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Your First Gynecological Exam
Most girls will start going for gynecological care when they are having any abnormal symptoms (such as vaginal discharge), if they have just started having sex (or are planning to start), or even if they haven't yet become sexually active but have reached the age of 18. Here is a step-by-step breakdown of exactly what is going to happen during the exam.
Deciding to Make an Appointment
First off, the patient should make sure that she schedules her appointment during the middle of her menstrual cycle. If it gets too close to menstruation, the uterus will start to shed cells, which can interfere with the Pap smear results. If the patient feels that she may want someone to be in the exam room with her during the exam for support, she should ask what the doctor's policies are on this subject while making her appointment. Also during the scheduling, the patient should make it known that it is her first visit and exactly why she will be coming for the visit. Secondly, the patient should not put anything into her vagina for 2 days before the appointment, as this can cause an abnormal Pap smear. This means that the patient should not have intercourse, douche, or put dildos, tampons, or fingers into her vagina.
It is helpful for the patient to write down any specific questions, symptoms, or anything else she may be wondering about and take it to the exam. If considering birth control, the patient should think about her preferences before her visit. The patient will be asked about any current medications, so be sure to bring the bottles for any current medications and also any old medical records if uncertain about the details of any previous procedures. Also, waits at the doctor's office may be long, so if nervousness is going to be a problem, make sure to bring a good book or something else to do that can provide a distraction.
Before the Exam
Before the nurse takes the patient back to the examining room, she may ask the patient for a urine sample in order to diagnose urinary tract infections or pregnancy. Even if a sample is not requested, it is a good idea to empty the bladder to aid in avoiding feelings of discomfort during the exam. Once back in the exam room (which will be set up with a tray for the various tests), the patient will have to give her medical history. She will be asked about such issues as family history of cancer of the female reproductive organs, past operations or hospitalizations, and any medications that the patient may be using.
The doctor and nurse will now leave the room so the patient can get undressed. She will either put on a hospital gown (maybe 2 if she wants to cover her back) or she will be given a paper top with a sheet covering her bottom half. After she is finished covering up, she should sit on the exam table and wait for the doctor to come back.
The Physical and External Genitalia Exams
During the exam, it is likely that a nurse will also be in the room to assist the doctor. The doctor will first examine the patient's breasts to check for any abnormalities. She may also conduct a physical exam of the rest of the patient's body. After this is done, the doctor will ask the patient to get into the stirrups. The best way to do this is for the patient to put her feet in the stirrups one at a time, then slide her bottom down to the end of the table (towards the doctor). She should then slowly lie back. The patient can put her gown down between her legs to cover herself up until the doctor is ready, at which point she will let her knees open.
To examine the external genitalia, the doctor will use a couple of her gloved fingers to spread the lips apart. The doctor will examine the structures of the vulva and will check the tone of the pelvic floor muscles. If wanted, the patient may ask for a mirror to see her genitalia during the examination.
Speculum Examination
Before starting the speculum exam, the doctor will warm the speculum to avoid any discomfort the patient may feel from a cold speculum. The doctor will then insert one finger into the vagina to locate the cervix and to determine the angle of the vagina. This is done so she will know the correct angle to insert the speculum. A speculum is a metal instrument that looks somewhat like a duck's bill. The "bills" are inserted into the vagina and opened in order to spread the vaginal walls and visualize the cervix. After the speculum has been opened, a cervical brush and then a spatula will be used to rub a sample of cells off the cervix. This may cause the patient to experience some spotting after the exam, but it will not hurt. The sample of cells is spread onto a slide and this is the Pap smear. Any samples for testing for infections will be collected. Some doctors screen for sexually transmitted diseases routinely. However, most tests will only be done if there is a reason. The speculum is then closed and removed from the patient's vagina. There will be some clicking noises during the locking and unlocking of the speculum; these noises are routine, so there is no need to be concerned by them.
Bimanual Exam
For this part of the exam, the doctor will lubricate her index and middle fingers with K-Y jelly to aid in the comfort of the patient during insertion into the vagina. The doctor will place these two fingers on the cervix while placing her other hand on the patient's abdomen (over her uterus). She will then press down lightly, which does not feel much different from when a doctor presses on the abdomen alone. Both hands are used to get a feeling for the size of the uterus. The doctor may use the fingers inside the vagina to move the cervix around a little to check for any pain, as this would indicate pelvic inflammatory disease. The doctor will then move both her fingers inside the vagina to both the right and left sides of the patient's cervix. She will move her abdominal hand also a little to the right and left to feel for the size of the ovaries and to try to locate any abnormalities. This whole exam may feel a little funny to the patient, but it won't hurt. The patient can try not to tighten her abdominal muscles during the procedure to minimize the discomfort. Some doctors may perform a rectal exam after the pelvic exam.
After the Exam
After the doctor has finished the exam, the patient will need to get up and out of the stirrups. The best way to do this is to stay lying down and push against the stirrups to straighten the knees. The patient can then use her arms on the table to help herself up to a sitting position. Some patients will hold either side of the table to pull themselves up while straightening their knees. Either way, the patient should not take her feet out of the stirrups before sitting up unless she has already scooted back on the table, because this will result in the patient having to engage in an awkward flailing movement in order to sit up. Sometimes the doctor may offer a hand to pull the patient up; if not, feel free to ask for a hand. The patient should then get a tissue from the doctor to wipe off any excess jelly that may be left over. The doctor will then leave the room so that the patient can get dressed. During this time the doctor will perform any tests that she can in her own lab.
When the doctor comes back, she will discuss the results of any tests she was able to do in the office with the patient. If any infections or potentially serious conditions were found, the doctor will recommend and prescribe treatment. If the patient is there to start birth control, her options will be discussed. This time after the exam is basically a time to wrap up the visit and offer the patient a last chance to ask any questions or voice any concerns she may have.
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