Health Library ~ Family Medicine in Mullica Hill, NJ

Going to the doctor's office for an annual gynecological examination isn't exactly something that women eagerly anticipate. And if you add in the fact that it is a young woman's first gynecological exam, that heightens anxiety even more.

What to Do Before the Exam
Many times, young women wonder what the exam itself is like. "The most important piece of information you can give to young women to put them more at ease about this exam is that it doesn't hurt," says Karen Nichols, D.O., an osteopathic internist in Arizona. "They also should know that they have the right to ask for explanations of procedures at any point during the exam." Because the exam can be a bit intimidating, women may forget some of the questions they had intended to ask their physicians. Dr. Nichols suggests that women write down their questions and bring that list to the appointment.

She encourages patients to ask about anything, even embarrassing or uncomfortable issues, because such matters are probably the most important ones to address. "When dealing with your health, no question can be considered stupid," Dr. Nichols stresses.
During the appointment, it is important that women be ready with information about their family medical history, especially patterns of breast disease or cancers of the reproductive organs. In addition to inquiring about the family, the physician will ask questions about personal health. Among the most common questions are the following:

* At what age did you start menstruating?

* When did your last period start? The physician will want to know the actual date your last period began.

* How long does your period usually last?

* Do you tend to have a light, medium or heavy flow?

* How many pads or tampons do you use the first day of your period?

When to Schedule a Visit
Dr. Nichols emphasizes a few points to keep in mind when scheduling a gynecological exam. First of all, young women should get this exam when they become sexually active or reach age 18, whichever comes first. Also, women need to remember to make an appointment when they will be in between their menstrual cycles. A Pap smear cannot be done during the menstrual period because the blood covers up the cells the physician needs to examine. The Pap smear is important because it can detect pre-cancerous and cancerous cells in the cervix.

Women should immediately make an appointment if they experience any of the following problems:

* Severe pain in the abdomen or pelvis

* Unusual pain in the vagina

* Unusual discharge, itching or bumps in or around the vagina

* Exposure to a sexually transmitted disease

* Severe pain during periods or irregular periods

* Breast discharge, changes in breast size or changes in the skin of the breast

* Pain during intercourse

It's Exam Day-What Can You Expect?
The exam consists of a variety of steps.
First, you sit down with the physician and talk about your medical history, both personal and family. During this time, you can also bring up any questions you may have about birth control, sexually transmitted diseases (STDs), menstruation or other issues.
Carol Henwood, D.O., an osteopathic family physician in Pennsylvania., encourages open dialogue with her patients. In fact, when she sees patients for their first gynecological visit, she sits down with them to remind them that she was once in the very same position, and she understands that they are scared. "While they view it as a scary situation, I tell my patients the gynecological exam is a necessity to ensure their health," says Dr. Henwood. "Also, I make sure they have all the sexual health information they need, especially if they are sexually active."

The next step is that you change into an examination gown. Usually, you will be given a sheet to drape over yourself as well.When the physician returns to the room, he or she will perform a breast exam to look for lumps that may be a sign of cancer. If you have never done a self exam, the physician can show you how to do it and tell you what to look for.
Dr. Henwood strongly recommends performing self examinations on a monthly basis. She adds that the best time for a self exam is about 10 days after your period.
According to the American Cancer Society, breast cancer is the second leading cause of cancer deaths among women. This year alone, an estimated 184,200 new cases of invasive breast cancer will be diagnosed.

Women over the age of 20 should get a clinical breast exam performed by a physician or a nurse every year and should perform a self-exam every month.

The Dreaded Pelvic Exam
Next comes that part that you probably have been dreading the most-the pelvic exam. Dr. Henwood makes it a point to explain this procedure beforehand as well as during the exam. However, if your physician does not provide explanations, and you want some answers, just ask. At this point, you will be instructed to slide to the end of the table and place your feet into stirrups. Staying relaxed is very important because you will be more comfortable and the exam can be more complete.

The first step in the pelvic exam is for the physician to examine the external genital area for any signs of irritation, discharge, cysts, genital warts or other problems. Next, the physician inserts a speculum. This instrument, which is made of metal or plastic, is used to separate the walls of the vagina. Once placed inside, it is opened up so that the doctor can examine the cervix and the vaginal walls.

If you need to be tested for any STDs, the physician will collect cervical mucus on a cotton swab. If you are at risk for any STDs, you need to tell your physician up front.
"It's so important for patients to be honest about their sex lives and their risk for contracting STDs," stresses Dr. Henwood."For instance, human papilloma virus (HPV), more commonly known as genital warts, causes 95 percent of cervical cancers."
The American Cancer Society estimates that, in the year 2000, just under 13,000 new cases of invasive cervical cancer will be diagnosed and about 4,600 women will succumb to this disease.

If tests do not need to be conducted for STDs, a Pap smear will be done. This involves using a small brush or spatula to collect cells from the cervix. This test can detect the presence of pre-cancerous or cancerous cells, infections of the cervix and thinning of the vaginal walls due to lack of estrogen.

With the speculum now removed, you've reached the halfway point of exam. Next, the doctor inserts gloved fingers into the vagina while pressing on your abdomen to examine your internal organs-the uterus, the fallopian tubes and the ovaries.
Lastly, the physician will insert a gloved finger into the rectum to check the condition of the muscles in between the vagina and the rectum. Sometimes the doctor will have one finger in the rectum and one in the vagina for a more thorough exam.

When that test is completed, you will have successfully completed your first gynecological examination. Results from the Pap smear are usually ready in 7-10 working days. If the results come back normal, you will not need another exam until the next year. If the results are abnormal, your physician will schedule you for follow-up exams and possibly advise you about other treatments.

Knowing what to expect during the first gynecological exam can alleviate many anxieties young women have. Not only does this exam provide an opportunity to catch health problems in their early stages, it is also an opportunity to learn about ways to maintain good gynecological health.

As physicians who emphasize prevention and wellness, D.O.s strongly support the U.S. Surgeon General's Healthy People 2010 initiative in the quest to improve the quality of life and increase the number of years of healthy life.

The American Osteopathic Association (AOA) reminds you that November 12-18 is National Osteopathic Medicine Week. This year's target group is young women from the age of ages 12 to 24. During this time, osteopathic physicians (D.O.s) will work to raise awareness among young women regarding the many issues they face as they strive to maintain healthy lifestyles. In addition, D.O.s hope to educate them on how preventive care can help maintain good health throughout their lives.D.O.s are fully licensed physicians who have additional training that focuses on the body's structure and function as well as its ability to heal itself.

For more information on osteopathic medicine or to locate a D. O. in your area, call the AOA at 1. 800. 621. 1773, ext. 8252, or visit the AOA's Web site at www.aoa-net.org.

Did You Know. . . ?

* The best time for a gynecological exam is one week after your menstrual cycle.

* Women should not douche or use vaginal creams for at least 72 hours before the exam.

* For 24 percent of women, the gynecological exam is the only regular exam they undergo.

* Every three minutes, a woman in the United States is diagnosed with breast cancer.

* After the age of 20, women should perform a self breast exam every month.

* This year, about 13,000 new cases of invasive cervical cancer will be diagnosed in the United States.

* Ovarian cancer accounts for the fifth most common cancer among women, with approximately 24,000 new cases diagnosed each year.
 

Sources: American Osteopathic Association and
American Cancer Society

You can contact the following organizations for additional information:

American Cancer Society
1.800.ACS.2345 (1.800.227.2345)
www.cancer.org

Planned Parenthood Federation of American
810 Seventh Avenue
New York, NY 10010
1.212.541.7800
www.plannedparenthood.org

The Susan B. Komen Breast Cancer Foundation
5005 LBJ Freeway, Suite 250
Dallas, TX 75244
1.800.462.9273
www.sdkomen.org