PER VAGINUM EXAMINATION

In any of your antenatal checkups, after completing your general examination, the doctor will proceed for a vaginal examination.
Why is an internal vaginal examination necessary?

At first visit-
1) To diagnose pregnancy in 1st trimester.
2) Assessment of the gestational age
3) To confirm intra uterine pregnancy
4) To identify any abnormality in the genital tract
5) A general examination of the cervix

Now a days transvaginal scans, being more informative, accurate and safer, are replacing routine internal examination in early days of pregnancy. So mostly you will be spared of the PV examination in your first trimester.

At any subsequent antenatal visit
1) For investigation of a threatened abortion- i.e. - if the patient complains of lower abdomen pain, excessive cramps, or any abnormal vaginal discharge.
2) To confirm diagnosis of pre-term labor
3) To confirm pre-term rupture of membrane
4) Assessment of the cervical length, smoothness, consistency and regularity of the surface.
5) For detection of cervical effacement or dilatation in a patient with a previous history of pre-term labor or a mid trimester abortion
6) A general pelvic assessment to predict the possibility of a normal delivery or an impending cephalopelvic disproportion.

And before labor-

1) To assess the favorability of the cervix prior to induction of labor
2) Identification of the presenting part in the pelvis
3) For artificial rupture of membrane to induce labor.
As a patient it is your right to be completely aware of the procedure and its cause. Your consent for the procedure is also important, though not on paper, but your doctor will definitely explain you about it and take you in confidence before proceeding for the examination. But being informed about the procedure beforehand will help to reduce your anxiety of unknown.
You will be first asked to pee and completely empty your bladder.
In a closed room and in complete privacy you will be asked to remove your bottom clothes and lie down on the doctor’s examination bed, with your legs spread open and bent at the knees. The accompanying nurse will help you to settle down comfortably with extra sheets if required. Any female accompanying you for the visit will also be allowed to be with you during the examination.
The doctor will the use his/her pre-washed, sterile gloved hands to first see the vagina by separating the labia. At this point he/she will look for any vaginal discharge or any abnormal protruding mass or growth.
In case of presence of any discharge, he/she might want to take a vaginal smear for examination. In that case, a bivalve speculum will be used to keep the vagina open and under a good source of light, vaginal swab will be collected from the upper vagina with the help of a small soft bottle brush tip on a long stick.
This procedure will be a little painful but it is not done in normal cases unless there is an indication.
Thereafter the doctor will proceed for per vaginum examination, by introducing two fingers, index and middle finger of the right hand deep into the vagina while keeping the labia separated with the fingers of the left hand.
Once inside the vagina he/ she will use the left hand to manipulate the fundus or top of the gravid uterus.
Per vaginum examination is done at least once during any one of the antenatal visits, may be either in the early, mid or late days of pregnancy as per the requirement of the presenting situation. It is certainly not painful but a little discomforting. It will be easier and more tolerable if you are mentally prepared for it. You should try to be completely relaxed and calm mentally and allow your pelvic muscles and thighs to be relaxed too. In that case the penetration will be easier and pain free.
It is completely normal and natural to feel uncomfortable and shy to spread open the legs even if the examining doctor is a female. But you have to trust your doctor and be assured that your privacy is being given utmost priority. You also have to acknowledge the fact that you are pregnant and at the time of your delivery, be it normal or a c-section, there will be a lot more medical personnel other than the doctor and the nurse present now, looking at your private parts in anticipation of the birth of the baby. So, it’s better to get comfortable with your examining doctor from this stage onwards.
You don’t need to feel embarrassed about the pubic hair growth down their even if you have gone unprepared for it, neither do you need to rush to get it waxed, trimmed or removed in a hurry. Because, doctors are used to seeing various kinds of growth and for pv examination it doesn’t matter at all.
Yes, before delivery or while nearing the term, you may want to go for removal as per your personal wish, if you are not comfortable with the idea of getting shaved off by a medical personnel. So, ladies, it is the time to shed down all reservations and shyness and start getting prepared for the upcoming delivery on the D day as well as for breast feeding in public. These natural functions of our body should not pull us down from our path of moving ahead as an urban, modern, achiever woman of the 21st century at all.