Having routine pelvic exams are important for good reproductive health. A woman should have her first GYN exam when she is first thinking about becoming sexually active, or as soon as she becomes sexually active, or by the time she is eighteen. There are many female gynecologists, nurse practitioners, and physician's assistants these days if you prefer a woman to provide you with gynecological health care. It is usually easy to find one in the United States and Canada. Many women still use male health care providers or gynecologists for their GYN exams; that is fine also.
Whomever you choose as your gynecological care provider, it is essential that you be comfortable and honest with her/him, and that you feel confident that you will receive quality, attentive care. If you are not satisfied with someone you have seen, find someone else. Ask a friend or an older sister who they see for their pelvic exams. Gynecology does not have to be an unpleasant area of health care.
At the visit to the gynecologist you will have a short general physical exam including a breast exam. You will wear some sort of hospital gown and nothing else. For the actual pelvic examination, you will lie down on an examining table with your feet resting in elevated "stirrups" -- props that support your legs in the air. Stirrups might look a little scary, but they are really just there to rest your feet in and keep you more comfortable. Your legs will be spread apart, with your knees falling to each side to expose your genitals. Almost everyone feels uncomfortable and vulnerable the first few times they are in this position... of course, who wouldn't, but it's important to relax and realize that everyone goes through this, and soon you won't feel so uncomfortable. Even the health care provider who is examining you (if it is a woman) goes through the same exam.
The pelvic exam should not hurt and if at any point it does, make sure to let the practitioner know. If it is stressful or uncomfortable, the best way to help is to try to relax with some deep breaths. As with any other medical procedure, if you tense up your muscles and go stiff, the exam becomes more difficult. If you are informed ahead of time about what the exam involves, and you're comfortable with your practitioner, there is no reason to be nervous. She or he will most likely tell you what they are doing when they are doing it. Make sure they know if this is your first pelvic exam.
The practitioner will visually examine your vulva for discoloration, irritation, swelling and other abnormalities, and she will gently feel for glands.
There are two parts to the internal exam. The first involves a speculum (speck-you-lum), which is a metal or plastic instrument that the practitioner inserts into the vagina. The speculum is shaped sort of like a duck's bill, and once it is inserted into the vaginal canal it can be gently widened to spread the interior vaginal walls. (The vagina is collapsed in its relaxed state, but it can widen easily to accommodate tampons, fingers, penises, and even babies.) As the vaginal walls are spread, the practitioner is able to see clearly the walls of the vagina itself, and up the vaginal canal to the cervix.
In viewing the vaginal canal and the cervix, the practitioner can look for discoloration, abnormal discharge, lesions, growths and signs of infection. It is possible for you to look at your own cervix during this process by propping yourself up on your elbows and using a mirror. Some practitioners ask if you would like to do this, but feel free to ask to if she doesn't mention it first. It is incredibly enlightening to actually see what your anatomy looks like, and it can clear up a lot of confusion.
Next the practitioner will take a pap smear. She/he uses a long stemmed cotton tipped swab to collect a sample of the cells in the cervix. Some women feel a slight cramping sensation when their cervix is touched. The collected cells are smeared onto a slide and sent to a lab for testing and examination. The pap smear is extremely important for picking up abnormalities of the cells in the cervix which may indicate infection or disease.
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