Gynecologic Exam

A number of different kinds of doctors and nurses have special training in women's reproductive health:

• Gynecologists have been specially trained in women's health issues, and are one of the doctors who can prescribe birth control and teach patients how to use it.
• Nurse practitioners have had advanced training that allows them to give gynecological exams and pay special attention to women's reproductive health.
• Many family doctors perform gynecological exams and prescribe birth control, so this may be an option as well.

Whether you want to see a male or female health care professional is up to you. Some women say that they prefer being examined by a female doctor or nurse because it puts them more at ease and they feel like they can talk more openly about women's health problems and sexuality issues. Other women feel comfortable being examined by a male doctor. If the doctor is male, he will usually have a female assistant in the room with him during all parts of the exam. The most important thing is that you feel comfortable with the person you choose to examine you. You want to be able to talk with him or her about important personal health and relationship issues, including birth control.

If cost is an issue, clinics like Planned Parenthood have fully trained staffs that can often care for you at a lower cost and will respect your need for confidentiality.

Don’t schedule your appointment at the time of your period. It's also recommended that you don't have sex in 24 hours before your exam. When you arrive for your appointment, you may be asked to fill out some forms while you wait. These forms ask questions about any illnesses or conditions you have, your health habits (like whether you drink or smoke), any family illnesses that you know of, and your history regarding sexual activity, pregnancy, and birth control. You might also be asked for the date of your last period (or a doctor or nurse will ask during your exam).

When you first go into the exam room, a nurse or medical assistant will do a few things that your doctor has probably done a million times before, such as recording your weight and taking your blood pressure. You'll then be left alone to change out of your clothes. It may feel weird taking off even your underwear because you may not have had to undress completely for a medical exam before. The nurse or medical assistant will leave you a paper sheet- one for your upper torso and one for your bottom half to cover you.

After a few minutes, the doctor will knock on the door to make sure you're in your body is not exposed. If you're ready, he or she will come in and start the exam. The doctor may start by going over anything you wrote down on your forms or the exam will begin. At the beginning of your exam is a good time to ask about birth control. Some doctors like to discuss these things before the exam, and some like to do it after. Your aim is to make sure you get your questions answered.

During the physical part of the gynecologic exam, you'll be asked to lie on your back on the table. You'll have the paper sheet covering you, and the doctor will only uncover the parts of your body being examined.

The doctor will give you a breast exam by lightly pressing on different parts of your breasts. After finishing, he or she may show you how to examine your own breasts. This helps you become familiar with how your breasts feel so you know which lumps are normal and which may be the result of a change.

Next, the doctor will ask you to move down so your behind is at the end of the table. You'll bend your knees and rest your feet in two stirrups, which are metal triangular loops that stick out from the end of the table. These might look a little scary, but they're just there to rest your feet in and keep you more comfortable. The doctor will ask you to relax your knees out to the sides as far as they will go. It might feel a little funny to be lying with your legs opened like this, but everyone feels that way at first.

The doctor will put on gloves and examine the outside of your vagina to make sure that there are no sores or swelling and that everything looks OK on the outside. Next, the doctor will want to look at the inside of your vagina and will do so with the help of a speculum . A speculum is a thin piece of plastic with a hinged piece on one end that allows it to open and close (like the bill of a duck’s mouth for example). The doctor then slides it into your vagina telling you everything he is doing at each moment something is being done. Once the speculum is in the vagina, it can be opened to allow the doctor to see inside. Putting in and opening the speculum can cause a bit of pressure and discomfort. Because the vagina is surrounded by muscles that can contract or relax, the exam can be more comfortable if you try to stay calm and relax the muscles in that area. If you feel like you're tensing up the muscles in your vagina, try breathing deeply or doing some breathing exercises to help you stay relaxed. Sometimes humming your favorite song or making small talk can distract you and allow you to feel more relaxed. After the speculum is in place, the doctor will shine a light inside the vagina to look for anything unusual, like redness, swelling, discharge, or sores. He or she will then do a Pap smear , which involves touching the cervix to pick up cells from that area. The cervix is the opening to the uterus, and it's located at the very top of the vagina. The Pap smear should not hurt, but it might be uncomfortable. The cells that have been collected are then sent to a laboratory where they are studied for any abnormal cells, which might indicate infection or warning signs of cervical cancer. The pap smear process is the same for STD’s and determining whether or not a patient has any STD’s.

The ovaries and uterus are so far inside the body that they can't be seen at all, even with the speculum, the doctor will need to feel them to be sure they're healthy. While your feet are still in the stirrups, and after the speculum is removed from the vagina, the doctor will put lubricant on two fingers (while still wearing the gloves) and slide them inside your vagina. Using the other hand, he or she will press on the outside of your lower abdomen (the area between your vagina and your stomach). With two hands, one on the outside and one on the inside, the doctor can make sure that the ovaries and uterus are the right size and free of cysts or other growths. During this part of the exam, you may feel a little pressure or discomfort.

This may seem like a long exam, but the entire pelvic exam (the parts involving your vagina, cervix, uterus, and ovaries) really only takes about 3 to 5 minutes. Now that the physical exam is over it is time for the patient to ask questions. Don't be afraid of asking serious questions that sound stupid or silly — no question about your body is stupid, and this is the best time to get answers- so ask away and continue to ask until you understand.

The Pap smear is almost always normal in young women, but if for any reason the doctor needs to see you again, the office or clinic will let you know. Unless you notice any health problems, you won't need to go for an exam for another 6 months to a year. If you don't want to return for another exam because you didn't like the doctor, look into finding a new doctor or clinic. If the exam made you very uncomfortable, remember each time it gets easier and easier to relax. Naturally, no one loves getting an exam, but having a doctor you trust can really help.