What is a breast examination?

A breast examination is looking at the size and shape of both breasts, feeling the breast tissue and checking to see if you have any fluid leaking from either nipple.

Why do I need a breast examination?

The breast examination ensures that your breasts are normal. It also helps your healthcare provider find any medical conditions (such as infections or tumors) that could become serious if not treated. Many healthcare providers recommend that you have breast examinations regularly when you become sexually active or by 18 years of age.

How common is breast cancer?

Breast cancer is a leading cause of cancer deaths in women throughout the world (age standardized rate for world population is 13/100,000). Factors that appear to increase the likelihood of developing breast cancer include:

• Age over 40
• Mother or sister with breast cancer
• Menarche prior to age 12
• No children or children only after age 30
• History of breast biopsies
• Overweight

What are the warning signs?

The changes that can be seen by looking at the breasts are:

• Unusual increase in the size of one breast
• One breast hangs unusually lower
• Puckering of the skin
• Dimpling or puckering of a nipple or areola
• Swelling in upper arm
• Change in the appearance of the nipple
• Milky or bloody discharge from a nipple

The changes that can be found by examining the breast are:

• Lump in the breast
• Enlargement of lymph nodes in axilla or neck

Will the examination hurt?

The breast examination will not hurt. Other than being uncomfortable because someone else is touching your breasts, there should be no pain or discomfort.

I feel scared to have one. Do other women feel this way?

It is normal to feel uncomfortable, embarrassed or scared during this examination. Many women complain that the most uncomfortable part of the examination is that it is embarrassing to show their breasts to a healthcare provider. It may help to remember that your healthcare provider is highly trained in performing these examinations. To make you feel more comfortable, you can have someone with you, such as your mother or close girlfriend, during the examination.

Do I have to take off my clothes?

You will be asked to remove your outer clothes, including your bra, from the waist up. You can undress in privacy and cover yourself with a cloth sheet or drape before your healthcare provider comes in for the examination.

Can I see what is happening during the examination?

Yes, it is important that you watch how your breasts are examined and listen carefully to what the healthcare provider says. You will also have the opportunity to learn how to perform breast self-examination.

How long will the examination take?

Usually the breast examination takes no more than 2-3 minutes. It takes an additional 5-10 minutes to teach you how to perform breast self-examination.

What is breast self-examination?

Breast self-examination is learning to look at and examine your own breasts each month. Doing this on a regular basis helps reassure you that you are healthy.

Why is doing monthly breast-self examinations important?

By doing monthly BSE, you also will have the best chance of finding a lump or other problem at the earliest stage (i.e., when it is small), and when treatment, if needed, will be the most effective and easiest to provide.

As shown in the figure below, women trained in BSE can detect smaller lumps than those who are not.

Average Size of Lumps Detected

Source: Spence 1994.

What is a pelvic examination?

A pelvic examination is looking at the labia, clitoris and pubic area and checking the inner female organs including the vagina, cervix, uterus and ovaries.

Why do I need a pelvic examination?

The pelvic examination ensures that your pelvic organs are healthy. It also helps your healthcare provider find any medical conditions, such as infections or abnormalities in the cervix or vagina, that could become serious if not treated. Many healthcare providers recommend that you have your first pelvic examination when you become sexually active or by 18 years of age.

Will the examination hurt?

The pelvic examination will not be painful. Many women describe their experience as a feeling of crowding or fullness in the vagina; however, there should be no pain. Sometimes a woman will feel discomfort, especially if she is not relaxed. Women who have not had a baby or who have an infection may feel some pain.

What will the examination feel like?

You will feel gloved fingers touching the outside of your genitals. During the bimanual examination, you will feel two fingers in the vagina and the other hand on the abdomen gently pressing the tissue between the two hands. At one point during the examination, the healthcare provider will insert an instrument called a speculum into the vagina. Healthcare providers sometimes will complete the examination by doing a rectovaginal examination by placing one finger in the rectum and one finger in the vagina. Doing this examination allows the healthcare provider to feel higher and deeper in the pelvis to ensure that everything is normal.

I feel scared to have one. Do other women feel this way?

It is normal to feel uncomfortable, embarrassed or scared during an examination. Many women complain that the most uncomfortable part of the examination is that they feel embarrassed to show their genitals to a healthcare provider. It may help to remember that your healthcare provider is highly trained in performing these examinations.

Do I have to take off all of my clothes?

You will be asked to remove your undergarments and other clothing as needed. You can undress in privacy and cover yourself with a cloth sheet or drape, if it is available, before your healthcare provider comes in for the examination.

What is the most common position for the pelvic examination?

The most common position is lying on your back with your feet resting in stirrups; however, various positions can be used for a pelvic examination. You will be asked to move your buttocks down to the end of the table and let your knees fall wide apart. The reason for this position and the stirrups is to give the healthcare provider enough access to the genital area.

Can I see what is happening during the examination?

Ask your healthcare provider if you can watch the examination by holding a mirror in your hand. Many healthcare providers are happy to show women their external and internal genital organs.

How long will the examination take?

Usually, the whole examination takes no more than 5 minutes. Although many women find the examination uncomfortable, it is important to your health now and in the future. After the first examination, most women find that it was not as uncomfortable as they might have imagined.

Can my healthcare provider tell if my cervix is healthy?

A Pap test or Pap smear is a screening test that helps healthcare providers find any abnormal changes in the cells of the cervix. A Pap test is done to find changes before they can become cancer. The Pap smear includes taking a sample of cells by wiping or scraping a small wooden stick (similar to a tongue depressor) over the cervix. During the Pap smear you will feel a swab being wiped across the cervix; this feels somewhat scratchy, but is not painful. If your Pap test is abnormal, do not be alarmed. Many women incorrectly believe an abnormal Pap test means they have cancer.

An alternative to a Pap smear is called visual inspection with dilute acetic acid. With this test, your healthcare provider looks at your cervix after it has been wiped with a small amount of vinegar solution. Putting this solution on the cervix does not hurt. It helps your provider immediately see if your cervix is healthy because abnormal cells appear white after being washed with vinegar.
 

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