During pregnancy, you will be undergoing various pre-natal checkups. These checkups are to monitor your health as well as the growth and development of the unborn baby. Pelvic exam is one such prenatal checkup. Most doctors perform pelvic exam as part of their routine prenatal care. While in some cases pelvic exams are helpful prior to labor, but in case of a healthy pregnancy, these don’t provide any necessary information. Read on to know more about pelvic exam, how and when it is performed and risks of having one during pregnancy.

What Is A Pelvic Exam?

A pelvic exam is a procedure in which the doctors assess the vagina and the adjoining organs of the pelvis. Usually, vulva, cervix, uterus, Fallopian tube, ovaries, bladder and rectum are examined during a pelvic exam.

When Is Pelvic Exam Performed During Pregnancy?

Usually, pelvic exam is performed during the first and third trimester unless there is some complication in the pregnancy and the pregnant woman needs continuous monitoring.

• During the first trimester, the pelvic exam is conducted where the doctor checks whether the cervix is been properly sealed with mucus plug. The tests like Pap smear are also conducted during the first trimester of pregnancy. If nothing is wrong in test results, no more pelvic exams are done up to the 36th week of pregnancy
• After the 36th week of pregnancy, the doctor will do pelvic exam more frequently or even on every visit. This is to monitor the effacement and dilation of the cervix so that it will be easy to determine how near the delivery is
• A doctor may also do pelvic exam more frequently if there are any of the following complications and it requires close monitoring :
  • If you have a medical condition that increases risk of a preterm labor
  • If you experience spotting
  • If you experience some vaginal infections (like genital herpes)
  • If there is some growth in pelvic area

How Is Pelvic Exam Performed During Pregnancy?

Usually, examination of the size, shape and position of the pelvic organs are done during a pelvic exam.
A pelvic exam includes two components – manual and visual. Manual assessment includes the examination of the external genitalia (vulva) and inside the vagina for an internal assessment of the vaginal walls. The visual examination is performed with a small device called speculum which allows a clear view of all the pelvic organs which helps in easy evaluation.

• • While performing a pelvic examination, you will be required to remove your lower clothing and lie on your back on the examination table
  • The doctor will ask you to draw your knees up and spread them wide apart
  • He will place a gloved index and middle finger into the vagina and assesses the cervix
  • A speculum exam is the next step. During this exam, a speculum, which is a hollow cylinder with a rounded end that is divided into two hinged parts, fairly like the mouth of a duck, is used. The speculum is inserted into the vagina to expand it for examination. When inside, the two halves of the speculum will open up, making it easier for the doctor to examine the cervix and the upper part of the vagina

• The Pap smear test is conducted during this time of the pelvic examination
• Bladder and rectal examination are also usually included in a pelvic exam to rule out the chances of UTI and hemorrhoids
• During the final weeks of pregnancy, pelvic exam is performed to find out:
  • Effacement and dilation of cervix
  • Position of the cervix
  • How far into the pelvis the baby is descended
  • Presentation of the baby

The pelvic exam towards the final week of the pregnancy also has an advantage. The pelvic exam has higher chances to stimulate the cervix so that labor induction is not necessary.

Are There Risks In Pelvic Exam During Pregnancy?

Pelvic exam has its own risks during pregnancy:

• The risk of infection increases even though the doctor uses sterile gloves. This is because there are chances of the bacteria from the vagina being pushed up towards the cervix
• As already mentioned, the examination can stimulate the cervix and initiate labor and if you are not due or your baby is not ready to be born, it can increase the chances preterm labor
• Pelvic exam has a chance to cause PROM(premature rupture of membrane)
• After a pelvic exam, the pregnant women are usually told as to how many centimeters they are dilated and when can they expect to go in labor. If the days pass and still there is no sign of labor, it can make the pregnant woman anxious and in this anxiety she can give her consent or request for labor induction

If your doctor insists on a pelvic exam, you should ask him for specific reason for the exam, what he is trying to find out and if in any way it will affect your pregnancy or delivery. If you are not convinced about having a pelvic exam, you have a right to decline it or request a second opinion. If you decide to go ahead with the exam, here are following things you should keep in mind:

• Your bladder is empty
• You are comfortable and properly covered
• Ensure your privacy
• Breathe deeply and relax your pelvic floor muscles. This will decrease the discomfort of the exam

Deciding to go in for a pelvic examination during pregnancy should be totally on you. You should understand why the exam is suggested and what the doctor is trying to find out and how it is going to help in your pregnancy. A doctor cannot perform the pelvic exam without explaining you the procedure and taking your consent.