Introduction — Who does them? "I am going to the gynecologist! What fun!" OK—so most of us don’t feel EXACTLY that way the first time. We know pelvic exams (also called gynecological exams) aren't a trip to the beach, but most girls and women say that their first exam wasn’t as bad as they thought. The pelvic exams are usually painless, and it takes only about 10 minutes. Which means it will probably take you longer to read this walkthrough than it will to have an exam. So read on, get informed, and get comfortable. The more you know, the easier it will be. Who does pelvic exams?A lot of different kinds of health care professionals can do pelvic exams. One is a gynecologist (guy-nuh-CALL-uh-jist)—a doctor who specializes in women’s reproductive and sexual health. These doctors usually are also obstetricians (called OB/GYNs), who see pregnant women and deliver babies. You could also go to a pediatrician, family doctor, or internal medicine specialist. Before you go, find out if these doctors actually do the pelvic exams—some prefer to refer you to a gynecologist. Some other health practitioners can also do pelvic exams. These include: Nurse practitioner Certified nurse clinician Certified nurse midwife Physician’s assistant
To keep it simple on this site, we’ll use the term "doctor" to talk about the professional doing the pelvic exam. You can find a doctor a few ways. A lot of people feel that word of mouth is the best. Ask a friend or a female relative who she uses. If you have health insurance, check with your insurance company for a list of participating doctors. You can also ask your family doctor or the school nurse for a referral. Why get pelvic exams?Usually a pelvic exam is a routine visit. But here are some reasons why a teen or woman should have her first pelvic exam: You’re 18 and have never had a pelvic exam You’re 16 and haven’t had your first period You’re having a problem—like painful periods or PMS You’ve been having periods for 1 or 2 years, but still aren’t seeing regular patterns You have irregular periods or have missed more than three periods You have vaginal itching, redness, sores, swelling, or unusual odor You have abnormal discharge—this is any vaginal discharge that differs in consistency, color, or quantity from what you normally see Your flow is really heavy, unusual, or lasts more than 7 days (you have unusually heavy flow if you go through a super plus tampon or super pad in less than one hour) You have a burning pain when you urinate, or you have to urinate a lot You had an injury to your pelvic area You’re sexually active You’re thinking about becoming sexually active and need to discuss contraception and safe sex habits You think you’re pregnant You think you have been exposed to a sexually-transmitted disease (STD) You have been sexually assaulted Feeling comfortable at pelvic examsIt’s normal to feel nervous and maybe embarrassed at pelvic exams—we’re not really used to baring our private anatomy like that! But remember, the doctor has done this hundreds—maybe thousands—of times before. To her or him, it’s like looking at your tonsils. So try to relax about that. Here are some ways to make your pelvic exams more comfortable:
You can go to whomever you want for your exam (within the limits of your insurance plan if you use one). If you get a referral from someone, ask that person if the doctor is easy to talk to—that’s important. You might prefer to see a male or female doctor—it’s your choice. More important than gender is how you feel with the Be picky about who you see person—male or female. After meeting the doctor, if you feel uncomfortable for any reason and want to leave—that’s totally your right.
When you make your appointment, find out if that doctor always, usually, or never has a nurse present for the pelvic exams. This may help you decide if you want to bring someone with you. Ask about having a nurse present during the exam
It’s nice to have the support of another person when you have to deal with a new experience. A first pelvic exam is a good example. Maybe you’d like to go with your mom. If she can’t make it, ask an older sister, aunt, other female relative, or a friend. They can be in the room for the exam or when you talk with the doctor—or both. But the decision to bring someone is totally up to you. Bring a pal
When you call for your appointment, tell the person who sets it up that this is your fist pelvic exam. Ask if you could have a longer appointment than usual so the doctor will have time to talk to you and answer your questions. Speak up
If you feel nervous about this exam, talk to someone who’s been through it—like an older sister, your mother, female relative, or female friend. Just talking about how you feel may ease your anxiety. Talk about it Getting ready for the exam Shower or bathe on the morning of the pelvic exam. It’s just good hygiene, and at least you won’t be angst-ing about THAT. If you use douches, DON’T use one at least 24 hours before pelvic exams. It could mess up your Pap smear or make it hard to detect a vaginal infection. If you get your period the day of the appointment—cancel it and reschedule it for a week or two. Or you could decide to go and just use the time to talk. Write down the date of your last period. You should be keeping track of your menstrual cycle. (The is a great tool for charting your period.) You could also write a list of any symptoms that are bothering you to bring to the exam. Period Predictor Asking questionsPelvic exams are a great opportunity to practice talking about your health. For generations, people never questioned doctors about procedures or medications. Dumb! So ask questions like your health depends on it—it does. Before you go, make a list of questions to ask. You can also read the sections on or Menstruation to get a clear picture of what’s going on—and get clear on your questions or concerns. Female Anatomy You can ask your questions before the actual exam, when you’re first meeting with the doctor, during the exam, or after. NEVER be afraid to ask questions. If you don’t feel comfortable asking or if the doctor isn’t answering your questions, you may want to change doctors. You want to be able to ask questions and feel that your doctor is really listening. With any doctor, you should ask what pelvic exams they will be doing, why, what the medications are for and what you can expect. So here’s a checklist of info and things you might want to bring to your pelvic exams: The dates of your last period. The length of your periods and your cycle. A list of questions for the doctor and any issues you’d like to discuss. The names of any medications that you’re taking. (Write down the name of the medication and the dose, or just put the bottle in your purse and show the doctor). You may have questions about STDs (sexually-transmitted diseases), birth control, or pregnancy. Your doctor can answer specific questions, and probably give you brochures and info on these topics. But you have to remember to ask, so write it down. Answering questions at the exam The first few minutes are like any medical visit. First, you’ll probably sit down with the doctor in the consultation room. If you feel uncomfortable or nervous at this point, tell the doctor that it’s your first appointment. This is a good way to start talking, and it will make it easier for you to ask questions. It will also clue the doctor in that you might need some extra explanation —he or she can tell you what to expect and what’s happening during the exam. Some doctors will do this without being asked, but many won’t think of it unless you speak up. The doctor will then ask you questions about your general medical history, and questions about your period, including: When was your last period?Of course, if you haven’t had one yet—that’s a no brainer! If you have had your period and you keep a calendar, you’ll know the exact date. How many days does your period last? This refers to the number of days that you actually have flow—whether it’s light or heavy. If you flow starts and then skips a day, mention that. What’s your menstrual flow like?
Your flow may go from light to heavy, be lighter red or a darker, more maroon red, and may include some clots. How long is your cycle?You figure this out by marking the first day of your period for a couple months in a row, and counting the days between those first days. Do you have any symptoms that bother you?This is the time to mention things like cramps, spotting between periods, itching, bad-smelling discharge, or anything that has been worrying you about your genital area or reproductive system. What else do you want to tell me? If this question isn’t asked, you may need to bring up other things here, like birth control methods, getting tested for a specific condition (STD or HIV), and questions about sex. The Pelvic Exam—Visual InspectionAfter you and the doctor have asked all the questions you want, the doctor or nurse will take you to an examining room. He or she will ask you to undress and put on a gown, then probably leave while you’re undressing. Find out if they’ll need a urine sample. If not, make sure it’s okay for you to go to the bathroom. With a full bladder, it’s harder for the doctor to feel your pelvic organs. And it’s not as comfortable for you. A few other tips: Unless you’re told something else, take everything off—bra and underwear, too. But most doctors let you keep your socks on! When you put on the robe—remember—it opens in the front. Just sit at the edge of the table and relax. Once you get changed, the doctor or nurse will come back in and check your weight and blood pressure. Then the doctor may listen to your heart and lungs, and examine your thyroid (in the neck area) and abdomen (belly). Visual inspectionDuring the exam you’ll be lying on your back with your butt at the very end of the table and your heels resting in metal supports called stirrups. The doctor sits at the end of the examination table so that he or she can examine your external and some internal organs. The doctor will wear plastic gloves during all parts of the examination. This is the part of the exam that can feel awkward and embarrassing. There are a few things that you can do to make it easier: Ask your doctor to tell you what she or he will be doing next so you know what to expect. Sometimes just talking a little bit makes the situation more comfortable. Take deep breaths and try to relax. (If you’re relaxed, chances are the muscles in your pelvic area will be loose and relaxed, too.) If you’re embarrassed, tell the doctor. Sometimes just saying it out loud makes you feel better. (You could just say, "This feels so weird.") Ask for a pillow if your head is uncomfortable. Interested in your own biology? Ask for a mirror so you can watch as the doctor examines the vulva. You can even look into your vagina during the next part—the speculum exam. The speculum examThe speculum is an instrument that’s inserted into the vagina and gently opens to let the doctor check the vaginal lining and cervix (located at the top of the vagina) and take specimens for further tests. The speculum may be plastic or metal. If it’s metal, it may be cold. (You can ask the doctor to run it under warm water to make it more comfortable.) When the doctor starts the exam, you’ll feel the speculum and the doctor’s hands in the area of the vulva and vagina. It might be a little uncomfortable when the speculum goes in, but it shouldn’t be painful. It feels more like a pushing. Again, try to relax (don’t forget to breathe!) so the muscles will be less tense. If you have any pain or discomfort when the speculum is inserted, tell your doctor so that adjustments can be made. For girls who haven’t had intercourse or whose muscles around the vaginal opening are tighter, a smaller speculum can be used. During this part of the exam, some women like to take the opportunity to space out! You might try closing your eyes, and thinking about something else—like waves at the beach, a favorite song, or just what you’ll be doing when you get out of this exam! Others like to ask questions or have the doctor explain each thing he or she is doing—talking to the doctor makes them feel more comfortable. See what works for you. A note on the hymen and virginity A virgin is defined as a girl/woman who has not had sexual intercourse. But some people still think a virgin is a girl/woman whose hymen is still intact—which is wrong. You can be a virgin, and strenuous sports or even riding a bike could have already affected your hymen. And, believe it or not, some women can have sexual intercourse without the hymen being affected. So the real issue at pelvic exams is comfort—if a woman hasn’t had sexual intercourse, the muscles around the vagina may be tighter. So if you are a virgin, tell the doctor before your exam. She or he could use a smaller speculum, which is more comfortable and generally could keep the hymen in tact. Pap smear and other testsWith the speculum in place, the doctor can take sample cells from the cervix. This is called a Pap smear, and it’s done to see if there’s anything unusual about the cells in the cervix. It’s a simple test that isn’t much different from using a Q-tip. For the Pap smear, the doctor lightly rubs or "scrapes" the surface of the cervix with a small flat spatula (kind of like a Popsicle stick). This cell sample is "smeared" onto a slide and sent to a lab. The test usually doesn’t hurt and it only lasts a few seconds, but sometimes it might be a little uncomfortable or cause some cramps. Also, you might notice a little blood after you’ve had a Pap test, but this is normal. Pap smears should be performed annually—from age 18, or when a woman becomes sexually active—whichever comes first. You can’t be having your period when you get a Pap smear. The doctor might do other tests, including cervical and vaginal cultures and a wet mount. Testing the pH (or acidity level) of vaginal fluid can be helpful in detecting infection. None of these tests should cause any pain or discomfort. Bimanual, breast, and other exams After the speculum is removed, the doctor will do a gentle exam to feel your reproductive organs. This is a Bimanual exam—which means it’s done with two hands. It’s used to check the size, shape, consistency, and location of the cervix and uterus. Here’s how it goes: With one hand, the doctor presses on your lower belly area (abdomen) from the outside. One or two fingers (gloved and lubricated) from the other hand are placed inside the vagina. Then the doctor’s hands move gently to both sides of the abdomen to find the ovaries and check for any areas that feel unusual or tender. You may feel a little tenderness—this is normal because ovaries are sensitive to pressure and it doesn’t mean anything is wrong. But speak up if you feel any pain—this isn’t a test of your bravery. Telling your doctor about pain or discomfort lets her/him adjust the exam a little, and may be important for her/him to know. The Breast Exam Now it really is just about over! For the breast exam, the doctor will stand at the side of the table and feel the breast tissue for lumps. The doctor examines all around the breast with his or her fingers in a kind of rolling motion—like kneading bread but much more gentle! Additionally, the doctor squeezes the nipples to check for any discharge. This exam is quick and easy—and not usually uncomfortable. It’s important that you know how to examine your own breasts. It’s an easy and very good thing to do. The doctor may explain it to you and show you—so pay attention! If she or he doesn’t offer—ask for instruction on how to do a breast exam or click here. The Rectal Exam Just when you think it’s over—it’s possible (but unlikely) that the doctor will do a rectal exam. Take a few deep breaths and relax. She or he will put one gloved, lubricated finger into your rectum to check for irregularities, and to complete your evaluation. Again, it shouldn’t be painful especially if you can relax. But let the doctor know if it is. The very very end
So that’s it! The doctor will let you know you can get dressed. When you’re finished, just go to the front desk like you would after any exam. Don’t forget any prescriptions you need, and make sure you have all the information/brochures you asked for. Oh, and don’t forget to schedule another visit for next year!
Ready for your first pelvic exams? Get tips and advice for your gynecologist visit at BeingGirl.com.