Why is bimanual pelvic exam performed after pap smear?

Bimanual pelvic exam (BPE) is generally performed before, not after, a Pap smear during a comprehensive pelvic exam. The order of a standard pelvic exam is as follows:

1. History taking and visual inspection: The healthcare provider will ask about your medical history, menstrual history, sexual history, and any current symptoms. They may also visually inspect the external genitalia for any abnormalities.

2. Speculum exam: A speculum, a small instrument, is gently inserted into the vagina to separate the vaginal walls and visualize the cervix. This allows the healthcare provider to perform the Pap smear, which involves collecting a small sample of cells from the cervix for laboratory analysis to check for abnormalities, including cancerous or precancerous changes.

3. Bimanual pelvic exam (BPE): After the Pap smear, the healthcare provider will perform the BPE to examine the internal pelvic organs. This involves inserting one or two lubricated fingers into the vagina while pressing on the abdomen with the other hand. This allows the healthcare provider to assess the size, shape, and position of the uterus, ovaries, fallopian tubes, and any surrounding structures.

4. Rectovaginal exam (optional): In some cases, a rectovaginal exam may also be performed to assess the rectum and surrounding tissues, particularly if there are concerns about rectal bleeding, masses, or other abnormalities.

5. Breast exam (for females): If a breast exam is also included as part of the comprehensive exam, the healthcare provider may perform it after the pelvic exam. This involves examining the breasts for any lumps, changes in shape or texture, or other abnormalities.

It's important to note that the specific steps of the pelvic exam may vary depending on the individual's medical history and healthcare provider's preferences.