When a person with a cervix turns 21—or when they have been sexually active for three years (whichever is later)—it is important for them to start getting regular pelvic exams and pap tests, regardless of sexual orientation.
Pelvic exams and pap tests can detect early signs of health problems, including cervical cancer and sexually transmitted infections. Based on current health recommendations, pelvic exams and pap tests should be done by a doctor every three years for folks between the ages of 21 and 65, though a person might need to have more or less frequent tests based on their medical history and previous test results. The best time for a pap test is around five days after a person’s period has ended (i.e., five days after they finish bleeding).
Before a pelvic exam, the doctor will likely ask a person questions about their period, whether they are sexually active or not, what type of contraception they are using if they’re sexually active, and if they have noticed any changes in their body, such as pain, unusual discharge, or bumps. The doctor will ask the person to lie down on their back while they place one hand on their abdomen and then two gloved and lubricated fingers into their vagina. This is called a bimanual exam and helps the physician to feel the shape of the ovaries and the uterus inside a person’s body.
After examining the vulva, the doctor will place an instrument called a speculum into a person’s vagina. A disposable, plastic vaginal speculum with two valves (or ‘beaks’) is often used in office gynecology.
Although it can feel weird or sometimes a bit uncomfortable for someone to have a speculum inserted into their vagina, it should not cause significant pain. The speculum allows the doctor to see a person’s cervix and to insert a small wooden spatula (which looks like a popsicle stick) inside the vagina to gently remove some of the cells from the cervix for testing. The cells are smeared onto a glass slide (a “pap smear”) and sent to a laboratory to test for abnormal cell growth and if requested, sexually transmitted infections (STIs).
If a person wants STI testing done during their pelvic exam and pap test, they usually need to ask for this specifically. Getting a Pap test is not the same as an STI test. Doctors cannot do this testing without a person’s permission.
The pelvic exam should not hurt, and if at any point it does, a person should make sure to let their health practitioner know. If they feel uncomfortable about having a pelvic exam done, they can ask that the doctor’s assistant be present in the room with them or even bring a friend along for support. If it helps, remember that the doctor has probably seen hundreds of vaginas (or more).