HEALTH EDUCATION

Gynecological visit/exam

Gynecology is health care for women. It helps you take good care of your sexual and reproductive health. Here’s what’s involved and what you can expect during your gynecological visit.

Routine gynecological care

Prevents illness and discomfort
Allows for early detection of cancers of the breast and cervix — when they are more curable
Detects sexually transmitted infections and other conditions before they cause serious damage
Prevents sterility
Promotes healthy pregnancy and childbirth

Staying healthy is important. Whether you’re young or old, married or single, sexually active or not, or whether you’re lesbian, straight, or bisexual — good gynecological care is the key to good health.

Take control of your health
It takes teamwork to have good health. Your job is to learn how your body works and what is normal for you.

Watch for changes in your body and its rhythms that may signal problems. Your clinician’s job is to help you identify problems before they become serious and to provide care if you become ill.

Talk with your clinician about how often you should have periodic GYN visits and exams.

You may need to have frequent checkups if you have:

A breast lump
A history of abnormal pap test results
A history of sexual health problems
A mother or sister who developed breast cancer before
menopause
A sexually related illness
A sexually transmitted infection or a sex partner with an infection

You should visit your clinician if you have:

Abnormal or unexplained change in vaginal bleeding or discharge
Any concerns about your sexual or reproductive health
Changes in size or shape of the breast
Lumps or thickening of the breast or armpit
Increased pain or discomfort before your period
Newly retracted nipples or bleeding or discharge from
the nipple
Pain, swelling, or tenderness of the vulva or vagina
Puckering, dimpling, or other changes in the skin of the
breast
Severe pelvic or lower abdominal pain
Sores, lumps, or itching of the vulva or vagina
Unusual vaginal or pelvic pain

Many women worry about having a GYN exam — especially if it’s the first time. You will be more comfortable if you know what to expect.
Periodic GYN visits and exams may include:

Talking about your personal, family, sexual, and medical history
Laboratory tests and screening for sexually transmitted infections and other conditions (at your own or your clinician’s request)
Counseling
A breast exam
A pelvic exam
Cancer screening
Pap smear

Prepare for your office visit
1. Schedule your GYN visit and exam for a time when you will not have your period — unless you have bleeding problems that your clinician wants to observe. Menstrual fluid can affect the results of some lab tests. Let your clinician know if it turns out that you will be having your period during the exam. You may want to reschedule.

2. Make a list of all the questions and problems you want to talk about. Include:

Bleeding after sex
Heavier than usual flow
Pelvic pain or other problems
Spotting between periods
Vaginal discharge
Unpleasant vaginal odors

It’s easy to forget these things during your appointment.

3. Women shouldn’t douche. If you do, however, don’t douche for at least 24 hours before the appointment. Don’t use any other vaginal preparation, either. They can mask many vaginal conditions.

4 Don’t have vaginal intercourse or insert anything into your vagina for between 24-48 hours before your visit.

Your medical history
Before you are examined, you will be asked to fill out a questionnaire. It will include some of these questions:

When was your last period?
How often do you have periods?
How long do they last?
Do you have any bleeding between periods?
Do you feel any pain when having sex?
Is there any bleeding after sex?
Do you have any unusual genital pain, itching, or discharge?
Do you have any other medical conditions?
What medical problems do other members of your family have?
Are you using birth control?
Do you suspect you are pregnant?
Are you trying to become pregnant?
What method do you use to prevent sexually transmitted infections?

You will be asked about your history of allergies, illnesses, pregnancy, risks for sexually transmitted infections, and surgery. You may be asked about your lifestyle, for example if you smoke, how much you smoke, or if you drink alcohol or use other drugs. You may also be asked if you have problems holding your urine.

Your clinician will review your contraceptive needs. If you are using birth control, you will be asked if you’ve had side effects.
Your contraceptive needs change throughout your life.

To decide which one to use now, consider how well each method will work for you:

How well will it fit into your lifestyle?
How effective will it be?
How safe will it be?
How affordable will it be?
How reversible will it be?
Will it protect against sexually transmitted infections?

Your clinician can provide you with the information you need to make the best choice for you.

It is very important to be frank and honest about your sex life. Up to one out of two women will have a sexually transmitted infection in her lifetime.

These infections can cause sterility, cancer, as well as problems with pregnancy, childbirth, and infant health. Some can cause death. Great harm can be done even when there are no symptoms. Very often, women have no symptoms. That’s why it’s important to let your clinician know whether or not you are at risk for sexually transmitted infections.

Previous pregnancies, sexually transmitted infections, or bruising may be detected during the exam. But, in general, your clinician will not be able to tell if you’ve had sex, how often you have it, how many partners you have, or if you masturbate.

So don’t let embarrassment become a health risk. Be precise about your sexual health risks and questions about your sex life. Being clear will help your clinician suggest the best solutions.

The urine test
You may be asked for a urine sample. The test can tell if you’re pregnant. It can also help screen for some sexually transmitted infections and other health problems.

Urinating before a pelvic exam to empty your bladder may also make you more comfortable during the exam. It will also be easier for the clinician to examine you — your cervix and uterus are located behind your bladder.

The breast exam
You will change into an examination gown or be covered with a drape sheet. Some clinicians provide both. Your clinician will examine your breasts for lumps, thickening, irregularities, and discharge. Many clinicians will continue to talk to you about your health history during the breast exam.

Breast lumps are often discovered by a woman or her sex partner. Your clinician will ask if you have noticed any changes in your breasts since your last exam. You should become familiar with the way your breasts normally look and feel. That way you will be more likely to notice any changes.

Some women use breast self-exams (BSEs) to get to know their breasts. If you would like to learn how to do a BSE, your clinician can teach you. The best time for a BSE is one week after your period, when your breasts are not swollen or tender. Lumps are also noticed during day-to-day activities such as showering or sex play. Most lumps are not cancerous. But report anything unusual to your clinician as soon as possible.

Women over 40 should have mammograms every year. Younger women whose families have a history of breast cancer should consult with their clinicians about whether or not mammograms would be of value to them.

The pelvic exam
After your breasts have been examined, you will be asked to place your feet in the footrests at the end of the table. Some tables have knee rests instead of footrests.

Slide your hips down to the edge of the table. Let your knees spread wide apart, and relax as much as possible. If your buttocks and abdominal and vaginal muscles are relaxed, you will be more comfortable, and the exam will be more complete. You can cover your lower abdomen and thighs with the drape sheet to feel less exposed and more comfortable during the procedure.

You’ll feel less tense if you:

Breathe slowly and deeply with your mouth open
Let your stomach muscles go soft
Relax your shoulders
Relax the muscles between your legs
Ask the clinician to describe what’s being done as it’s happening

If your clinician is a man, you may request having another woman in the room. Her presence may help you feel more relaxed. She may hold your hand or just talk to you to ease your tension. Ask in advance if you want to see what’s going on and/or know what your vagina and cervix look like. A mirror may be positioned so you can see.

Sexual abuse and other concerns
Some women are very anxious about having a pelvic exam because of difficult experiences that may include sexual abuse. You may have more pelvic pain, fear, and discomfort during your pelvic exam if you’ve been sexually abused in the past, heard alarming stories about GYN exam, or had other negative sexual experiences

Remember that the exam is not emotional or sexual for your clinician. Talk with your clinician about your fears, any pelvic pain you may have, and your experience of abuse.

Talking with your clinician about your experience will help your clinician tailor the exam to your special needs, help you feel as comfortable as possible, and understand how your physical and emotional health may be affected.

It is also okay to have a trusted friend or relative with you during the exam.

Usually, the exam lasts just a few minutes. There are four steps:

Step 1. The external genital exam
The clinician visually examines the soft folds of the vulva and the opening of the vagina to check for signs of irritation, discharge, cysts, genital warts, or other conditions.

Step 2. The speculum exam
The clinician inserts a metal or plastic speculum into the vagina. When opened, it separates the walls of the vagina, which normally are closed and touch each other, so that the cervix can be seen.

You may feel some degree of pressure or mild discomfort when the speculum is inserted and opened. You will likely feel more discomfort if you are tense or if your vagina or pelvic organs are infected.

The position of your cervix or uterus may affect your comfort as well. If a metal speculum is used, you may feel the chill of the metal. Most clinicians lubricate the speculum and warm it to body temperature for more comfort. Talk with your clinician about any discomfort you feel.

Once the speculum is in place, the clinician checks for any irritation, growth, or abnormal discharge from the cervix. Tests for gonorrhea, human papillomavirus, chlamydia, or other sexually transmitted infections may be taken by collecting cervical mucus on a cotton swab.

These tests may not be done unless you have a concern about infections and ask for testing. Be sure to talk with your clinician if you have symptoms or concerns about your partner(s).

Usually a small spatula or tiny brush is used to gently collect cells from the cervix for a pap test. The cells are tested for abnormalities — the presence of precancerous or cancerous cells. You may have some staining or bleeding after the sample is taken.

As the clinician removes the speculum, the vaginal walls that were covered by it are also checked for irritation, injury, and any other problems.

Pap tests can detect:

The presence of abnormal cells in the cervix
Infections and inflammations of the cervix
Symptoms of sexually transmitted infections (With the exception of trichomoniasis, Pap tests cannot identify specific sexually transmitted infections, but they may detect symptoms)
Thinning of the vaginal lining from lack of estrogen commonly related to menopause

The cell sample will be sent to a laboratory. The results will be sent back to your clinician within a few weeks. Pap tests need to be repeated if there is too much blood present for an accurate reading or if there are not enough cells to be examined.

Interpreting pap tests
If you have abnormal results, your clinician will advise you on follow-up care:

If noncancerous abnormalities and infections are found, be sure to complete the prescribed treatment and repeat the tests as advised.
If early precancerous or suspicious growths are found, you will need careful follow-up. You may also be advised to:
- Repeat the pap test in a few weeks or have them at more frequent intervals.
- Have other tests.
- Have a colposcopy and biopsy.
- Have growths removed with cryotherapy, laser surgery, or electrocautery.
If cancerous growths are found:
- Discuss your options with your clinician.
- See another provider or specialist.

Remember —

Most abnormalities that are detected are not cancer.
Early treatment of precancerous growths can prevent cancer from developing.
Follow-up examinations are necessary if an abnormal condition is found.

Step 3. The bimanual exam
Wearing an examination glove, the clinician inserts one or two lubricated fingers into the vagina. The other hand presses down on the lower abdomen.

The clinician can then feel the internal organs of the pelvis between the two fingers in the vagina and the fingers on the abdomen.

The clinician examines the internal organs with both hands to check for:

Size, shape, and position of the uterus
An enlarged uterus, which could indicate a pregnancy or fibroids
Tenderness or pain, which might indicate infection
Swelling of the fallopian tubes
Enlarged ovaries, cysts, or tumors

The bimanual part of the exam causes a sensation of pressure. You may find it somewhat uncomfortable. Deep breathing through the mouth helps. If you feel pain, tell the clinician.

Step 4. Rectovaginal exam
Many clinicians complete the bimanual exam by inserting a gloved finger into the rectum to check the condition of muscles that separate the vagina and rectum.

They also check for possible tumors located behind the uterus, on the lower wall of the vagina, and in the rectum. Some clinicians insert one finger in the anus and another in the vagina for a more thorough examination of the tissue in between.

During this procedure, you may feel as though you need to have a bowel movement. This is normal and lasts only a few seconds

After your exam
This is a time for further consultation with your clinician. You will discuss the results of your exam, arrange for any follow-up or consultation that may be needed, and ask any further questions you may have.

This is another opportunity to discuss your concerns about sex and sexuality, birth control, pregnancy, abortion, sexually transmitted infections, problems holding your urine, inherited disorders, infertility, cancer signals, changes in your breasts, and menopause. Don’t let embarrassment become a health risk. Speak up.

If the lab tests indicate anything unusual, you will be contacted when the results are completed. Pregnancy test results are usually ready during your visit. Other test results may take a few days or weeks. Your clinician will tell you how long you’ll have to wait. Be sure your clinician has your current address and phone number.

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