Facts on File Encyclopedia of Health and Medicine

over the glans. When these measures are inade-
quate, the doctor may make an incision through
the foreskin to release it. The definitive treatment
for paraphimosis is CIRCUMCISION(surgical removal
of the foreskin).
See alsoPHIMOSIS.

pelvic examination A manual and visual exami-
nation of a woman’s VULVA, VAGINA, and CERVIX. A
routine pelvic examination has three parts: visual
examination of the external GENITALIA, bimanual
palpation, and speculum examination of the inner
vagina and the cervix. A pelvic examination is
painless and is part of a ROUTINE MEDICAL EXAMINA-
TIONfor women beginning around age 18 and con-
tinuing throughout life. For a routine pelvic
examination a woman lies on her back on the
examination table with her feet in stirrups and her
knees spread apart. The doctor also performs
pelvic examination during labor to assess the sta-
tus of the cervix and progression of labor.
Visual examination The doctor visually exam-
ines the external genitalia to detect abnormalities

such as growths, sores, discoloration, and other

indications of INFECTIONor disease.

Bimanual examinationFor the bimanual por-

tion of the pelvic exam the doctor inserts two

gloved and lubricated fingers into the vagina and

with the other hand palpates the outside of the

abdomen. This procedure allows the doctor to feel

the size and placement of the UTERUS and the

OVARIES, which may detect abnormalities such as

swelling, hypersensitivity or PAIN, displacement

(such as tipped uterus), and other indications of

health concerns.

Speculum examinationThe doctor then inserts

a lubricated speculum into the vagina. The specu-

lum has two opposing blades that fit together to

form a smooth, thin blade that easily enters the

vagina. Once the speculum is in position the doc-

tor gently opens the blades to spread apart the

walls of the vagina, providing access to the cervix.

The doctor visually examines the cervix and inner

vagina with the aid of a bright light, and may take

a cervical smear (sampling of cells and mucous

from the cervix) for a PAP TESTor other laboratory

316 The Reproductive System

PAP TEST RECOMMENDATIONS

Woman’s Age Health Status Pap Test Interval
under 21 sexually active every year

21 to 30 all women regardless of health status every year

31 to 64 three consecutive normal Pap tests every two to three years
noSEXUALLY TRANSMITTED DISEASES(STDS)

31 to 64 multiple sex partners every year
HUMAN PAPILLOMAVIRUS(HPV) INFECTION
abnormal Pap test within three years
has had treatment for cancer of the CERVIXor endometrium (UTERUS)

65 to 70 normal Pap tests for the previous 10 consecutive years no longer necessary
total HYSTERECTOMY

any age mother took diethylstilbestrol (DES) when she was pregnant every year
HIV positive
organ transplant recipient
long-term corticosteroid therapy
impaired immune function