Chapter 20: The pelvic exam
When to do a pelvic exam
It is safe and useful to do a pelvic exam when:
• the woman wants to know about the health of her cervix, womb, and ovaries.
You should certainly do this exam if the woman has signs of infection or
cancer. But women can have infections or cancer in the cervix or womb and
have no signs. So if possible, women should have this exam every few years —
even if they have no signs of problems.
• the woman is pregnant and you need to know how long she has been pregnant.
• the woman wants an IUD (see Chapter 21).
• the woman is having problems after a miscarriage or abortion (see
Chapter 22), and needs an MVA (see Chapter 23).
WARNING! It is not safe to do a pelvic exam when:
• the woman is in labor. It is not necessary to do a visual exam,
a speculum exam, or a bimanual exam when a woman is in
labor. If you must check her cervix to see if it is opening, see
• the woman has broken waters. If the woman is pregnant and
her waters are broken, this exam can spread an infection into
• the woman is in late pregnancy and is bleeding from the
vagina. If the woman is bleeding from the vagina in late
pregnancy, she may have placenta previa (see page 112).
Do not do a pelvic exam — or you could make the
• the woman gave birth in the last few weeks.
Making the pelvic examsafe
The pelvic exam is usually safe, but it can have risks. When you do
a pelvic exam, you must be sure not to put any germs into the
woman’s vagina. When you do a pelvic exam:
• always wash your hands well, before and after the exam (see page 53).
• always wear very clean or sterile plastic gloves (see page 54).
• always use clean tools.
If you cannot wash your hands or wear gloves, it is not safe to do the exam.
There may be other ways to get information about a woman’s health if you
cannot make a pelvic exam safe, or you do not know how to do a pelvic exam, or
the woman does not want a pelvic exam.
A Book for Midwives (2010)