What to Expect at Your First G-Y-N Appointment
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Becoming a woman carries with it many new experiences and responsibilities. Among these responsibilities is caring for one’s body and making sure it is functioning normally. A regular gynecological exam should be part of every woman’s plan for caring for her body. Many girls and young women have little information about their first gynecological exam and may not know what to expect. This fact sheet provides answers to some of the most common questions regarding annual gynecological exams and is designed to help demystify the process so that you feel more confident about your first appointment. This fact sheet will also provide you with important information about reproductive health and well-being. Information also should be useful for parents or professionals working with girls and young women. A glossary of the terms used can be found at the end of this fact sheet.
Why do girls and women need gynecological exams?
Having a regular gynecological exam is an important aspect of responsible and preventative health care and a critical step in ensuring your physical, sexual, and reproductive well-being. During a gynecological exam, doctors and other health care providers review your medical and family history, provide information and education about sexual and reproductive health, and answer any questions and/or address any concerns you may have. Annual gynecological exams make sure that you are developing normally. If you are sexually active you should discuss methods for preventing sexually transmitted infections (STI’s) with your care provider. If you have a male partner and participate in vaginal intercourse you should let your care provider know and discuss birth control options. By scheduling an annual gynecological exam, you are taking control to make sure you are healthy- on the inside and out.
When should girls schedule their first gynecological exam?
You should schedule your first gynecological or G-Y-N exam, after you start having regular monthly periods. Some recommend that girls as young as 13 years old schedule an appointment for an annual gynecological exam with a care provider to discuss reproductive health concerns. These early appointments may not include an internal pelvic exam but are rather an opportunity for you to begin a relationship with your health care provider and develop a greater understanding of your reproductive health. Generally, women should have their first internal exam and Pap smear no more than 3 years after becoming sexually active, or by age 21 (Crooks & Baur, 2005).
You should try to schedule your first exam during a time when you are not expecting to be having your menstrual period. This is sometimes difficult to predict as many girls and young women do not have regular monthly periods. Ask the receptionist what you should do in the event that your period is occurring at the time of your appointment. Some health care providers will see a patient who may be just beginning or just ending her period. The receptionist at the practice can tell you the policy and give you information about what to do if this happens to you.
What are some of the considerations for selecting a health care provider?
It is important that girls and young women become knowledgeable about their options and have a voice in selecting their provider. There are several things that you may want to consider as you select the person who will provide your care, including the types of providers available and whether you prefer a man or a woman.
You may be able to continue to see your regular doctor as many family doctors and pediatricians perform pelvic and breast exams for teens. This may be a great option for you if you have a good relationship with your doctor and feel comfortable talking with him or her about your sexual and reproductive health. Some teens may not feel comfortable having these important conversations with their family doctor and may wish to see someone with specialized training in women’s reproductive health, such as a gynecologist, nurse practitioner, or someone specializing in adolescent medicine.
You also may want to determine if you prefer to see a male or female
health care provider. Some girls and young women feel more comfortable
talking with another female about their bodies and sexuality and may feel
embarrassed having these conversations with a male doctor or nurse. Other
girls and young women may not have such a preference. If you choose a
male doctor or nurse, he generally will have a female assistant in the
room. Choosing a care provider is a very personal choice and one that
is yours to make. What is most important is that you feel comfortable
with the person you select.
You may be concerned about your health care provider sharing information
with your parents. Some providers, such as teen clinics and Planned Parenthood,
ensure client confidentiality and will not share personal information
with your parents or anyone else. Other practices may not have this policy.
If this is an important consideration for you, ask about client confidentiality
before you schedule an appointment and share personal information.
If you are not sure what type health care provider you want to see, ask your mom, favorite Aunt, or best friends for recommendations, or visit your local teen health clinic if there is one available. And after the appointment, think about your experience. If the doctor or nurse seemed rushed, didn’t address your questions or concerns, or made you feel uncomfortable, find a new one. Gynecological exams are a necessary part of maintaining good health, and it is important that you feel comfortable with your provider.
Preparing for your first visit
It is not unusual for girls and young women to feel embarrassed, nervous, anxious, or even scared about their first visit to the gynecologist. But you can feel good about the fact that you are taking responsibility to care for your body and get the information you need to make good choices. Although you don’t have to do anything special for your first appointment, it may be a good idea to write down the questions may have, and bring a pen and some paper to the appointment to jot down notes. You can take someone (your mother, another relative, or friend) with you, if it will make you feel more comfortable. This person could also help you remember all of the questions you want to ask and write down answers for you.
What to expect during the gynecological exam.
The first thing you’ll do when you arrive at the appointment is check in with the receptionist. She will give you some forms and paperwork to complete before you see the doctor or nurse, unless you received them in the mail to complete ahead of time. These forms may ask you about your health habits (such as if you wear your seatbelt and if you use tobacco products), your reproductive and sexual history (such as when your periods first began or if you are sexually active), and family illnesses. Having gathered this information from your parents before the appointment can help you complete these forms.
After the forms have been returned to the receptionist, a nurse will come and bring you into the examination room. He or she will take your temperature, and check your height, weight, and blood pressure. He or she will then leave the room so that you can change into a gown.
In a few minutes, the doctor or nurse practitioner will knock on the door to make sure you are undressed and in the gown. The doctor will then enter the room and will begin the exam.
The exam has three distinct components to it:
1. Talking with your doctor or other health care provider
2. Physical exam (breast and abdomen)
3. Pelvic Exam (Pap smear and internal exam)
The doctor will begin the appointment by reviewing the forms you completed and asking you questions about your health. It is important that you respond to these questions truthfully so you get the information and care that is most useful to you. The doctor also may provide you with some information about your health. Let the doctor know this is your first appointment and if you are feeling nervous. Although your doctor will do his or her best to make you feel comfortable and make sure you understand the information s/he is providing, telling your doctor that this is your first visit will remind him or her to go slowly and explain what s/he is doing.
The Physical Exam (breast and abdomen)
The doctor may begin the physical examination by looking into your mouth and ears or listening to your heart and lungs. Next, she or he will check your breasts and abdomen. The breast and abdominal exam will take about 3 minutes and should not cause you any pain. During the breast exam, you will be asked to lie back on the examination table and the doctor or nurse practitioner will check your breasts to make sure they are healthy. This is done by lightly pressing on different parts of the breast, including the nipple. The doctor will also show you how to do a self-exam, so that you can become familiar with your own breasts and make sure that you do not have any unusual lumps. The doctor also will feel your stomach and abdomen, making sure everything is normal. This is done by applying pressure to your belly to feel your spleen, kidneys, and liver.
The Pelvic or Internal Exam
The pelvic exam is an important aspect of this appointment and allows your care provider to check your reproductive system. When you enter the exam room, you may notice metal foot rests at the end of the bed. These foot rests, or stirrups, are intended to help make you feel more comfortable during the exam. For the pelvic, or internal, exam, the doctor or nurse practitioner will ask you to lie on your back, with your bottom at the end of the table and your feet resting in the stirrups. You will then be asked to relax your knees as your health care provider gently pushed your knees apart. It is normal to feel uneasy about lying on the bed like this. Most girls feel this way at first.
The doctor or nurse will then put on a pair of gloves and examine the outside of your vagina to make sure that everything looks okay. Next, the doctor or nurse will want to look inside of you to make sure you are developing normally. To do this, your care provider will use a speculum to open up your vagina and look inside. Your care provider should tell you about each step of the process. For example, she may say something like “Ok, now I am going to take a look inside. You may feel a little pressure as I place the speculum inside your vagina.” Knowing what comes next can help you feel more relaxed. Sometimes the speculum may feel cool to the touch. You can ask your care provider to warm the speculum so that it feels more comfortable.
After the speculum is inside of you, the doctor or nurse practitioner will gently open it. Placing the speculum inside you and opening it up should not be painful. However, some women do feel some pressure. You may want to consider taking a few slow, deep breathes. This will help relax your muscles, which can help make you feel more comfortable during the exam. Some care providers may be willing to provide a mirror so you can get a look at your cervix to help you get to know your body better.
The doctor or nurse will take a small light and shine it into your vagina to check to make sure that you look health inside. Next, using a small brush, cotton swab, or tiny spatula, she will do a Pap smear or thin-prep cervical smear by taking some cells from your cervix (American Academy of Family Physicians at http://familydoctor.org/138.xml. Accessed 6/30/05.) This shouldn’t be painful, although some women may feel some minor cramping when the doctor scrapes the cervix. The cervical cells are placed on a slide or rinsed in vial of special solution and sent to a laboratory for examination (Medic8 Family Health Guide. Accessed 6/30/05 at http://www.medic8.com/healthguide/articles/thinprepcervicalsmear.html )
Your care provider will now slowly close and remove the speculum. The
internal exam is almost finished. Next the doctor or nurse practitioner
will want to examine your uterus and ovaries. Because your uterus and
ovaries cannot be seen, your care provider will need to feel them to make
sure they are developing normally and are healthy. Your doctor or nurse
will put some lubricant on two fingers and gently insert them into your
vagina. She will place her other hand on the outside of your lower abdomen
and apply some pressure. With one hand inside you, and the other hand
on your abdomen, the doctor is feeling your ovaries and uterus to make
sure that they are the right size and shape and that they are healthy.
Although this should not cause you any pain, you may feel pressure and
some discomfort during this final part of the internal exam. Continue
to take deep breathes to help you relax, and remember, the exam is nearly
complete. Although it may seem like it is taking a long time, the entire
internal exam lasts only
3-5 minutes.
Congratulations! You just completed your first G-Y-N appointment. By now you should have had an opportunity to discuss your health and share your questions with your doctor and learn about healthy self-care. You also will have had a physical and internal exam. In a few weeks you should learn the results of the Pap smear or thin-prep test. If everything is healthy and normal, you should not have to return to the doctor until next year. If for some reason there is a problem with your test results, your doctor or care provider will contact you directly to discuss your next steps.
How can parents support your reproductive health?
Parents are important, too. Parents can become partners in ensuring their daughters’ health by helping them understand that annual gynecological exams represent preventative and responsible health care. A mother who talks about her own personal reasons for seeking gynecological care and shares her experiences models the importance of reproductive health. Sharing these experiences can also help reassure daughters that the procedures are not painful and last only a few minutes. Mothers can also help daughters research and select health care providers. Health insurance companies may impose guidelines about participating health care providers. Parents can help navigate these guidelines so that daughters can select a doctor or nurse that will be covered by the insurance company but with whom they can feel comfortable.
Some parents may have difficulty talking with their daughters about reproductive and sexual health. Helping one’s daughter connect with a gynecologist or other reproductive health care provider may provide just the opening needed to begin to discuss other issues related to sexual health and well-being. For example, knowing that the gynecologist will probably ask about sexual activity and birth control may prompt a discussion about these issues and the family’s moral standards.
This fact sheet was reviewed by Lisa Bujno, MSN, NH Bureau of Maternal
and Child Health
_____________________________________________________________________
This fact sheet was prepared by Gretchen Bean, MA
UNH Center on Adolescence
This fact sheet was made possible, in part, through a grant from the NH Charitable Foundation- Madison Fund
References
Crooks, R., & Baur, K. (2002). Our sexuality. (8th Ed.) Pacific Grove,
CA. Wadsworth.
University of New Hampshire - Pettee Hall - 55 College Road - Durham, NH 03824 8/29/05