Going to the Gynecologist 101

When to See Your Ob / Gyn

Have you ever been to an obstetrician/gynecologist or Ob/Gyn for a pelvic exam and Pap test? If your answer is "no" and you are 21 or older, pick up your phone today and make an appointment with your doctor or a family planning clinic in your area. On the other hand, if your answer is "yes," then how long has it been since your last Pap smear and pelvic exam? All women should have a Pap smear every three years between the ages of 21 and 29, according to the American College of Obstetricians and Gynecologists.

Women aged 30 to 64 should have a pap smear alone every 3 years, or pap smear and an HPV test every 5 years.

See: How To Prepare For Your Pap Smear

When Do Women Need Pelvic Exams?

Teenage girls should see an OB/GYN between the ages of 13 to 15. While pelvic exams are rarely required during this first visit, this visit helps to establish a relationship with the doctor of your choice and to go over your medical and sexual history (even if you have not had sexual intercourse.) This is a good time to ask questions about sexually transmitted diseases and contraceptives.

Should I Be Tested For STDs?

You should always see your gynecologist if you experience:

While a yearly Pap smear is not, in most cases, necessary after age 30, all women still require an annual pelvic exam to check for any other changes or infections.

If you've had an HPV test that was negative that doesn't mean you don't need to have a yearly pelvic exam. The ACOG established these guidelines with full knowledge that HPV causes cervical cancer.

Did you know that with each new sexual partner your risk of getting HPV increases by 15 percent? This means that having multiple sex partners raises your risk of HPV substantially.

According to the ACOG guidelines for Pap testing women diagnosed with HIV or other diseases or conditions that lower immunity should continue having annual Pap smears after age 30.

Fact: The greatest single reason for the occurrence of cervical cancer is not having Pap smears according to recommended guidelines.

The majority of women diagnosed with cervical cancer have not had a Pap smear in five or more years. Sadly, these women are usually at an advanced stage of cancer when they receive a diagnosis.

Other Times to See Your Gynecologist

Now, several circumstances may occur during the rest of the year. Consult your Ob/ Gyn whenever you experience abnormal signs and symptoms. These signs and symptoms include:

  • Pelvic pain or menstrual cramps severe enough to disrupt your daily routine for even a few days a month.
  • Abnormal bleeding occurs you must change sanitary napkins, tampons, or other menstrual products more often than once every two to three hours.

Any of these symptoms can indicate a vaginal infection or sexually transmitted disease or STD which could affect your future fertility. They may also indicate other diseases such as:

Of course, if you think you are pregnant, see your healthcare provider as soon as possible to help ensure a healthy pregnancy and healthy baby.

Also see your gynecologist more often if:

  • you plan of getting pregnant,
  • you think you may have a sexually transmitted infection or have a partner who has STI,
  • have a history of sexually related illness,
  • or have a mother or sister who developed breast cancer before menopause.

Consult your healthcare provider, if you notice any changes in your breasts such as puckering, dimpling, or other changes to the skin of your breasts; have newly retracted nipples, or discharge from your nipples, not associated with breast feeding; if there is any change in your breast size or shape; or if you experience an increase in breast pain, discomfort or emotional issues before your period.

How to Prepare for Your Pap Test and Pelvic Examination

The best time to schedule your annual pelvic exam and to obtain the most accurate results from your gynecological examination and annual Pap smear is one or two weeks after your period.

Vaginal Douching is never a good idea, because of the risk of infection it presents. It is particularly important not to douche for at least two or three days before you see your gynecologist.

You also should refrain from sexual intercourse for at least 24 hours prior to your examination.

Make sure to empty your bladder just before your exam for a more comfortable examination. You may also want to keep a health diary that you can go over with your doctor during your appointment. You can use a calendar to keep track of your periods, any pain experienced, discharges, or other symptoms that occur during the month.

If your annual pelvic exam is the only doctor you see on a regular basis, as it is for 24 percent of women, your gynecologist may order routine tests, such as urinalysis, cholesterol, and blood sugar levels, as well as others.

What Happens During an Annual Pap Test and Pelvic Exam?

The first thing that usually happens during your annual exam is getting checks of your blood pressure, weight, pulse, and often urine. Be prepared to give the nurse the date of your last period -- this is the date of the first day of your last period. Also go over any concerns that you want to discuss with the doctor.

After your initial discussion with the nurse, you'll be directed to take all of your clothes off (you may leave your socks on.) Most gynecologists provide a short examination gown and a paper sheet to cover yourself until your examination begins.

When you're finished, and sitting on the exam table, your gynecologist comes in, accompanied by the nurse. A female nurse should always be present during your annual exam, particularly if your gynecologist is male. The presence of the nurse provides protection for both you and your gynecologist. Your physician will listen to your heart and lungs, check your breasts for any changes or lumps, and palpitate your abdominal area for any irregularities. A reliable examination of your breasts takes approximately 30 seconds per breast.

During your breast examination your physician should discuss monthly breast self- exam with you and also provide instructions if you are unfamiliar with how to perform BSE. If you are 35 or older, your physician should also discuss mammogram screening for breast cancer.

During the pelvic exam/ Pap smear portion of your visit, you'll need to lay down on the table and put your feet in the stirrups.

You may need to scoot down to the end of the table and spread your knees apart. Next a speculum is inserted into your vagina to hold your vaginal walls open so your physician can view the inside of the vaginal walls and the cervix, and collect a sample of cervical tissue for your Pap test.

What is the Procedure for Collecting a Pap Smear Sample?

Obtaining the Pap smear requires that your gynecologist insert a long cotton swab into your vagina.

The cotton swab gently swabs against your cervix so that a sample of cervical cells is retrieved for evaluation by a pathologist. Labs generally require about five days for your test results to return to your gynecologist.

What if My Pap Smear Is Abnormal?

In the unlikely event that your Pap results are abnormal, the first thing you should not do is jump to the conclusion that you have cancer. In the majority of abnormal Pap smears, the cause is not cervical cancer, but one of a variety of other causes that include inflammation, the presence of blood or sperm, or an infection such as a vaginal yeast infection or bacterial vaginosis, and sometimes the presence of an undiagnosed sexually transmitted diseases.

Try to remember that the Pap smear is not a diagnostic tool -- it does not diagnose cancer or any other disease. The Pap test is a screening tool that indicates whether further evaluation is necessary. If you receive abnormal Pap results your gynecologist may recommend a follow-up Pap test in three to six months.

Or other options for further testing such as colposcopy or the LEEP may also be recommended.

What is the Procedure for the Bimanual Exam?

Another part of your annual pelvic exam is called a bimanual exam. To perform this test, gynecologist inserts two fingers into your vagina, places her other hand on top of your lower abdomen, then compresses the tissue between her two hands, feeling for any abnormalities that might have occurred since your last pelvic exam. The bimanual exam allows your doctor to check the size, shape, and mobility of your uterus, to look for any changes in your ovaries, such as ovarian cysts, and to feel for any other abnormalities in your uterus or the surrounding tissues (such as endometriosis, fibroid tumors, or other common uterine conditions).

The bimanual exam can be a bit uncomfortable, but should not result in overt pain. Fortunately, this part of the gynecological examination usually lasts for less than 30 seconds. Because it can give your doctor important information, it is worth a bit of temporary discomfort.

Aside From The Pelvic Exam Itself

In addition to the gynecological examination itself, your doctor should take a careful medical history. It’s important for you to be as accurate and complete as you can in answering her questions and describing any symptoms you may have.

This is when you should tell your gynecologist about the timing and frequency of any illness or other condition you might have experienced since your last appointment. Also make sure to include information about whether you have experienced irregular periodsor painful periods, or any other menstruation menstrual problems, vaginal infections, or painful sexual intercourse.

Other health issues to discuss include any dramatic weight change, hair loss or skin changes.

Finally, while not strictly part of a gynecological evaluation it is important for women forty and older to be screened for colon cancer. This usually includes a colorectal exam, as well as a fecal blood occult test.

If your GYN does not do this, you should ask her about it.

Sources:

Carr SE, Carmody D. Outcomes of teaching medical students core skills for women's health: the pelvic examination educational program. Am J Obstet Gynecol 2004; 190:1382.

Committee on Gynecologic Practice. Committee opinion No. 534: well-woman visit. Obstet Gynecol 2012; 120:421.

Edited by Richard N. Fogoros, MD

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