Your First Pelvic Exam
by: Amy Otis, RN
First Pelvic Exam
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 age eighteen. There
are many female gynecologists, nurse practitioners, and physician's
assistants today if you prefer a woman to provide you with
your GYN health care. Its usually easy to find one in
the United States and Canada. Of course, many women still
use male health care providers or gynecologists for their
Whomever you choose,
its 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.
your appointment be ready with some information about your
family medical history which you may be asked to provide.
Among the most common questions are the following:
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.
will visually examine your vulva for discoloration, irritation,
swelling and other abnormalities, and she will gently feel
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. (See
our Pap Smears section
for more details.)
If you are sexually
active, the practitioner will then test for STDs. Be sure
to ask the person to do them. She or he will swab the inside
of the cervix with what looks like a long cotton swab or two.
The speculum is then slid out of the vagina. The samples are
sent out to a laboratory where they tested for various STDs.
The tests will take a couple days or more depending on how
busy the lab is. Ask when your results will be back so you
can call them if you want your visit to be totally confidential.
If you want to be tested for HIV,
you need to have blood taken. They can do that there also.
But, they may not do that routinely, you will need to ask.
(See our STDs section for more
is a blood test now that can show if a person has been infected
at any time with genital herpes (HSV).
There are also newer blood tests that can tell whether a person
has been infected with HSV-I and/or HSV-II. This test will
not be done routinely, so that is also something you would
ask for if you are or had been sexually active.
The second part
of the pelvic exam is called the manual or bi-manual exam.
The practitioner will insert one or two fingers into your
vagina and press with her/his other hand on the outside of
your lower abdomen. They will use a lubricant on their fingers
so it is more comfortable and easier to feel things. The person
can then feel the uterus, fallopian tubes and ovaries, and
check for any swelling or tenderness. Once the doctor or nurse
practitioner is finished checking your uterus and ovaries,
the exam is complete. Even though reading about it may make
it seem long, the entire pelvic exam (the parts involving
your vagina, cervix, uterus, and ovaries) really only takes
about 3 to 5 minutes.
The doctor or nurse
practitioner will give you a breast exam by pressing with
his or her fingers on different parts of your breasts. This
is necessary to help look for "normal" lumps (which
are quite common and are harmless), cysts, or, in very rare
cases, breast cancer. After finishing, he or she may ask you
to examine yourself, or may move your fingers to show you
how to do it. Although breast
cancer is very unusual in teenage girls, it's important
that you learn to examine your breasts yourself, since knowing
how your breasts feel early on can help you detect problems
later. The doctor or nurse practitioner will explain exactly
how and when to do breast self-exams and answer any questions
you have. (See our Breast Exams section
for more details.)
If you have painful
breasts that the doctor says are fibrocystic, find out
more about those...
For more on your GYN health, go to GYN
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