months - a year? - later I had the same pain and ended up in the ER. I don’t know what my diagnosis was, but it’s never recurred.
My mom was mad at me that she had to take me to the ER. Cuz I sure as hell wasn’t going to go back to that quack doc.
I don’t know why I’m posting this, really. I guess just to share my experience of a questionable diagnosis based on a gyno exam…
Maybe mittelschmerz. I had that a couple of times as a teen and it was intensely painful.
niblet_head wow, that gyn sounds like an asshole.
You could have had endometriosis, an ovarian cyst or any number of things going on. I’d put my money on ovarian cysts as the cause of your pain (they can hurt like a motherfucker when they burst).
PID requires pain, fever, discharge caused by an infection. PID is usually caused by STDs, but it is perfectly possible (albeit rare) to have an infection in the uterus or fallopian tubes that has been caused by a NON sexually transmitted organism. It wouldn’t be the first diagnosis I’d leap to in a 15 year old virgin with abdominal pain.
Thanks for the responses, everyone. 
niblet_head, I once had a physical exam that left me feeling like a drunken slut. I had a trich infection and elevated liver enzymes. I’d been married for 20 years and never had sex with anyone but my husband, and I drank maybe once a year, on my birthday. I’m sure the doctor thought I was lying. (My husband never did admit to screwing around and we stayed married until he died.)
Yeah, it’s a mystery. I wish I could go back and get my records from the ER visit just to see what they diagnosed me with. They were cool. They believed me when I told them I was a virgin.
What was a shock was how much my mother didn’t know. And how because of that she just accepted what the doctor said. She didn’t even ask him what PID was. She asked me on the way out to the car! (Because I was pretty pissed off. “There is NO WAY I have PID. Just because I’m a 15-year-old American teenager doesn’t mean I’m having sex!”)
When I told my mother that PID comes from an STD that’s been untreated or a botched abortion I think her brain 'sploded.
I wish you’d been my doctor!
I used to take cortosteroids to treat another medical condition, and this wound up causing me big problems with yeast infections. I had two different doctors and a nurse who all felt this problem necessitated a speculum exam for young, virginal me.
There was a lot of screaming involved on all three occasions.
The nurse who tried to examine me actually TOLD me – didn’t ask, TOLD – that I must have been sexually abused as a child or I wouldn’t have had such an extreme reaction. Seeing as how I was only there because I had a vaginal infection, I’m not sure why she expected me to be delighted to have a full-size adult speculum shoved into my irritated, virginal vagina.
I never went back to that clinic again.
Owie! Owie! Owie!!!
Let us now take a moment to thank all those docs and PA’s and Nurse Practioners who warm up their speculums. Who put socks on the stirrups. Who let you know what they’re going to do next before they do it. Who put posters on their ceilings to give you something to read. Who apologize for causing you pain. Who believe you when you tell them what’s going on with you.
Interesting anectdote.
Trichomonas infections can be caught from hot-tubs, jacuzzis, whirlpools and similar.
A former colleague of mine used to work in the STD clinic in Soho, London.
She tells the story of a spate of Trich infections in rather wellheeled ladies who all calimed they didn’t know where they had been infected. The first two or three were “yeah, yeah lady, whatever, here’s some tablets” but after 10 women of all ages who all claimed to be faithful appeared with similar symptoms, staff began to suspect something was up and did some digging to try and make some connections between them.
It was eventually traced back to the jacuzzi of a rather upmarket spa, which was then closed for “renovations” until the problem was sorted out.
Lamia again, that’s just horrid. Yeast infections re yeast infections, I’d have taken swabs, but unless there was reason to suspect a retained foreign body, there is no reason to do a speculum examination in someone who is not sexually active on steroids with chronic thrush.
I have found the Uk’s Royal College of Obstetricians and Gynaecologists Guideline for Gynaecological examinations, if anyone would like to read it. Here it is (warning pdf).
Some important bits and pieces from it:
Prior to performing pelvic examination, it is essential for the
gynaecologist to consider what information will be gained by the
examination, whether this is a screening or diagnostic procedure and
whether it is necessary at this time.
Pelvic examination should not be considered an automatic and inevitable
part of every gynaecological consultation. However, the management of
many gynaecological problems is based on competent pelvic examination
preceded by an explanation of its purpose and followed by effective
communication about the findings. Pelvic examination should not be
carried out for non-English-speaking patients without an
interpreter/advocate except in an emergency.
Throughout the examination the clinician should remain alert to verbal
and non-verbal indications of distress from the patient. Any request that
the examination be discontinued should be respected.
The low productivity of pelvic examination in the asymptomatic young woman prior to commencing use of the oral contraceptive pill makes it difficult to justify
such an examination, which may deter uptake of contraception in vulnerable
young women. The British Society for Colposcopy and Cervical Pathology
considers that bimanual examination of the pelvis should be performed in a
woman attending for colposcopy only if indicated.
The reasons for carrying out a speculum examination must be clearly
explained to the patient and her verbal permission sought. As the object of
speculum examination is inspection of the vulva, vagina and cervix, it may not
necessarily be appropriate for such an examination to accompany bimanual
palpation on every occasion.
A small speculum may be required in the nulliparous or virginal
woman, although such examination is rarely indicated in a virgin.
Hope that helps clarify that the bad experiences some of you have had are not the way things should be done and were very unfortunate.
I’ve heard that in a lot of cases that is intentional - unmarried, aristocratic, and not a virgin? Better take up horseback riding before you get married.