What purpose is served by my ob-gyn inserting his finger in my ass during a pap smear?

August 15, 2007 2:37 PM

I went to a new doctor on a recommendation from a friend to get Implemnon (sp?). The ob-gyn performed a pap smear (it's been a year since my last one). At the end of it, he stuck his finger in my ass -- he was feeling my belly at the same time. Why did he do it?
posted by anonymous to health & fitness (11 comments total)

Palpating your Uterus and probing for cysts, not very hot but likely the reason.
posted by Freedomboy at 2:41 PM on August 15, 2007

poking around to feel if there are any unusual masses like abdominal tumors or ginormous cysts or something like that.
posted by rmd1023 at 3:10 PM on August 15, 2007

Digital rectal exam is what it's called.
posted by katemonster at 3:12 PM on August 15, 2007

Yes, most likely feeling for masses. Just as a side note, if you're curious and/or concerned about this kind of thing, please feel free to ask your doctor to explain to you each thing they do as part of your pelvic before they do it. A good doctor should be willing to do that, and it can make the whole experience less weird, I've found.
posted by Stacey at 3:38 PM on August 15, 2007 [1 favorite]

You don't push on the belly during a digital rectal exam, but you would during a rectovaginal exam - did he also have a finger or two in the vagina? This can be helpful in assessing the uterus if it is retroverted or retroflexed (tilted back).

Please tell me this guy warned you before sticking his finger in your bum!
posted by tuff at 3:57 PM on August 15, 2007

I hope it's clear that it's totally normal for a gynecologist to examine your rectum. It's definitely not pleasant, and not all docs have the best bedside manner, but it's not out of the ordinary.
posted by annabellee at 5:48 PM on August 15, 2007

It's a part of the bimanual exam. Basically it's the way to examine the pouch of douglas (peritonealized free space between the vagina and rectum) for abnormalities (tumors, endometriosis, etc). It's the 'full-service' gyn exam.
posted by i_am_a_Jedi at 7:23 PM on August 15, 2007

Jedi is correct. The bimanual (two-handed) female pelvic exam something I learned to do as a medical student; as I progressed further in my medical career, I learned that a lot of docs don't do it. Some believe that it's not useful, but I believe the majority of them omit it because they are uncomfortable with it, fear that their patient will be uncomfortable with it, and/or they don't want to be sued.

This is kind of too bad in my opinion because it's part of a proper comprehensive female physical exam and it can be useful (in experienced hands) in diagnosis of pelvic masses ranging from ovarian cysts to cancer.
posted by ikkyu2 at 8:58 PM on August 15, 2007

Yes , many doctors don't perform this -- unfortunately, as I learned. Had my GP done a bimanual pelvic exam, my ovarian cancer would likely have been diagnosed and treated a good four or five months earlier than it was, potentially sparing me a uterus and cervix.
posted by Felicity Rilke at 10:55 PM on August 15, 2007 [2 favorites]

I hate to be a stickler, but what anon is describing is not the bimanual exam. It is a rectovaginal exam, which can be part of a pelvic exam. The bimanual exam, meaning with two hands, is when one or two fingers of one hand are in the vagina, and the other hand is pressing on the lower abdomen at the same time. The bimanual is standard for any pelvic exam. The rectovaginal exam is NOT routinely performed by all providers.
posted by tuff at 4:14 AM on August 16, 2007

While they're in there, you can ask in advance for the fecal occult blood, and they will have the cardboard sleeve on the counter handy. It's not expensive, and a good idea to do once in a while.
posted by unrepentanthippie at 6:57 AM on August 16, 2007