Quick Answer
During a pelvic exam, it is standard practice for patients to remove their pants and underwear before the examination begins. This allows the doctor full access to examine the pelvic region externally and insert instruments like a speculum internally if needed. While some doctors may offer the option to just unzip pants or pull them down slightly, removing pants and underwear fully is recommended for the most thorough exam.
Exam Gown
Once pants are removed, patients are provided with an examination gown to wear during the pelvic exam. Gowns open in the front to allow access for the exam and provide coverage over the top portion of the body. Gowns help preserve modesty and privacy during the pelvic exam.
Why Pants Need to Be Removed
There are several reasons why removing pants is necessary for a proper pelvic exam:
- Allows access to perform external visual exam of genitalia – With pants on, it would be difficult or impossible to visually inspect the vulva for any signs of infection, cysts, lesions, etc.
- Allows access for speculum exam – A speculum needs to be inserted into the vagina to view the cervix and take samples. This cannot be done properly with pants on.
- Allows access for bimanual internal exam – The provider needs to insert gloved fingers into the vagina and place the other hand on the abdomen to palpate the reproductive organs. Pants need to be removed to perform this assessment.
- Provides proper positioning – Being fully undressed from the waist down enables the patient to get in position for the exam with knees bent and feet in stirrups.
- Prevents contamination – Removing pants helps prevent microorganisms from being introduced into the vagina during the pelvic exam.
Options if Uncomfortable Removing Pants
For patients who feel uncomfortable completely removing pants, there are some possible options:
- Wear an exam skirt – This is a paper skirt that wraps around the waist and covers the lap/upper legs during the exam.
- Leave socks on – This preserves some degree of coverage and modesty.
- Request a female provider – Some patients feel more comfortable with a woman provider if available.
- Talk to the provider – Express any concerns you have with undressing and see if they can accommodate requests within reason.
However, keep in mind these options may limit the exam in some way or prevent the provider from getting all the necessary views. Removing pants fully is still recommended for the most complete pelvic examination.
Pelvic Exam Steps
Below are the typical steps of a pelvic exam once pants and underwear have been removed:
- Visual exam of external genitalia – The doctor inspects for any abnormalities, irritation, discharge, etc.
- Insertion of speculum – The speculum allows visualization of the vagina and cervix.
- Pap smear – Cells are collected from the cervix to screen for cervical cancer.
- Bimanual exam – The provider inserts fingers into the vagina with one hand while pressing on the abdomen with the other to assess reproductive organs.
- Rectovaginal exam – Sometimes the provider will also insert a finger into the rectum to evaluate certain structures.
- Collection of any other needed samples – Swabs may be taken to test for infections.
Once the exam is complete, the provider will leave the room briefly while the patient removes the exam gown and gets dressed. Being fully undressed for the pelvic exam facilitates the doctor’s access to thoroughly inspect the female anatomy.
Why a Pelvic Exam is Necessary
While removing pants for an exam may feel awkward or cold, remember that a proper pelvic exam serves important health purposes:
- Screens for cervical cancer via Pap test.
- Detects STIs, yeast infections, bacterial vaginosis.
- Identifies uterine fibroids, ovarian cysts, and other anatomical abnormalities.
- Assesses for pelvic organ prolapse.
- Evaluates pelvic pain or dysfunction.
- Provides reproductive health surveillance.
Pelvic exams allow issues to be diagnosed and treated early before they become more serious problems. Though unpleasant, they are a vital part of women’s health care.
Preparing for the Exam
There are a few things women can do to prepare for a pelvic exam to make the experience go more smoothly:
- Schedule the exam when you are not on your period – This provides better visualization and avoids interference with Pap smear collection. If you need an urgent exam while on your period, just let your provider know.
- Shower/bathe before the exam – This helps you feel fresh and promotes proper hygiene.
- Use minimal bath products prior – Heavily scented soaps or sprays can interfere with any samples collected.
- Trim nails – Prevents accidentally scratching the provider during the exam.
- Go to the bathroom – This provides comfort and empty bladder is needed for part of the exam.
- Relax – Deep breathing and meditation can help manage anxiety.
- Communicate with your provider – Tell them any concerns or questions you have.
During the Exam
To make removing pants and undergoing the pelvic exam easier:
- Listen to provider instructions – Follow their directions for positioning and relaxing muscles.
- Breathe deeply – This helps you stay calm and be able to better relax pelvic floor muscles.
- Focus on breathing – This gives you something to concentrate on besides the exam procedures.
- Communicate any discomfort – Let the provider know if you experience any pain so they can adjust.
- Ask questions – Speaking up can help ease anxiety and clarify anything you are unsure about.
- Know the provider will be professional – They perform pelvic exams regularly and will approach it in a clinical manner.
After the Exam
Once the pelvic exam is finished:
- Get dressed – Remove exam gown and put your clothes back on once the provider leaves the room.
- Discuss any findings – Ask the provider to explain test results and any issues found during the exam.
- Ask about needed follow-up – Based on exam findings, additional testing or treatment may be recommended.
- Provide feedback – Let the provider know if there are things that could improve your comfort with future pelvic exams.
- Schedule recommended follow-up – Make any required appointments for procedures or testing after abnormal pelvic exam findings.
- Practice self-care – Do relaxing activities and treat yourself kindly after the exam.
When to Get Pelvic Exams
Below are the recommendations for routine pelvic exam frequency:
- Ages 21-29: Pelvic exam every 1-3 years. Annual exam is no longer recommended starting at age 30.
- Ages 30-65: Pelvic exam every 3-5 years or as advised based on health conditions.
- Over age 65: Discuss with provider on case-by-case basis.
- After abnormal Pap or pelvic exam: Follow-up annually or as directed.
Pelvic exams should also be received anytime abnormal symptoms arise like pain, discharge, or bleeding that warrant evaluation.
Conclusion
Having to remove your pants for a pelvic exam can feel uncomfortable. However, it is a necessary part of the process in order for your provider to fully visualize and access the pelvic structures to provide appropriate screening, detection, and sample collection. While options like exam skirts exist, taking pants off fully is recommended for the most thorough exam. Preparing mentally, communicating with your provider, and focusing on breathing can make the experience better. Though pelvic exams can be unpleasant, try to remember they are an important way to protect your health.
References
- American College of Obstetricians and Gynecologists. (2019). The Pelvic Exam. https://www.acog.org/womens-health/faqs/the-pelvic-exam
- U.S. Preventive Services Task Force. (2018). Screening for Cervical Cancer. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cervical-cancer-screening
- Centers for Disease Control and Prevention. (2021). What Happens During a Pelvic Exam? https://www.cdc.gov/cancer/cervical/basic_info/screening.htm
- The American College of Obstetricians and Gynecologists. (2019). Having a Pelvic Exam. https://www.acog.org/womens-health/faqs/having-a-pelvic-exam