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Genital Examination

Jessica Evert, MD, edited by Benjamin McDonald, MD Updated: Jul 5th 2016

If you visit the doctor reporting symptoms suggestive of an STD, your doctor will likely ask to perform a genital examination. Such examinations help the doctor to better understand the symptoms you are experiencing, and gather evidence necessary to make the case for one disease over another as the cause of your discomfort.

Genital examinations are different for males vs. females. Each type of genital examination is described in some detail below.

Female Genital Exam

For women, the genital exam involves a pelvic exam. The pelvic exam allows a doctor or health care provider to check the internal and external reproductive organs for signs of disease. In females the reproductive organs include the vulva (the outside of the vagina), the vagina, the cervix, the uterus, the fallopian tubes, and the ovaries. Various lymph nodes in the groin area are also examined. The pelvic exam is often accompanied by a pap smear, which is when a sample of cells is removed from the cervix for testing.

Women should schedule their pelvic exam to take place on days when they are not having their periods, when examination is not urgent. However, when worrisome symptoms are present, such as abnormal discharge, or burning during urination, the pelvic exam should be scheduled as soon as possible regardless of where a woman is in her cycle.

A proper pelvic examination requires preparation. Women should not douche, use tampons or vaginal sprays or powders, or insert anything into their vagina (including a penis or any other sexual object!) for 24 hours before their scheduled examination.

Upon the start of the exam, women should tell their doctor all about their symptoms, and be able to report the first day of their last period, as well as the length of that period. Women should also report if they believe they may be pregnant, if they are using any birth control (and what sort), and whether this is their first pelvic examination.

Once a woman has removed her clothes from the waist down and been draped with a sheet/gown, the pelvic exam begins with the health care provider looking at the genitals on the outside of the body. A speculum (an instrument that looks a little like a duck's beak) is then inserted into the vagina and then expanded so as to dilate the opening of the vagina. The doctor will choose a speculum that is the appropriate size for the person being examined. The speculum may feel cold as it is inserted, and a sensation of pressure will occur as it expands. It is helpful to take deep breaths to relax the pelvic muscles so as to ease any discomfort the expansion of the speculum creates. The speculum may feel uncomfortable, but it should not hurt.

As the speculum expands, the doctor examines the walls of the vagina looking for disease. Next, the doctor positions the speculum and examines the cervix looking for abnormalities. A small brush will be used to collect cells from the cervix (this is the "pap smear"). The doctor may also use large cotton swabs to collect samples for later STD testing (for Chlamydia, Gonorrhea and related conditions). This first part of the pelvic exam concludes with the doctor collapsing and then removing the speculum.

Following the speculum examination, the doctor does a "bimanual" examination, meaning that he or she uses his or her hands to examine the internal reproductive organs. The examiners hands will be gloved for the bimanual exam, and may have lubricating jelly on them causing them to feel cold. The doctor inserts part of one hand into the vagina while placing the other hand on the top of the stomach. He or she feels the internal organs making sure they are the right size and shape.

A "rectovaginal" examination may follow the bimanual examination. During the rectovaginal exam, in which the doctor's fingers are inserted into both the vagina and the anus/rectum, the doctor examines the internal space between the rectum and the vagina, making sure that this tissue is healthy and free from abnormalities.

If the woman being examined is over 50 years old, the doctor may recommend that her stool be tested for blood.

The entire pelvic exam is usually complete within 10 minutes. The exam is quicker and easier when the patient breaths deeply, is able to relax her pelvic and buttocks muscles, and doesn't make sudden movements. Though the doctor's visual findings can be immediately communicated to the patient, any collected fluid or tissue samples requiring testing may take a few days to be processed and interpreted.

Male Genital Exam

During the male genital exam, a doctor performs a visual and manual examination of the male genitals which includes the penis, testicles, epididymis, spermatic cord, and vas deferens (the latter three being tubes connecting the various parts of the male reproductive system). If indicated, the doctor will also examine the rectum/anal area, and the prostate gland.

It is important for male patients to tell their doctor about any worrisome sores or ulcers, discharge, pain or other symptoms they may be experiencing before the actual examination is underway, so that the doctor knows what to look for during the examination.

Prior to the examination, patient will be asked to remove their clothing from the waist down (they are given a sheet or gown for privacy). The doctor then examines the genitals, examining the skin for any abnormalities, the testicles for symmetry (that they are the same size and shape), and the penis for any odd discharge. Next the doctor palpitates (touches) the testicles and the cords connecting the testicles to the body to make sure they are the proper shape and size.

Depending on what the presenting problems are, the doctor may conduct additional examinations. For example, the doctor may insert a small swab into the the urethra (the hole at the tip of the penis) so as to sample fluids found therein for STDs. This swab insertion stings, and may cause soreness while urinating for the next several days. The doctor may also feel the muscles in the groin area in search of hernias (which occur when a part of the intestines poke through a hole in the muscles of the groin and stomach area).

If appropriate, a rectal examination may be done. The doctor will insert one or two gloved and lubricated fingers into the patient's anus so as to examine the tissues found there for abnormalities. The doctor may also manually examine the prostate gland (which is accessible from within the rectum) for abnormal bumps and overall enlargement. An enlarged prostate gland can indicate prostate cancer, but there are also benign (non-disease) causes (such as benign prostatic hypertrophy). Other conditions such as prostatitis cause the prostate to be painful to the touch.

The examination process can be embarrassing for some men, and at times, physically uncomfortable. At no time should the exam be particularly painful, however. A man can take deep breaths to help make the situation better.

Though the doctor is able to report his or her impressions immediately after the examination is finished, any tissue or fluid samples will likely require laboratory analysis and results may not be available for several days.

 

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