The Annual Gynological Exam: What to Expect
Soma Mandal
Features Columnist
Issue date: 10/4/06 Section: Features
Reprinted from Washington Square News
Dear Dr. Mandal: I have my first gynecological exam coming up, and I'm nervous. I don't know what to expect, and I've heard really horrible stories. Does it hurt? What should I anticipate? Can my doctor answer any questions I have?
Thanks,
Nervous in New York
Dear Nervous,
The gynecological exam (sometimes called "pelvic exam" or "annual exam") is very important because it allows your physician to make sure that your genitals and reproductive organs are healthy. During this visit, breast health and sexual health is addressed as well. The American College of Obstetricians and Gynecologists and the American Cancer Society recommends a gynecologic exam for any woman who is sexually active or over 21 years of age.
It may seem daunting for many women. Many stress over their first exams because they don't know what exactly the exam entails.
THE EXAM, STEP-BY-STEP
Once you are in the examination room, you will be given a gown and sheet to cover your torso. The doctor will ask general questions about your health and then do a brief external physical exam.
The doctor will examine your breasts for any lumps or any pain, then teach you how to do a monthly self-exam. Before beginning the pelvic exam, you will be asked to lie down and place each foot in a foot holders, called stirrups, at the end of the table. It helps to relax your knees and pelvic muscles to facilitate the exam.
In the beginning of the pelvic exam, the doctor will examine the external parts of the vagina, checking for any abnormalities in the skin. He should then inform you when he is ready to perform the internal exam. A speculum — a plastic or metal tube-shaped instrument that opens slightly once inserted — is gently inserted into the vagina. The doctor will inform you before he opens the speculum to better visualize your cervix. As the speculum opens, you will feel a light pressure in your pelvis. Occasionally, if the pelvic muscles are clenched too tight, you might experience pain. If this occurs, inform the doctor. He will probably use a smaller speculum and ask you to take deep, slow breaths and relax your pelvic muscles.
The speculum is locked to keep your vaginal walls open. At this time the cervix will be inspected to check for any abnormalities. The healthy cervix is pink in color and often resembles a small donut. A small brush or spatula is used to collect cells from the outer and inner portions of the cervix. During this time you may experience slight discomfort. These cells are collected in a vial and sent to the laboratory for a Pap smear (Papanicolau smear).
In the lab, the cells are examined for a HPV (human papillomavirus), a sexually transmitted disease and an indication of possible cancerous or pre-cancerous cells. Various types of HPV have been shown to be responsible for pre-cancerous or cancerous changes in the cervix.
After the speculum is removed, the doctor will perform a "bi-manual" exam. The doctor will insert two gloved fingers into the vagina and will then apply light pressure on your abdomen with the other hand. This exam is done to determine the size, shape and position of the uterus and to examine the ovaries. A rectal exam may be performed to check for any rectal abnormalities and to examine the back of the uterus and ovaries.
The doctor may not check automatically for sexually transmitted infections such as gonorrhea and chlamydia. Most insurance companies will not reimburse the provider if there are no symptoms that warrant these tests. If you want to be tested for any sexually transmitted diseases, it is important to address these concerns at the beginning of the visit. If you want to have an HIV test, the doctor will offer HIV counseling and obtain your consent before drawing blood for the test.
Before your visit, write down a list of questions you may have so the doctor can address the issues that are most concerning you. It is also a good idea to get a referral for a gynecologist through someone you trust. Ask your female friends whom they trust for their gynecological check-ups. You can also ask your general internist or student health center for a referral.
It is important to stress that the gynecological exam is an important aspect of preventing illnesses and maintaining your good health. Good communication between you and your doctor is imperative to ensure that you have the most comfortable and thorough exam possible.
****Just wanted to correct a written error. The PAP smear is inspected for atypical or abnormal looking cells. Only if this is present will an HPV test be performed. The HPV test is not routinely performed for each smear.
Soma Mandal, MD
(646) 509-0943
Soma Mandal is a board-certified internist in Greenwich Village. She is an attending physician and clinical instructor at NYU Medical Center. Her specialties include general internal medicine, women's health, preventive medicine and weight management. For more information, go to www.positivehealthpc.com [1]. E-mail Soma Mandal questions at features@nyunews.com [2].
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