I did my first gynecological exam more than ten years ago in medical school, but I still remember my first one in medical school with a brave volunteer called a GTA--gynecologic training associate. Can you imagine being willing to have multiple nervous medical students perform their very first pelvic exam on you, while the rest of the group watches, and being relaxed enough to teach them along the way? These women deserve medals, and all of us with a vagina that's been examined by a doctor owe them a debt of gratitude! That first exam was pretty scary...we've all been on the receiving end of a tough exam, and I was so afraid of hurting her. We both survived that encounter, and I may have fumbled through the next few exams as well. But now, after countless exams, I've learned how to both be gentle and to examine what I need.

First, of course, I start on the outside. Once you scoot down to the edge of the table, "a little more, a little more," I'll check your skin for moles (you can get skin cancer even here), signs of STDs like herpes, and other problems like hemorrhoids--you can have them even if you haven't had a baby. My patients are often embarrassed about what they think I see: they'll even apologize for how they look/smell/feel! But you'd be amazed by the wide range of normal bodies. And--I can't say this enough--for me, examining your parts is like looking at an ear. Each one is a little different, but an ear is an ear.

There's another reason you have to assume "The Position": It causes you to slightly tilt your pelvis down, which helps you relax your pelvic muscles. (I know that telling you to relax during your exam is both oxymoronic and insulting...but not tensing your muscles does make the exam easier.) It also allows me to put in the speculum without banging the handle against the edge of the table. The speculum (they come in two varieties, plastic and metal) holds the vaginal walls open about 1-2 inches: just enough for me to get a look at your cervix, which looks like a small Munchkin with a hole in the middle. Then I can do a Pap test, scraping a few cells off the outside of the cervix with an instrument that's like a small spatula, and then collecting cells from inside the cervical opening with what looks like a mascara wand. I can also do tests for certain infections at this point, with a long cotton swab along the walls of your va-jay-jay.

Once the speculum comes out (blessed be), it's time for the manual exam. I'll place two fingers inside your vagina, and use the other hand to press down on your pelvis. At this point, my fingers can tell me even more than my eyes, and here is what they feel:
 

• Your cervix, which feels smooth and firm, very much like the tip of your nose. It sits at the end of your vagina looking like a wider, shorter cork in a bottle of Malbec. The cork's not a bad simile: since the cervix is always closed (except if you're in labor), it's why nothing that goes into the vagina--tampons, slipped condoms, the contraceptive ring--will ever get lost "up there."

• Your uterus, or your womb. It's usually the size of an orange or a baseball. With my inside hand behind it, I gently push it back and forth between my hands and feel if it's enlarged or if you've got fibroids, and assess its position. If you've heard that you have a "tipped" uterus, it means that yours tilts back toward your tailbone, or is "retroverted."  Perfectly normal, and nothing to worry about.

• Your ovaries, which are usually about the size of walnuts or golf balls. They feel very different from what's around them--your intestines are squishier, your bones are harder--ovaries feel almost like hard-boiled eggs. If I can't feel them, it's actually a good sign--it means they're small and not causing any trouble. 

Sometimes, I'll finish with a rectal exam--but that's material for another post. Then you're set for another year (and probably set for a glass of wine at this point as well).

The whole exam and how women feel is kind of amazing--no matter how we look on the outside, our insides feel pretty much the same way. Have you ever wondered about any parts of your pelvic exam...or of your pelvis, for that matter?