posted: 10/10/2008 12:00 am
Dear Dr. Myrtle,
I’m interested in seeing my own cervix. Could you tell me how to perform a cervical exam on myself?
Benefits of Cervical Self-examination
There are many benefits to examining your own vulva and cervix. By examining yourself regularly, you can gain a sense of what your body normally looks like. You can understand how your body is put together, what your discharges look like, and how your cervix and cervical mucus change throughout your menstrual cycle, or after menopause. For some women, doing a self-exam allows them to see a part of their bodies that they have learned to ignore or even fear. Other women like the sense of control they get from using a medical tool to see for themselves what others see. This helps to decrease their need to rely on what other people tell them about their bodies.
Also, some women struggle with a medical condition called vaginismus, in which the pelvic floor muscles spasm involuntarily, making penetration difficult if not impossible. In the recovery process, women who have regained control of their vaginal walls and pelvic floor muscles often find that examining themselves with a speculum prior to an examination by a health provider can give them confidence that the exam can be completed without pain.
Remember, this self-examination is for you. You are in control of it; you can go at your own pace and stop at any point if you wish. You can do all the steps listed here at once, or you can try one step at a time. Go at your own speed and within your own comfort level.
To perform a self-exam, you will need:
- a light source (flashlight, or lamp with a stand)
- a speculum (available in different sizes)
- lubricant (either w arm water or a sexual lubricant)
- a mirror with a long handle
- a comfortable, secure place for the examination.
To begin your self-examination, start by looking at your vulva. The vulva is the part of a woman’s body that lies between her legs. Many important body parts are located here, yet it’s a place that most women can’t see for themselves without a mirror. Let’s take a look. Find some comfy clothing, a private place, a mirror, and a lamp. You may want to recline on your bed with a pillow behind your back and a pillow on which to prop your mirror.
Spread your knees apart a comfortable distance (use pillows for your legs, too, if you’d like) and gaze upon your lovely vulva. See if you can identify the different parts of your vulva. There are the fleshy, outer labia, or lips, which are usually covered with hair (unless you remove it). Between these lie the hairless inner labia, which may or may not protrude from the outer lips. Some women have longer labia, while others have shorter labia; it is also completely normal for each labia to be a different size and shape. If you use your fingers to spread apart the inner lips, you will find the vaginal opening and urethral opening. Some women have a urethral opening that is small and difficult to see.
At the top of your vulva where the inner labia join, there is some flexible skin called the clitoral hood. If you pull back on the clitoral hood, you can expose the tip of the clitoris. Your clitoris may be quite small (it may even be difficult to see), fairly large, or somewhere in between. Your clitoris may be several different colors—from tan to pink to deep purple—and any or all of these colors are normal. The tip of the clitoris is the only part that’s visible, but the entire clitoris is actually about 4-5 inches long. It has a shaft which lies beneath the clitoral hood and 2 legs which extend just under the surface of the outer labia and which swell with blood when you become aroused. Also identify the anal opening and the perineum—the area between the vaginal opening and the anal opening. This is the area that allows for the most flexibility during any type of penetration, and it can be a sensitive sexual spot for some women.
Take note of the color of your skin in the different sections of your vulva, and whether you have any moles that need to be watched over time (if you notice that a mole grows or changes over time, contact your healthcare provider). Touch different parts of your vulva and see how they feel—is the skin smooth, wrinkled, velvety, flexible, cushiony, etc? Are some parts more sensitive than others?
Congratulations! You’ve now been formally introduced to your vulva. It is normal for every woman’s vulva to look asymmetrical (some parts bigger or smaller than others) and for every woman’s vulva to be different. In this way, we are all truly unique. If you’d like to see pictures of the beautiful diversity of vulvas, get a copy of the book Petals by Nick Karras, or the Cunt Coloring Book by Tee Corrine (currently out of print).
If you choose to continue with the self-examination, lie back with your knees bent and your feet placed comfortably wide apart. Using a small bit of lubricant or water on your hands, place your thumb about 1 1/2 inches into the opening of your vaginal canal and gently massage the skin between your vaginal canal and your perineum (see the picture in the next column). Can you make the muscle under your fingers clench? (Yes? That’s great! You’ve just contracted your pelvic floor muscles. No? Please see our Pelvic Floor Health brochure for more information.) To further relax your pelvic floor muscles, push down toward your anus and continue massaging and relaxing. This is also a great introduction to something called perineal massage, which helps maintain vaginal flexibility, especially for women transitioning through menopause. For more information, see our Vaginal Renewal booklet.
Before you begin this part of the examination, familiarize yourself with the speculum. Notice that there are two main pieces connected together with a hinge-like mechanism. These pieces look like the bill of a duck. On a plastic speculum, there is also a locking clip that props the duckbill open once you’ve put it into position. This allows you to adjust the speculum to your personal comfort level and lets you see your cervix more easily. Be sure you feel comfortable locking the speculum in the open position. Also, before you are ready for insertion, be sure that you can easily unlock it.
When you’re ready to insert the speculum, lubricate it lightly with a sexual lubricant like Liquid Silk. Hold the speculum with the bills closed, with the handle pointing toward either your right or left leg. Gently slide the speculum in, pointing the tip down toward the small of your back. If you feel discomfort, many women find that pushing the speculum straight down (away from the urethra) is more comfortable, since perineal skin and the pelvic floor muscles are most flexible there.
Once you have inserted the speculum, turn the handle either up or down with a gentle twisting motion. You may need to experiment in order to find a comfortable position.
After you have fully inserted the speculum, slide the duckbill open. You can lock the speculum handle or leave it unlocked, depending on how easy it is for you to see your cervix with the speculum in either of these positions (see the picture to the right). For some women, placing the speculum and finding thecervix may take some practice. Breathe deeply and manipulate the speculum gently while looking into the mirror. Focus the light source on the mirror to help you see better—this is usually more effective than shining the light into your vagina (a friend might help you with this).
The vaginal walls will appear pink and bumpy. The cervix will be smooth, glossy, and donut shaped, with a small, dark opening or dimple in the center (this is called the os, or opening to the uterus) that you may or may not be able to see. Depending on where you are in your menstrual cycle, your secretions could be whitish, clear, creamy, stretchy like egg whites, or bloody, if you are menstruating. If your secretions are frothy, yellowish or greenish, consult your healthcare provider.
Congratulations! You’ve formally introduced yourself to your vagina and cervix.
When you’re done, unlock the speculum and carefully withdraw it, allowing the duckbill to close gently and gradually as you remove it. Be careful not to pinch the skin as you close it. Clean the speculum with soap and water and store it in its bag. We don’t suggest sharing a speculum with others, because infections could be transferred between people.
I can’t find my cervix. Is that a problem?
No. It’s not uncommon for a woman to have difficulty locating her cervix by herself. At your next gynecological exam, ask for a mirror and take a look with the help of your healthcare provider, who can act as your guide. Most healthcare providers are quite willing to help you with this.
Inserting the speculum is painful. What can I do?
Some women experience pain with penetration, including inserting a speculum. Frequently, this can be due to the condition of your vaginal skin or the flexibility of your pelvic floor muscles. For more information on painful penetration and what you can do about it, see our Pelvic Floor Health brochure and Vaginal Renewal booklet, and/or consult your healthcare provider.