What to expect during your 1st gynecological exam.

By Shari Levine

Many girls hear stories about what happens during a gynecological exam secondhand, from friends, television shows or magazine articles. But you may not have heard the REAL scoop about what happens behind closed doors. This article will give you the facts about what to expect at your first gynecological exam.

Expectations about the exam

Most girls have two big fears about their first gynecological exam: pain and embarrassment. I want to reassure you that, while it may be uncomfortable, the exam should not hurt. If you feel pain tell your health care provider immediately, and she or he should be able to fix whatever is hurting you.

You may feel funny about taking off your clothes and being examined by a health care provider you just met. Try to remember that the person doing your exam is a professional who has been trained to care for the female body. He or she is not there to judge you, your body or your lifestyle. Also, if you need support, it is perfectly okay to bring a parent with you into the exam room.

Who does the exam?

There are different types of health care providers who do gynecological exams, such as doctors who are trained in gynecology and obstetrics, your family physician or pediatrician, a nurse practitioner or a physician's assistant. From now on I will call this person "the provider" or "she."

Why should you have a gynecological exam?

• To get contraceptives (also called birth control) that are only available by prescription, such as the birth control pill, diaphragm, Depo Provera and the Patch.
• Test for sexually transmitted infections (STIs.)
• Screen for cancer - the provider will examine your breasts, ovaries and uterus for signs of a problem, and will give you a pap smear to test your cervix for pre-cancerous cells.

You should get an exam if you:

• Have any abnormal symptoms related to your reproductive system like strange discharge, itching or bumps on your vagina, severe pain during your period, irregular periods or changes in your breasts like lumps.
• Just started having intercourse (sex).
• Are 18 years old, regardless of sexual activity.

How to get ready for the exam

There are a few things you can do to prepare for your exam. Be sure to know your family's medical history (especially if anyone has/had breast, ovarian, uterine, or cervical cancer) and the details about your period (when did you get it, how long does it last, etc.) Also, this is a good time to think of any questions you want to ask and write them down beforehand.

The exam

There are several parts to a gynecological exam and most providers begin by talking about your medical history (clothes on) and then do the physical exam (clothes off). You can expect the following things to happen:

1. Medical History

Before the exam you may be asked for a urine sample (you have to pee in a cup.) Then the provider will ask you questions about your personal and family's health history. If you can't ask your parents about your medical history, just answer the provider's questions as best as you can. Even if you feel embarrassed, it's important to be completely honest about everything so that she can take the best care of you.

After talking for about 10-15 minutes, she will ask you to change into a hospital gown (also called a Johnny) and may give you a sheet to put over your legs during the exam.

2. External Exam

Most providers begin with a breast exam and then teach you how to check your breasts for any changes (called a self-breast exam.) She may also feel your thyroid gland (a bump in your throat.)

Next you will put your feet into holders called stirrups, which help to keep your body in a position that lets the provider examine your private parts. She will look at your vulva and check for any signs of irritation, discharge, bumps or other problems.

3. Internal exam

This is also called the speculum exam and it should only last for about 1-3 minutes. The speculum is a tool used by the provider to open your vagina. It is made of either metal or plastic, comes in different sizes, and looks like a duck's bills.

First the provider will put her finger (covered with a glove) into your vagina to find your cervix (the small opening between your vagina and uterus.) Now the speculum is inserted and opened to spread the vaginal walls so that the provider can see your cervix. This may feel uncomfortable, but shouldn't really hurt.

A tool, which looks like a mascara brush, is used to rub a few cells off your cervix. The cells are then spread onto a slide and this is called the Pap smear. The speculum is removed and the exam is done.

A Pap smear spots abnormal cells in the cervix. You should have the test results in 7-10 days. If your results are normal, you will not need another exam for one year. If there's anything abnormal then your provider will call to set up another appointment.

4. Bimanual exam

This is the finale. Your provider will insert two fingers into your vagina and place her hand on your stomach over your uterus. She'll press down gently to feel the size and shape of your uterus. She will also check your ovaries, which are to the left and right of your cervix. She may do a rectal exam, and put a finger into your rectum to check for problems.

After the exam

You're done! Get up, get dressed, and pull out your list of questions to be sure they have all been answered.