An Ounce of Prevention... How to Do Self-Exams

Knowledge of your body is key to good health. If you don't know what you normally feel like, you won't be able to recognize signs of illness or infection. This also applies to our reproductive and genital health. Vaginal and breast self-exams help us to feel more comfortable with our bodies and gives us a baseline of how we look and feel when we're healthy. Self-exams also allow us to take action in protecting ourselves from cancer and cysts, since with regular self-exams we are more knowledgeable about our bodies than health practitioners who examine us once a year. However, they should not replace annual exams by professionals and it is best to begin self-exams after getting a pelvic and breast exam to make sure that you are healthy and that your baseline will be accurate. The information on breast self-exams is from "How to Do Breast Self-Examination," a 1988 pamphlet from the American Cancer Society. The section on vaginal self-exams is from Contraceptive Technology Update's Women's Health Patient Education Supplement (May 1995) and a brochure called What Every Woman Should Know by R. Allen Lawhead, MD. For more information call (404) 265-3614 or write R. Allen Lawhead, MD, Director of Gynecologic Oncology, Cancer Center of Georgia, GBMC, 285 Boulevard, Suite 430, Atlanta, GA, 30312, or contact Columbia or Barnard Health Services (go to the Health Introduction for phone numbers).

Breast Self-Exams

BSEs should be performed once a month after your menstrual period, when breasts aren't tender or swollen. If you're not always regular, do it on the same day every month. If this is your first BSE, ask your health practitioner for detailed instructions and so that you can be sure that what you feel is normal and healthy. Don't get upset if you feel some lumps or hardness; that's natural. It is also normal if your breasts are not exactly the same size.

How to perform the BSE

Most women examine themselves both standing up (usually in the shower) and lying on their beds (depending on the section of the exam).

Lie down with a pillow under your right shoulder and place your right arm behind your head.
Place the finger pads of your three middle fingers on you left hand on the outer part of your bare right breast. Pressing gently but firmly, circle inwards until you have reached your nipple. You can also move up and down or in straight lines out from the nipple, but do it the same way each time.
Gently squeeze the nipple and look for any discharge.
Lower your right arm and switch, raising your left arm and examining your left breast with your right hand.
Standing up in front of a mirror, check for changes in the way your breasts look. Look for dimpling of the skin, changes in the nipple, or redness or swelling.

What to look for

If any of the following occurs, check with your health practictioner.

you find any changes
you have pain in your breast
you have any worries about what you have found

Note: You may have seen instructions to squeeze your nipples to check for discharge. However, many practitioners do not advise doing this because overstimulation can cause a normal discharge and lead to unnecessary anxiety.

Vaginal Self-Exams

VSEs should be performed once a month between menstrual periods. Women with a history of vulvar disease should examine themselves more often, perhaps every two weeks. VSEs are especially important because of the link between genital warts, which have increased by 500% over the last 15 years, and vulvar cancer. Other STDs can also play a role in vulvar cancer.

How to perform the VSE

Find a comfortable, well-lighted place to sit. You may find it easier to squat over the mirror, perhaps in the bathroom. Hold a mirror in one hand and use the other to separate and expose the parts of the vulva around the vaginal opening. Once you have a good viewing position, examine the main parts of the vulva as follows:

Check the mons pubis. Look for any bumps, warts, or ulcers. Also look for any changes in skin color, such as white, red, or dark areas. Then use your fingertips to check any visible changes and to sense any bump beneath the surface.
Check the clitoris and the areas around it by looking and touching.
Examine the labia minora. Look and touch by holding the skin between thumb and fingers.
Look closely at the labia majora. Examine both right and left just as you did with the labia minora.
Move down to the perineum and check carefully.
Examine the area around the anal opening, both looking and touching.

What to look for

a new mole, wart, or growth of any kind
new areas of discolored skin, especially newly developed white, red, or dark skin areas
ulcers or sores, except for any minor injury with a known cause
areas of continuing pain, swelling, or itching

Report any new growths or changes to your health practitioner as soon as possible.

A particularly helpful page for those interested in VSEs is The Sexual Anatomy of Women.

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