Cervical Cancer Screening (Pap Test)
A pelvic exam and gynecological screening, also known as a well womxn exam may be recommended to a patient of any gender identity beginning at age 21. The main component of this exam is the pelvic exam, which allows a clinician to assess the health of the organs in the reproductive system. The exam also provides an opportunity to check, change, or update one's method of contraception (birth control) if desired.
Pelvic exams help protect one’s health. They are critical in the diagnosis and treatment of several types of diseases including cancer and sexually transmitted infections. If one is sexually active, getting tested for sexually transmitted infections is important to ensure that prompt treatment can occur if one has a positive test. During this exam, the provider can provide information about reducing one's risk for contracting an STD. Routine pelvic exams are also crucial in the early detection of certain types of cancer.
Knowing in advance the details of the procedures and why they are important may help make this exam a positive learning experience and a routine part of good health care.
The exam includes several steps. First, a clinician reviews your medical history, focusing on the reason for the exam, and information about the onset of menstrual periods, the regularity of periods, and the symptoms experienced during the menstrual cycle. Since so many elements of your sexual, emotional and dietary life can affect your reproductive system, you may also be asked about dating, sexual intercourse, eating habits, and athletic activity. The clinician may listen to your heart beat and to your lungs while you breathe in and out normally or as requested.
Breast examination is often included in this exam. The clinician examines each breast to feel for any lumps or abnormalities. The clinician will also teach you how to do the breast self-exam monthly, so you can detect any changes that may occur in your breasts.
The next step is to examine the abdomen externally to check if there are any abnormalities, including swelling or pain. The clinician then examines the external genitalia to check for any lesions, bumps or lumps, which could indicate a problem.
Since the organs being checked are internally located, it is important for the clinician to perform a pelvic exam. The pelvic exam can include a speculum exam, cervical cancer screening (pap smear), and a bi-manual vaginal exam.
Since the walls of the vagina rest very close together, the clinician must hold open the two sides of the vagina in order to see the reproductive organs. This is done with an instrument called a speculum. The clinician inserts the closed speculum gently into the vagina. Once the speculum is in place, the clinician opens it and is then able to get a good view of the cervix (the opening to the uterus), and the walls of the vagina. Putting in a speculum is not painful, but can be uncomfortable if you are nervous or tense.
The clinician looks for abnormalities in the vagina, such as redness, inflammation, or discharge, which can be a sign of infection. They will also check for abnormalities on the cervix, such as lumps, bumps, discoloration, or discharge which may signal an infection.
If testing for sexually transmitted diseases is requested or indicated, the clinician will use a long q-tip to take a swab of mucous from the walls of the vagina and/or cervix. This sample is then sent to the lab for analysis.
To perform cervical cancer screening (also called the pap smear), the clinician will take a long, thin plastic or wooden spatula-like instrument and gently swab some cells from the cervix. The sample is then sent to an outside laboratory (at cost) to determine if there are any abnormal cells present. You will be notified within a few weeks if any abnormalities appear in your test. An abnormal pap smear does NOT mean that you have cancer. The clinician will give you further instructions on what to do if your result is abnormal. Getting a pap smear is generally not painful, but can involve some discomfort.
People who have a uterus should get their first pap smear at 21. Discuss with your practitioner the timeline for subsequent pap smears. The best time of the month to see your clinician for your pap smear is 10 to 20 days after the first day of your period. It is also best to refrain from sexual activity for 24 hours prior to your appointment.
After the pap smear, the clinician removes the speculum from the vagina.
The clinician will put a thin rubber glove on one hand and lubricate one or two fingers of that hand with lubricating jelly. Gently, they will insert the finger or fingers into your vagina while placing the other hand on your lower abdomen. This allows the clinician to feel the size, shape, and position of your uterus, ovaries, and fallopian tubes, and to check for tenderness, growths, or other abnormalities. This exam usually does not hurt. Be sure to let the clinician know if you experience discomfort.
I had a vaginal exam at my last doctor appointment. Does that mean I had a pap test?
Not necessarily. Having a vaginal exam does not always include a pap smear. Always ask your clinician for the specifics of your exam.
I had a pap smear at my last pelvic exam, does that mean I had STD testing as well?
The pap smear and STD testing are not the same! You and your clinician should discuss whether STD testing is right for you. Don't assume that you had STD testing at your pap smear visit. Again, ask your clinician to explain exactly what she/he is doing during your exam.
REFERENCES: http://www.cdc.gov/cancer/cervical/basic_info/screening.htmTesticular Cancer Screening
- Stand in front of a mirror, check scrotal skin for any swelling.
- Examine each testicle with both hands. Place your index and middle finders under the testicle with the thumbs placed on top. Firmly but gently roll the testicle between your thumb and fingers. Feel for any irregularities on the surface or texture of the testicle. Look and feel for any hard lumps or nodules (smooth rounded masses) or any change in the size, shape, or consistency of your testicles.
- Find the epididymis (a soft, rope-like structure on the back of the testicle). If you're familiar with this structure you won't mistake it for a suspicious lump.
If you notice any changes or irregularities, tell your doctor immediately.
Source: Testicular Cancer Society
Breast Cancer Exam
Can detect a lump in your breast or other changes that might require more testing. During a clinical breast exam your doctor or nurse will:
- Look at both of your breasts shape, size, and texture of skin.
- Feel breasts with tips of their fingers to check if there are any lumps or irregularities.
- Start with one breast and then move to other side, including checking nipples and armpits.
- Talk to you about your risks for breast cancer and what you can do to help prevent it.
Source: Planned Parenthood
Should be done to help you understand the normal look and feel of your breasts.
1. Begin with a visual examination of your breasts
Sit or stand shirtless and braless in front of a mirror with your arms at your sides. To inspect your breasts visually, do the following:
- Face forward and look for puckering, dimpling, or changes in size, shape or symmetry.
- Check to see if your nipples are turned in (inverted).
- Inspect your breasts with your hands pressed down on your hips.
- Inspect your breasts with your arms raised overhead and the palms of your hands pressed together.
- Lift your breasts to see if ridges along the bottom are symmetrical.
If you have a vision impairment that makes it difficult for you to visually inspect your breasts, ask a trusted friend or a family member to help you.
2. Use your hands to examine your breasts
Common ways to perform the manual part of the breast exam include:
- Lying down. Choose a bed or other flat surface to lie down on your back. When lying down, breast tissue spreads out, making it thinner and easier to feel.
- In the shower. Lather your fingers and breasts with soap to help your fingers glide more smoothly over your skin.
When examining your breasts, some general tips to keep in mind include:
- Use the pads of your fingers. Use the pads, not the very tips, of your three middle fingers for the exam. If you have difficulty feeling with your finger pads, use another part of your hand that is more sensitive, such as your palm or the backs of your fingers.
- Use different pressure levels. Your goal is to feel different depths of the breast by using different levels of pressure to feel all the breast tissue. Use light pressure to feel the tissue closest to the skin, medium pressure to feel a little deeper, and firm pressure to feel the tissue closest to the chest and ribs. Be sure to use each pressure level before moving on to the next spot. If you're not sure how hard to press, talk with your doctor or nurse.
- Take your time. Don't rush. It may take several minutes to carefully examine your breasts.
- Follow a pattern. Use a methodical technique to ensure you examine your entire breast. For instance, imagine the face of a clock over your breast or the slices of a pie. Begin near your collarbone and examine that section, moving your fingers toward your nipple. Then move your fingers to the next section.
If you have a disability that makes it difficult to examine your breasts using this technique, you likely can still conduct a breast self-exam. Ask your doctor to show you ways you can examine your breasts.
Source: Mayo Clinic Breast Self-Exam