Diagnostic Evaluations

Pap test and pelvic exam

The Pap test is only used to screen for cervical cancer. It is not used to screen for other gynecologic cancers, such as ovarian, vulvar, vaginal or uterine.

Women should begin to have Pap tests at the age of 21 and continue to have the exam once every three years until the age of 65. However, women who are 30 years old or older may have a human papillomavirus (HPV) test performed in addition to the Pap test, and may only need to have the test every five years. Women who have the following risk factors may need to have Pap tests more frequently:

  • HIV infection
  • Exposure to diethylstilbestrol (DES), a man-made form of estrogen, before birth
  • A weakened immune system caused by chemotherapy, organ transplant or chronic corticosteroid use
  • A cervical cancer diagnosis
  • A previous abnormal Pap test that showed precancerous cells

Abnormal (positive) test results may indicate the cells examined are:

  • Atypical, but not necessarily cancerous
  • Precancerous
  • Cancerous (i.e., squamous cell cancer or adenocarcinoma cells)

Patients who have abnormal results should undergo additional testing, including a colposcopy, so their doctor may further examine the cervix, vagina and vulva, and obtain additional samples for lab analysis.

Pelvic exam

Doctors perform pelvic exams to examine a woman’s pelvis and surrounding organs. Typically, a pelvic exam is the first step in diagnosing gynecologic cancers, which include cancers of the vulva, uterus, cervix, fallopian tubes, ovaries, bladder and rectum. A gynecologic oncologist may perform a pelvic exam to determine the exact type and stage of cancer. In addition to cancer, pelvic exams may detect infections or sexually transmitted infections (STIs).

Before the exam, the patient is advised to empty her bladder to avoid discomfort. She is then asked to disrobe and put on a gown. A doctor feels the patient’s organs by pressing down on different parts of the stomach and pelvic area.

Once the external exam is complete, the patient places her feet in stirrups and her doctor inserts a speculum into the vagina so that the vagina and cervix are visible. Once the speculum is removed, the doctor places two fingers inside the vagina and uses the other hand to press down on the pelvic organs in order to note changes in size or shape, which may indicate a problem. In some cases, a rectal exam may also be performed in order to detect possible tumors or other abnormalities.

A pelvic exam usually takes about 10 minutes to perform. It may feel uncomfortable but should not be painful.