A Pap smear, or Pap test, is a specific procedure for cervical cancer screening that does not inherently involve the rectum. However, the Pap smear is typically performed as one component of a broader physical assessment called the comprehensive pelvic examination. It is within this larger context that a rectal exam may sometimes be included, though the procedures are distinct.
The Purpose and Procedure of a Pap Smear
The Pap smear is a screening tool designed to detect precancerous or cancerous changes in the cells of the cervix. It looks for cellular abnormalities (dysplasia), often caused by the human papillomavirus (HPV). Early detection allows treatment before these changes develop into cervical cancer.
The procedure involves inserting a speculum into the vagina to visualize the cervix. A small brush or spatula collects a cell sample from the transformation zone. The collected sample is then sent for microscopic analysis to identify abnormal findings. The sample may also be tested for high-risk HPV strains (co-testing).
The Comprehensive Pelvic Examination
The Pap smear is part of the comprehensive pelvic examination, a multi-step physical assessment of the female reproductive organs. This broader exam begins with a visual inspection of the external genitalia, where the provider checks the vulva for irritation, lesions, or other abnormalities.
The second part is the speculum examination, during which the Pap smear cell collection occurs. The third part is the bimanual exam. The provider inserts one or two lubricated fingers into the vagina and uses the other hand to press down on the lower abdomen.
This bimanual technique allows the provider to feel the size, shape, and position of internal structures, including the uterus, ovaries, and fallopian tubes (adnexa). The goal is to detect abnormal masses, tenderness, or growths, such as cysts or fibroids, that cannot be seen visually.
When a Rectal Exam is Performed
A rectal exam is not a standard, routine part of every pelvic examination. It is a conditional step performed when specific clinical indications are present or when the patient reaches a certain age. When performed alongside the pelvic exam, it is often called a rectovaginal examination.
A primary reason for the rectovaginal exam is to better assess the posterior parts of the pelvis, such as the uterosacral ligaments and the rectovaginal septum. By placing one finger in the vagina and a second finger in the rectum, the provider can better palpate a retroverted uterus or certain adnexal masses.
The rectal exam is also performed to check for non-gynecological issues, especially in patients presenting with relevant symptoms. These symptoms include rectal bleeding, unexplained changes in bowel habits, or pelvic pain. It allows the provider to screen for hemorrhoids, assess anal sphincter tone, and check for masses or tumors in the lower rectum.
For some women, particularly those over 50, a rectal exam may be recommended as part of routine physical screening. However, a separate colonoscopy remains the gold standard for colon cancer screening.