Preparing For Your Visit
If it's your first gynecological visit, you may be wondering what the exam will be like. "The most important piece of information about this exam is that it doesn't hurt," says Karen Nichols, DO, an osteopathic internist. "Young women also should know that they have the right to ask for explanations of procedures at any point during the exam."
To be sure you get answers to any questions you may have, Dr. Nichols suggests you write down your questions beforehand and bring that list to the appointment. She encourages patients to ask about anything, even embarrassing or uncomfortable issues, because such matters are probably the most important ones to address. "When dealing with your health, no question can be considered stupid," Dr. Nichols stresses.
During the appointment, it's important to be ready with information about your family medical history, especially patterns of breast disease or cancers of the reproductive organs. In addition to inquiring about your family, the physician will ask questions about personal health, like the age when you started menstruating, when your last period started and how long your period usually lasts.
When to Schedule a Visit
Dr. Nichols emphasizes a few points to keep in mind when scheduling a gynecological exam. First, young women should get this exam when they become sexually active or reach age 18, whichever comes first. Also, women need to remember to make an appointment when they will be between menstrual cycles.
Women should immediately make an appointment if they experience any of the following problems:
Severe pain in the abdomen or pelvis
Unusual pain in the vagina
Unusual discharge, itching or bumps in or around the vagina
Exposure to a sexually transmitted disease
Severe pain during periods or irregular periods
Breast discharge, changes in breast size or changes in the skin of the breast
Pain during intercourse
It's Exam Day - What Can You Expect?
First, you'll sit down with the physician and talk about your medical history, both personal and family. During this time, you can also bring up any questions you may have about birth control, sexually transmitted diseases (STDs), menstruation or other issues.
Next, you'll change into an examination gown. Usually, you'll be given a sheet to drape over yourself as well. When the physician returns to the room, he or she will perform a breast exam to look for lumps that may be a sign of cancer. If you've never done a self exam, the physician can show you how to do it and tell you what to look for. It's strongly recommended you perform self-examinations every month; the best time is about 10 days after your period.
The Pelvic Exam
For the pelvic exam, you'll be instructed to slide to the end of the table and place your feet into stirrups. If you have any questions about how the exam will work, just ask your physician to explain the procedure. It's important to stay relaxed because you will be more comfortable and the exam can be more complete.
The first step in the pelvic exam is for the physician to examine the external genital area for any signs of irritation, discharge, cysts, genital warts or other problems. Next, the physician inserts a speculum. This instrument, which is made of metal or plastic, is used to separate the walls of the vagina. Once placed inside, it is opened up so that the doctor can examine the cervix and the vaginal walls.
If you need to be tested for any STDs, the physician will collect cervical mucus on a cotton swab. If you are at risk for any STDs, you need to tell your physician up front.
"It's so important for patients to be honest about their sex lives and their risk for contracting STDs," stresses Carol Henwood, DO, an osteopathic family physician in Pennsylvania. "For instance, human papilloma virus (HPV), more commonly known as genital warts, causes 95% of cervical cancers."
If tests do not need to be conducted for STDs, a Pap smear will be done. This involves using a small brush or spatula to collect cells from the cervix. This test can detect the presence of pre-cancerous or cancerous cells, infections of the cervix and thinning of the vaginal walls due to lack of estrogen.
Next, the doctor inserts gloved fingers into the vagina while pressing on your abdomen to examine your internal organs—the uterus, the fallopian tubes and the ovaries.
Lastly, the physician will insert a gloved finger into the rectum to check the condition of the muscles in between the vagina and the rectum. Sometimes the doctor will have one finger in the rectum and one in the vagina for a more thorough exam.
When that test is completed, you will have successfully completed your first gynecological examination. Results from the Pap smear are usually ready in 7-10 working days. If the results come back normal, you will not need another exam until the next year. If the results are abnormal, your physician will schedule you for follow-up exams and possibly advise you about other treatments.
Sources: American Osteopathic Association and American Cancer Society