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Women and Health: The Gynecological Visit and Exam
Every woman should have a routine GYN visit and exam every year if you have ever had sex or are over the age of 18.
An annual visit to the gynecologist is essential for women over the age of 18 or for women who have become sexually active because:
  • Annual visits can help prevent illness and discomfort
  • Your GYN can test and detect cancers of the breast and cervix early, while these cancers may be more curable
  • You can get tested for any sexually transmitted diseases or infections before they cause serious damage
  • Annual visits promote healthy bodies, healthy pregnancies, and healthy childbirth
A trip to the gynecologist can be a little intimidating if you have never been before. The following information is meant to prepare you for what generally happens during a GYN visit and exam.
  • Blood pressure and weight checks are generally given for any kind of doctor’s appointment and this visit is no different. Some offices will also require a urine screen.
  • You will discuss your personal body history and your family’s health history. By discussing your family’s health this allows your gynecologist to pay special attention to various parts of your body. For example, if one side of your family has a history of breast cancer, your gynecologist may discuss and exam your breasts more extensively.
  • If you are concerned about your sexual history, sexual abuse, or if you are scared about what happens during a gynecological exam, talk to you clinician. If you can discuss your fears, your experience of abuse, or any pelvic pain you may have, then it can help your clinician to tailor the exam to your needs. The important thing to remember is that the exam is not emotional or sexual for your clinician.
  • Your GYN will ask you to undress in order to perform a breast and pelvic exam. You will need to remove all under garments in order for your gynecologist closely examine your body. You will be given a garment or drop cloth, or both, and will probably be asked to lay on your back when your doctor comes back. The breast and pelvic exams will be discussed in more detail below.
  • During your pelvic exam, your gynecologist will perform a Pap Smear and tests for STDs. This will be discussed in more detail below.
  • After and during the exam, talk to your practitioner. The more you talk to your gynecologist, the more they will be able to help you and understand what you want to know. By expressing your concerns and problems with your gynecologist or clinician, you are helping yourself to get better care.
The Breast Exam:
  • At this point, your gynecologist is going to examine your breasts for lumps, irregularities, and discharge. If you have noticed any changes in your breasts since your last exam. Your clinician may also ask you if you know how to do a breast self-exam, if you do not know how, your clinician can teach you.
  • If you have never had a breast exam you may want to tell your clinician before they begin, or you may ask them to tell you what they are doing to you as they go along. Many people feel more comfortable knowing what their clinician is doing or looking for, don’t be afraid to ask, or they may talk you through it if they think it will make you feel more comfortable.
  • The exam itself is fairly simple. Your clinician will ask you to raise the arm besides the breast they are examining. Making direct contact with your breast, you will feel your clinician go over your breast in an up and down line pattern, feeling your breasts in a wedge pattern, and in a circular pattern. It is important that no part of your breast is overlooked, and these three patterns should cover your breast. Your clinician will do this to both of your breasts.
  • Another type of breast exam is the mammogram. Women over 40 should get a mammogram yearly. Women younger than 40 with a history of breast cancer may want to ask their gynecologist if a mammogram would be helpful for them.
  • Upon completion of the breast exam, your clinician will discuss any lumps or irregularities with you. If you have any questions about your breasts or how to do a breast self-exam now is a good time.
The Pelvic Exam:
  • Now your gynecologist will ask you to place your feet in the foot rests, or your knees at the knee rests, at the end of the table so they can begin to complete the pelvic exam. Your hips should sit along the edge of the table.
  • It is important for you to spread your knees apart as wide as comfortably possible. If you butt, abdominal, and vaginal muscles are relaxed, the exam will be more complete. Some tips for relaxing during this part of the exam:
    • Relax your shoulders and your stomach muscles.
    • Take slow, deep breaths with your mouth open.
    • Ask your gynecologist to talk you through the process.
    • If you feel uncomfortable and would like to have another person in the room with you (your friend or partner), tell your gynecologist. Having someone your trust in the room may help you to feel more relaxed.
    • If you would like to see what your gynecologist is looking at, ask. Often your clinician can provide you with a mirror that can be angled to allow you to see what they are looking at. This also may help you to better understand your body.
  • There are four steps to the pelvic exam: the external genital exam, the speculum exam, the bimanual exam, and the rectovaginal exam. Before the exam you may want to discuss your concerns about sexually transmitted diseases and infections about yourself or your partner(s). There will be an opportunity for testing during the exam.
  • The external genital exam is a visual examination. Your clinician will exam the opening of the vagina and the folds of the vulva. During this part of the exam your clinician is checking for any signs of irritation or infection, cysts, or genital warts.
  • The speculum exam is an internal examination of the cervix. A speculum will be inserted into your vagina to separate the walls of the vagina, which normally close and touch each other. By separating these walls, your clinician can see your cervix.
    • During this part of your exam you may feel some discomfort, especially if you are tense. Remember, your clinician will get better results and be able to perform a more accurate exam if your body is relaxed. See the above tips for relaxing. Discomfort can be caused when the speculum is being opened or closed. The position of your cervix and uterus will also have an impact on your comfort level.
    • Your clinician will be checking for any signs of irritation, growth, or abnormal discharge from the cervix. If you would like to be tested for gonorrhea, HPV, Chlamydia, or any other sexually transmitted diseases, that can be done at this point of your exam.
    • A small brush or spatula (often looks like a Q-tip with a longer than usual handle) will be used to collect cells off of your vaginal walls. This process is called a Pap test. The sample will be sent to a lab to be tested for cancerous or precancerous cells, inflammation and infections in the cervix, and signs of thinning of your vagina’s lining due to lack of estrogen. If you experience some staining of bleeding after the sample is taken do not worry, this is common.
  • The bimanual exam is the next step. With one hand pressing on your lower abdomen, and one or two lubricated, gloved fingers inserted into the vagina, your clinician feels the internal organs of the pelvis. This portion of the exam deals with the internal organs. Your clinician does this test to check for several reasons:
    • Tenderness or pain, to check for infection
    • Swollen fallopian tubes or an enlarged uterus
    • Size, shape, and position of the uterus
    • Enlarged ovaries, cysts, or tumors
    During this portion of the exam you may feel a sensation of deep pressure. If you feel pain tell your clinician. Deep breathing through an open mouth may help with discomfort.
  • The rectovaginal exam is the last step. Inserting a gloved finger into your rectum, your clinician will check the condition of the muscles that separate your vaginal and rectum. Signs of tumors located behind the uterus, on the lower walls of the vagina, and in the rectum can also be detected with this procedure. This procedure may cause you to feel like you are going to have a bowel movement, this feeling is natural and will subside within a few moments.
The Breast Exam:
Now is the time for further questioning and consultation. If you have any questions about STDs, pregnancy, abortion, inherited diseases, infertility, breast self-exams, cancer signals, or birth control, now is the time to ask. Do not let embarrassment on certain topics become a health risk. Your clinician is there to help you understand your body and meet your body’s needs.
Some things to keep in mind when going to the gynecologist:
  • An annual trip to the gynecologist is important.
  • If you have any questions specific to your body, ask them. If you think you might forget to ask them write them down. Your body is nothing to be ashamed or and you should take care of it in as many ways as possible.
  • If you have a male clinician and would prefer a female clinician, ask your clinician or other women in your community if they have any recommendations. You may feel more comfortable and confident with a female clinician if you are uncomfortable with a male clinician.
  • It’s only once a year! Once you get the appointment out of the way, you don’t have to worry about it for a whole year.
Remember, it’s your body, and it’s your responsibility to take care of it.
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