Your First Visit To The Gynecologist: What To Expect
When You Should Go
The first visit to a gynecologist can be unsettling. Learning what to expect before you have your first exam will help you be more comfortable during the exam. Look at the visit as an opportunity to learn more about your body and get answers to any questions you may have.
Regular gynecologic exams are important, even if you aren't sexually active. Your doctor may be able to identify early changes of breast and cervical cancers when they are easily curable. Testing for sexually transmitted diseases is important when you become sexually active so that infections can be identified and treated quickly so that your pelvic organs and general health are protected. The office visit will also give you a chance to talk with your doctor about general health concerns. It may be helpful to schedule an initial visit with your doctor just to talk about your health and your concerns. Then, schedule an appointment for your first examination at a later date.
You should see a gynecologist when you become sexually active, even if that doesn't include intercourse, or when you turn 21. You should also see a gynecologist if you are having abnormal vaginal bleeding or discharge, unusual menstrual pain, or other unusual pain in your pelvis or abdomen.
Before You Go
Schedule your appointment about a week before or after you expect your period. Menstrual blood can make it impossible to analyze the results of the Pap smear, therefore it can interfere with detection of abnormal or cancerous cells of the cervix.
To help your doctor get the most information from the exam, here are a few ways to prepare:
- Don't douche or use vaginal creams or lubricants for at least 24 hours before the exam.
- Prepare a list of questions. It's easy to forget things once you're in the doctor's office. Make notes of any worrisome symptoms or concerns, such as menstrual irregularities. Feel free to ask about any health problems that may be worrying you, even if they don't involve your reproductive health. No question is stupid. This is the place to get answers to your questions.
- Prepare your answers to questions the doctor may ask you. You may forget dates, previous illnesses or other important information when you are sitting in the office. You also may want to think about your answers to some questions, such as whether you want to use birth control.
The General Checkup
Usually there will be a detailed questionnaire or form asking you questions about your health and lifestyle.
Be honest with your answers, even if some of the questions make you feel uncomfortable or embarrassed. The information you provide may be helpful in your treatments. If you are under 18 and want to talk about something you don't want your parents to know, ask if your conversation can be kept confidential.
When you are called into the office, a nurse or medical assistant, will weigh you, take your blood pressure and check your pulse. You may also be asked to provide a urine sample, which is used to test for pregnancy, diabetes and kidney or sexually transmitted diseases. To give the urine sample, you go into a bathroom and urinate into a wide-mouthed plastic cup. It's not as difficult as it may sound. You can start urinating, then move the cup under the stream to catch a small amount.
In some cases you'll be asked to leave the cup of urine in the bathroom where the assistant will get it when you're done. Or you may be asked to bring the sample to a nurse or laboratory technician in the office. Even if you aren't asked to provide a urine sample, take a moment to urinate before the exam. This will help you feel more comfortable when your doctor does the internal exam.
Your doctor will begin by reading your answers to the questionnaire and asking you questions if more information is needed or if your answer isn't clear. If you let the office know this is your first visit, many doctors will also take time to explain the procedures before starting the examination.
Before the internal exam, your doctor will listen to your heart and lungs and feel your abdomen to see if the liver or spleen is enlarged.
He or she will then examine your breasts. The breasts may be examined while you are sitting up, lying on your back on the examining table, or in both positions. Your doctor will examine your breasts for lumps, thickening or other irregularities, or discharge. Sometimes the breast tissue and nipple may be firmly pressed or squeezed slightly during the exam.
This shouldn't hurt, but some women's breasts can be tender at certain times of the month, especially the few days before your period starts.
If the exam is uncomfortable, let the doctor know. During the exam, your doctor will also explain how to examine your own breasts at home. Self-examination can help you to detect unusual lumps or early changes of breast cancer.
The Pelvic Exam
This is the part that some women fear. Just remember that the exam usually doesn't hurt and takes only a few minutes.
Male doctors usually ask a female nurse to come into the room during the exam. If he doesn't do this, you may ask for a woman to be in the room as a chaperone.
You'll be asked to lie back on the table, place your feet in the stirrups or footrests at the end of the table, and slide your hips to the edge of the table.
Your doctor will wear gloves during the exam. He or she will first inspect the external parts of your genitals for irritation, sores, unusual moles, lumps or other abnormalities. Then your doctor will insert an instrument called a speculum into the vagina. This is a device shaped like a duckbill that holds the walls of the vagina open. Your doctor may warm the speculum first or coat it with a small amount of lubricating jelly to make it easier for the speculum to be placed within the vagina. The doctor inserts the speculum, then slowly opens the speculum to see the vaginal walls and the cervix. You will feel a little pressure, and some women with a narrow vagina may experience a little discomfort.
Trying to relax during the exam will make you more comfortable and will make it easier for your doctor to examine you. When you are scared, your muscles tense, which can make the exam more difficult.
Your doctor will examine the cervix (the opening of the uterus) and the inside of the vagina for abnormalities, such as irritation, growths or discharge.
Then your doctor will perform a Pap test for cervical cancer or precancerous cells. Using a special brush and spatula, your doctor will lightly scrape the cervix to collect cells. You may feel a little cramping or a scratchy sensation, but the test usually doesn't hurt. You might notice slight spotting of blood just after the test.
The cells will be put on a slide or transferred to a small vial of fluid and sent to a laboratory. Your doctor will have the results in one to two weeks and will notify you if the results show any abnormalities. Separate swabs may be taken of the cervix and used to test for bacterial or viral infections.
Your doctor will then remove the speculum and do what is called a bimanual (two-handed) exam. He or she will place two fingers into the vagina while pressing the abdomen with the other hand. This part of the examination shows:
- The shape and size of the uterus, cervix and ovaries
- Whether there are fibroid growths in the uterus
- Signs of infection, such as tenderness and pain
Finally, your doctor may perform a rectal exam. He or she will lubricate a gloved finger and insert it into your anus to evaluate the internal organs from a different angle. He or she will also check the condition of the muscles that separate the vagina from the rectum.
When the exam is over, you will be able to dress in private. Be sure to let your doctor or nurse know if you have any more questions. When the examination is complete and you have dressed, it is a good time to get additional questions or concerns answered. The doctor will usually spend time discussing the findings of the examination and explain if anything else needs to be done.
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