Doctors might perform a Pap smear, which is a test for cervical cancer. The patient lies on her back and places her feet in supports called stirrups, and the doctor inserts a speculum to keep the vagina open enough so that a swab can be inserted to scrape a small sample of cells from the cervix. Pap smears used to be done annually, but guidelines now recommend them every three to five years for women 21 and older. A breast exam might also be done.

Sometimes, but not always, gynecologists conduct a pelvic exam, which is usually the most uncomfortable part for patients. A doctor uses a speculum to examine the vagina and cervix and then places fingers of one hand inside the vagina and presses on the abdomen with the other hand. It’s intended to assess whether the uterus, fallopian tubes, ovaries and cervix are of a healthy size and position and an attempt to detect ovarian or other cancers.

When should gynecologists perform pelvic exams?

They are definitely not necessary for every patient. In fact, the American College of Physicians recommended in 2014 that pelvic exams not be done on nonpregnant women who show no symptoms of gynecological problems. The report found no evidence that pelvic exams were better at detecting ovarian cancer than ultrasounds or blood tests, and there was slim evidence of success detecting other conditions like bacterial vaginosis. And it said some patients experienced embarrassment or anxiety and sometimes didn’t return for another visit if the pelvic exam caused pain.

The American College of Obstetricians and Gynecologists (ACOG) recommends pelvic exams for women 21 and older, even if they have no symptoms. But it says the exam is unnecessary to screen for sexually transmitted diseases, which can be done with vaginal swabs or urine tests. And it isn’t needed unless a woman has begun taking oral contraceptives. Hormones from birth control pills can affect the vaginal lining and the cervix, and a pelvic exam can identify those effects, said Dr. Hoskins, who is also chairwoman of ACOG’s New York State district.

She also does pelvic exams on women who engage in “risky behavior,” like “if she’s telling me, ‘On weekends, I go to parties and I have multiple partners,’ ” Dr. Hoskins said.