Once a woman begins to have sex or reaches age 16-18, she should have regular pelvic exams, which should include a Pap smear. The gynecologic exam evaluates overall wellness and looks specifically at the development/health of a women's breasts and genitals.

Besides routine check-ups, it is important that you have a pelvic exam if you experience any of the following symptoms:

• heavy vaginal discharge that itches, burns, or smells,
• heavy vaginal bleeding,
• bleeding between periods,
• painful intercourse,
• menstrual cramps that cause you to miss school or work,
• any signs of pregnancy (a missed period, tender breasts, upset stomach),
• no signs of puberty (changes in breast size, hair under the arms and between the legs) by age 14 or no periods by age 16, or
• any side effects from birth control.

What is a pelvic exam? Will it hurt?

A Pap smear is a very important piece of a woman's annual examination. Before the exam, feel free to talk with the nurse or clinician about any worries you may have. You will find that she can answer your questions and help you relax. And don't be embarrassed--clinicians do many exams every day.

To get ready for the exam, you undress from the waist down and cover yourself with a sheet. You then get up on a table, put your feet in the footrests (stirrups), and scoot to the end before lying down.

A speculum is used to gently open the vagina. Relax and breathe deeply. Let the clinician know if you are at all uncomfortable--it?s not supposed to hurt. The speculum holds the vagina open so that the cervix (the opening of the uterus) can be clearly seen.

A flat stick is used to take some cells from your cervix. These will be tested (using the Pap test) to make sure that no unhealthy or pre-cancerous cells are present. The clinician will also put a finger in the vagina to feel the uterus and ovaries and make sure everything is healthy, and she will check for signs of any disease.

How is a breast exam performed?

During the annual exam, the clinician will also check your breasts for lumps. He or she will press gently in a circular motion around the breast and under the arm. Also, any dimpling or puckering of the breasts or any discharge from the nipples will also be checked at this time. Your clinician will teach you how to do a breast self-exam so that you can check for changes every month after your period.

Since breast cancer is the most common form of cancer among American women, it is important that you have periodic breast exams.

The most common cause of breast lumps in women ages 30-50 are fibrocystic changes. This is not a disease, but a non-cancerous condition experienced by at least 50% of women in their reproductive years.

Signs and Changes to watch for:

• lumps or thickening
• redness or soreness of the skin
• puckering or dimpling
• swelling
• nipple becomes drawn into the chest
• nipple changes shape or is crusty

Annual gynecological exams are available at all PPECI health centers. Costs for the exam and basic laboratory tests are on a sliding fee scale, ranging from $0-$140. For more information, please contact your nearest PPECI health center.

Exams for Men

The sexual health of men is just as important as that of women. Planned Parenthood recognizes that importance, and offers sexual health care exams for men. This yearly examinations are important, as they may identify not only Sexually Transmitted Infections (STIs), but also early warning signs of various cancers.

Each practitioner performs an exam a little differently. And, not every exam will cover the exact same things, due to the comfort level of the client. However, the following are steps that may be done during an exam of a male client.

Usually, the patient will stand in front of the seated practitioner, resting his back or buttocks against the exam table. He will first unfasten his pants and the lower his pants and underwear to the floor. Then, he will hold his shirt above his navel. This gives the clinician an appropriate view of the genital area.

The first stage in the exam is to visual inspect the penis and glans for signs of inflammation, lesions and discharge. Next, the clinician will touch the shaft of the penis, feeling for urethral structures and masses. The base of the shaft and the urethral junction will also be felt.

The scrotum will be visually inspected for contours and rashes, then the testes will be felt for masses and tenderness. If a mass is felt within the testes, a process called transillumination may be used. Transillumination involves placing the flashlight to show light through the teste, in order to evaluate the mass(es).

A rectal examination may be completed in order to exam in the prostrate gland. The rectal exam is a quick exam with little discomfort. To complete a rectal exam, the clinician will ask the patient to turn and face the exam table, bending over at the waist.

The sacrum area will be inspected for cysts or sinus. Next, the perianal area (between the penis and the anus) will be inspected for hemorrhoids, warts, and other masses. Then, the clinician will quickly inspect the anus while the patient "bears down." the inspection of the anus will include feeling the sphincter, rectal walls (for masses) and prostate gland.

The minimal cost for a male exam is $40 and does not include any additional testing or medications.