[6] During the pelvic exam, sample of cells and fluids may be collected to screen for sexually transmitted infections or cancer (the Pap test).

[9] In 2014, the American College of Physicians (ACP) published a review of the benefits and the risks of the exam and issued a guideline that recommended against performing this examination to screen for conditions in asymptomatic, nonpregnant, adult women, concluding that the potential harms outweighed the demonstrated benefits and that screening pelvic exams in asymptomatic women did not reduce mortality or morbidity rates.

[7] The guideline concluded that there was evidence of harm, including fear, embarrassment, pain, discomfort and unnecessary surgery.

[10] A 2020 update of the literature by the US Preventive Services Task Force concluded that the evidence remained insufficient to assess the balance of benefits and harms of screening pelvic examinations in asymptomatic women.

[11] Annual "well-woman visits" are an occasion for gynecologists to identify health risks for women; ACOG has noted that these visits may also include clinical breast examinations, immunizations, contraceptive care discussions, and preventive health care counseling.

They may have experienced sexual assault or negative experiences with pelvic examination in the past, which may lead to the exam triggering strong emotional and physical symptoms.

[15] Patients generally prefer to be asked about past experiences and are often helpful in suggesting ways to mitigate the discomfort of the exam.

Prior to asking the patient to position herself on the exam table or chair for examination, the examiner should collect all the instruments needed for the exam and any planned procedures, including the speculum, light source, lubricant, gloves, drapes, and specimen collection media.

During the internal exam, the examiner describes the procedure while doing the assessment, making sure that the patient can anticipate where she will feel the palpations.

[20] At this point of the pelvic exam, the examiner will insert the speculum to visualize other internal structures: the cervix, uterus, and ovaries.

The bimanual component of the pelvic examination allows the examiner to feel ("palpate" in medical terms) the structures of the pelvis, including the vagina, cervix, uterus, and adnexae (structures adjacent to the uterus, which include the ovaries and any adnexal masses).

The adnexal structures are similarly palpated, noting any enlargement of the ovaries and if present, the size, shape, mobility, consistency, and tenderness of ovarian/adnexal masses.

It also allows palpation of the recto-vaginal septum, the intra-abdominal area posterior to the uterus (the cul-de-sac or pouch of Douglas), and the adnexal.

[22] Nodularity posterior to the uterus along the uterosacral ligaments has been associated with pelvic endometriosis as well as implants of ovarian cancer.

Subsequently, beyond the 12th week of gestation, the uterus can be felt above the pubic bone, and abdominal examinations assess growth.