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Going to the Gynecologist

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Gynecologist Exam

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"Toni" is 13 and on the swim team at school. For a few days after a swim meet, Toni noticed a kind of thick white goopy stuff on her underwear, and she was really itchy in the crotch area. It was really uncomfortable, not to mention embarrassing trying to sneak a scratch every now and then!

Toni told her mother who called "Dr. Karen Faye"—the family physician. Dr. Faye said it was probably nothing serious, but she scheduled Toni for her first pelvic exam .

In this section, we’ll walk you through a first gynecology exam  (also called a pelvic exam). We’ll look at it from Toni and Dr. Faye’s point of view. It should clear up any questions you have.

The Day I Told My Mom
Toni:
I was really bummed when I noticed the white stuff and got all itchy. I didn’t want to tell anyone, but it was really a pain so I told my mom. Now I have to have a pelvic exam . I’m a little freaked, but my mom will be with me. And I like Dr. Faye —she’s been my doctor since I was a kid.

Dr. Faye:
I had a pretty good idea of what Toni’s problem was. But anytime a girl has a vaginal or menstrual problem it’s good to see a doctor.

By the way, I’m a family doctor and I do pelvic exams. They can also be done by a gynecologist (guy-nuh-COLL-uh-jist) —a doctor who specializes in women’s reproductive health. We call them pelvic exams because many different health professionals do them not just gynecologists. To have a pelvic exam, you could go to a:

• Pediatrician
• Internal medicine specialist
• Nurse practitioner
• Certified nurse
• Certified midwife
• Physician’s assistant

Your first pelvic exam should be when you’re about 18. But here are some other reasons to go:

• You have vaginal itching, redness, discharge (like Toni), or sores, swelling, or unusual vaginal odor
• You’re 14 and haven’t started to develop at all physically
• You’re 16 and haven’t had your first period
• You’re having painful periods or PMS
• You have abnormal discharge—one that’s different in consistency, color, or amount from what you normally see
• You have a burning pain when you urinate, or you have to urinate a lot (every hour or more)
• You had an injury to your pelvic area
• You’re sexually active
• You’ve been sexually assaulted

Getting Ready for the Visit

Toni:
So my appointment’s tomorrow. I feel nervous and a little embarrassed—I never had to bare my private parts like that before! But if I think about it, there are a few things I can chill out about.
 
First, I feel like I can talk to Dr. Faye about anything. And even though my mom annoys me sometimes, I’m glad she’s coming. She can even be in the exam room if I want—which I DON’T. Also, Dr. Faye knows it’s my first gynecologist exam, so she made the appointment a little longer to answer questions.

But I still felt nervous so I told my mom. I don’t know why, but just talking about it made me feel better!

Dr. Faye:
Try not to feel embarrassed. Doctors like me have done these exams hundreds or even thousands of times. It’s routine for us. You could see a male or female doctor —more important than gender is how you feel with the person. After meeting the doctor, if you feel uncomfortable for any reason and want to leave—that’s totally your right.

It’s great that Toni’s mom is going to come along. You can bring someone to the exam if you like—an older sister, aunt, other female relative, or a friend —that’s your right. Also, I always have my nurse present for the pelvic exam. In some states—that’s the law.

Toni:
My big day arrived. Whoopee. I made sure I took a good shower—I didn’t want to be angst-ing about THAT. I never use douches—but I was told that if you do, you shouldn’t use one before a pelvic exam because it could mess up some of the tests.

My mom made me write down my symptoms and any questions that I had. It felt like homework, but it was good because I knew I might be nervous and forget everything.

Which I did while I was sitting in her office! Good thing I had the list. I felt nervous again—so I said, "Dr. Faye, I’m a little freaked out right now." It worked again! Just telling her how I felt somehow made me feel better!

Dr. Faye:
Always feel free to ask questions—to any kind of doctor. Take an interest and learn about your own health and body. If your doctor doesn’t answer your questions, change doctors. You want to know he/she listens to your concerns.

I told Toni a little about what to expect during the exam. Some doctors will do this without being asked, but many won’t think of it—so you should ask.

Toni:
Since the last time I saw Dr. Faye, I had started menstruating and had a couple periods, so she asked me some questions—like the date of the last one. My mom told me I should keep a calendar when I started having my period, so I knew the exact date. She also asked these questions:

How many days does your period last?
This is the number of days that you actually have flow.

What’s your menstrual flow like?
That meant, like, is it light or heavy, light red or a darker? From only two periods, I couldn’t answer these exactly.

How long is your cycle?
This is the amount of days from the beginning of one period to the beginning of the next.

Do you have any symptoms that bother you?
So now I got to tell her about the itching and white stuff—which she called discharge. I also mentioned that I did get cramps a little when I had my periods.

The Pelvic Exam -- visual inspection
Toni:
After the question period, Dr. Faye’s nurse took me into an exam room. This is when I told my mom she could catch up on her reading in the waiting room.

I went in, and the nurse asked me to undress and put on a gown. Before she left the room, she said they needed a urine sample —which means going into the bathroom and peeing in a paper cup.

I did, and then I put on the gown. (Don’t be dumb like I was—put it on so it opens in the FRONT.) Also, you’re supposed to take everything off—bra and underwear, too. She did say I could keep my socks on! Then Dr. Faye knocked on the door and came in.

Dr. Faye:
Once Toni got her gown on the right way, I checked her weight and blood pressure. Then I listened to her heart and lungs, and examined her thyroid and abdomen (belly).

Toni:
Just when I thought this was a breeze, Dr. Faye asked me to lay back, and scoot down so that my naked butt was at the edge of the table. She put my feet in these metal things called stirrups—brrrr! Glad I had my socks on!

Dr. Faye:
This is when the exam can feel a little awkward. But again, just try to relax. It’s really quick and generally painless.

Sitting at the end of the exam table, I could examine Toni’s external and some internal organs. Doctors always wear disposable plastic or rubber gloves during this and all parts of the exam. As I did the gynecologist exam, I told Toni exactly what I was doing. I did notice some of the white discharge she talked about. And I noticed some redness at the opening of the vagina. Later, I took a sample of the discharge and looked at it under a microscope. Just as I thought—a common yeast infection, easily treatable.

Toni:
I was glad to know that the goopy stuff was no big deal. Looks like I’d make it to 16 after all!

The Speculum Exam
Dr. Faye:
Toni was doing great. The next thing was the speculum exam. The speculum is an instrument that’s inserted into the vagina and gently opens so I can check the vaginal lining and cervix, and take specimens for further tests.

At this point I explained to Toni that if a girl hasn’t had sexual intercourse, the opening of the vagina might be smaller and a doctor might use a smaller speculum, about the size of tampon, to make the exam more comfortable.

Toni:
I wanted to die when Dr. Faye started talking to me about sexual intercourse! But the idea of a smaller speculum sounded good so I told her I was still a virgin.

Dr. Faye:
Knowing Toni was still a virgin, I could adjust the exam to make it more comfortable.

Toni:
Once the speculum exam started, I felt Dr. Faye’s hands between my legs. She told me to take a few deep breaths and relax. The speculum didn’t hurt; it just felt like pushing. The more I remembered to breathe, the less weird it felt. Once it was in, it was cool—I could handle it.

Dr. Faye:
If you have any pain or discomfort with the speculum, tell your doctor so that he or she can make adjustments. Keep talking to us during the exam—we need to know if you have any pain or sensitivity.

Pap Smear

Dr Faye:
With the speculum in place, I decided to do a Pap smear—even though girls usually start getting them when they are 18 or so. This test is done to see if there’s anything unusual about the cells in the cervix, but it can also be used to detect inflammation. And since Toni had a yeast infection, I just wanted to make sure nothing else was going on.

For a Pap smear, I lightly scrape the surface of the cervix with a small, disposable spatula (this one is kind of like a Popsicle stick —but there are other types, too). This sample is "smeared" onto a slide and sent to a lab. The test usually doesn’t hurt and it only lasts a few seconds. Sometimes it might be a little uncomfortable or cause some cramps; or you might notice a little blood afterwards—but this is normal.

Toni:
The Pap smear definitely felt weird. It didn’t hurt—it was just kind of annoying. The best part was that it was really QUICK!

Bi-manual Exam

Toni:
After the Pap, Dr. Faye took out the speculum. Whew! Then she said she wanted to feel my reproductive organs.

Dr. Faye:
The bi-manual exam is done to check the size, shape, consistency, and location of the cervix and uterus. With one hand, I pressed on Toni’s lower belly from the outside. I placed one finger of the other hand inside the vagina. I moved my hands gently to both sides of the abdomen to find the ovaries and check for any areas that felt unusual or tender.

You may feel a little tenderness. This is normal—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. It’s important that we know about any pain or discomfort you have.

The very end—the breast exam
Toni:
Well that was the end of that part. It wasn’t really so bad —and it was quick. Then Dr. Faye stood at the side of the table and said she was going to do a breast exam. (I thought to myself—if you can find ‘em, go ahead!)

Dr. Faye:
A breast exam is really important. We recommend that you start examining your own breasts when you’re in your late teens. Toni did have some development, so I did an exam—more to show her how to do it. Doctors do breast exams to feel for lumps. It involves feeling around the breast in a circular motion with my fingers. This exam is quick and easy—and not usually uncomfortable. (For more info on how to do a self-breast exam, click here [link to ART77].)

Toni:
Now I know how pizza dough feels! I’m just kidding. It was really gentle and now I know how to do a breast exam.

So that was it! Dr. Faye told me to get dressed and go back to her office. For my yeast infection, she wanted to give me some vaginal cream to use internally. But she wanted to make sure I was comfortable inserting it. I did use tampons when I got my 2 periods, so I "knew my way around," and I could deal with the applicator. Dr. Faye suggested that I wear a pantiliner while I’m using the cream to help me feel fresh.

I didn’t want to ask how I got the infection, but Dr. Faye knew I was a swimmer. She told me that yeast infections could be caused by hanging out in a wet bathing suit—bingo! It creates the warm, wet conditions that make yeast grow.

So I lived through my first pelvic exam, and so will you. Knowing what’s going on really helps. And I guess it’s something I need to do the rest of my life. That’s cool. I can handle it.

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