(Posted by the Moderator on behalf of Brandye)
As women we have specific needs in health care – especially for our reproductive systems. During adolescence and, preferably, before becoming sexually active a thorough pelvic exam is indicated. Throughout our lives, this should be done, along with a pap smear, on a yearly basis. Because our genitals are internal and mostly hidden from view and touch, maladies of all sorts can get ahead of the capability of medicine with, sometimes, no symptoms. Even diseases that may be little threat and very noticeable to men can have devastating effects on our bodies. Your male friend with a case of clap (gonorrhea) will know it almost immediately – it burns terribly during urination. This common disease in us can render us sterile before showing any symptoms. We need to be examined regularly, especially from the beginning of sexual activity for the rest of our lives.
We each both eagerly await and dread our first gynecological examination – the internal, the pelvic. For those of you who have not had this experience the very fact that you are visiting this website indicates that it is about time. By the time we are sixteen, a few years after we begin menstruating, this should be done; and should be done before you become sexually engaged. If pain is experienced or other symptoms - very difficult periods, smelly discharge, absence of menstruation - are present this should be done earlier. So, what is going to happen?
It is actually quite simple, not painful and only takes about ten minutes. Most of the time you are with the doctor will be spent talking. Each doctor has her own way with this exam but we all accomplish the same things. Mine are focused on education as much as anything. The nurse will get you situated with a gown in an examination room while I tell your mother she is not going to be with you. If you are old enough for a pelvic you deserve the privacy of any other woman. Some mothers become persistent and I gently inform them that they can see another doctor because “your daughter is my patient.” There are some doctors who disagree with this approach but it is within your rights to ask for privacy and this should be respected.
We will begin by talking about your feelings about your health and, specifically, how your development is going. How long have your breasts been developing, how long have you been having periods? How frequent, regular and long are your periods? Do you use tampons or pads and have you any idea what a menstrual cup is? (Guess what I use most of the time!) Any irritation, pain or discharge from your vagina? I usually begin the exam with the breasts. You will lie flat on your back while your breasts, sides and armpits are pressed. Then, sitting up, I will show you how to do a self-exam. Recently, there have been studies published indicating that the breast self-exam does not make much difference. Statistically, that may be true but the fact remains that some women are the first to discover lumps and that enables treatment before things get too serious. Besides, most breast lumps are benign but you should know they are there. This also emphasizes your responsibility for your own care. You should be comfortable taking care of your own body because you will be living in it a long time. And you have about 350 periods ahead of you which require a bit of self-care.
Then back on your back. I will begin at the bottom of the rib cage and press firmly from several angles right down to the mons venus. Actually, I am seeking information on many organs and conditions that are not reproductive. Is everything in place? As firm as it should be? Then raise your knees and spread your legs. Unless something else is discovered, I do not have you use the stirrups at this first exam. We can find out what we need without those and you will get plenty of practice in the stirrups during your life. I may place a small pillow under your hips. Then your lips will be spread for a visual examination. Is everything there? Does the clitoris seem overly developed? Is everything the right color and size? This visual exam will extend all the way back past your anus. There will also be some pressing along the sides of vulva. An exception to the use of the stirrups would be if the woman tells me that she has begun sexual activity. Then I will use a speculum and do a pap smear to check the cells around the cervix. If I have no reason to believe that you are sexually active, the dreaded speculum will never be seen or felt.
Some doctors will give you a choice of the internal part of the exam being rectal or vaginal. I strongly prefer the vaginal for a few reasons but you can choose where I insert my finger. Through the walls of the rectum, some of the “touch” examination seems less accurate. With a finger inserted, I will again press firmly on parts of your lower abdomen. Mostly checking to insure that everything is in the right place and to determine if any pain is caused. That may require further checking. You may feel some discomfort as I examine your cervix and, once in a while, a sharp but brief pain if I bump an ovary.
Another advantage of the vaginal approach is that I can see if your hymen is abnormally tough. I draw no conclusion from the absence of a hymen. Tampons, sport, riding bicycles or horses, masturbation can all have removed it. At least half the virgin fifteen year olds have little or no hymen remaining. If your hymen is particularly resistant, I will ask whether you wish to have it partially cut to facilitate use of tampons or make your later introduction to sex a bit easier. This is a small touch with a scalpel that feels like a pin-prick and takes ten seconds. At worst, after a bit of antiseptic is put on (that will burn a little) you will want to wear a panty liner for a few hours. I have them available.
We will then chat about what I have observed and the importance of hygiene and the risks of sex. You will leave the office with the whole collection of pamphlets published by the NHS and Planned Parenthood – STDs, contraception, menstrual distress, sexual response, and we will discuss these in as much detail as you wish.
For women who get all the way to near marriage or departure for university or work, we get a bit more detailed on contraception and protection and the dangers of promiscuity. This is a real “sex lecture.”
oh, how wonderful! thanks so much for doing this Brandye.
i only wish I had read this before MY first visit. thankfully my doctor was great and explained everything first.
I don't think anything can take away the butterflies feeling, but knowing all this would have sure saved me from a lot of the worrying beforehand.
hi everyone,
I havent bin for my 1st checkup yet but I feel lots better about it now i read this.
thanks a lot brandye.
My first exam was horrific. I was 13 in there cuz my period was erratic...didnt know what to expect. The doctor was very apathetic and rude. Wish I knew then what I know now!
Juno,
I hear this entirely too often. Rarely about women doctord. I am biased but when I get messed with I want the messaer to know what it feels like - physically and psychologically. Most other treatment I will use the best available. man or woman.
Hopefully, schools and internships are getting this turned around. 13 and being treated that way is inexcuseable.
This was actualy a male Gyn.
I certainly never returned to him.
Since that visit , I will only see a midwife for my exams.
Mine is a wonderful young woman who is gentle and personable. And I will be very happy to pass on the wisdom of my first horrible expirience to my daughter so that she may feel free to be picky about who she sees.
I was forteen. I remember this because my Mother took me. I also remember that for some odd reason she insisted on a male doctor. I never understood this. I thought at that age that a female would be more understanding and like two girlfriends discussing the topics that intailed. I guess my mother thought that a man should be the one to be fiddling down there. I thought it was a doctor not a relationship and I still think this way. I only go to a woman doc. If I want a man down there I want it to be my man lol. It is just that a female doctor knows about the female bod. A man just knows what he learned.
I got my first pelvic done, my doctor had two different speculums, a big one and a small one...and the small one is about the size of a tampon...it didn't hurt a bit...
m.
My first pap was this march and I'm 20 years old. It was so awful, more awful then when I played it out in my mind. I had been dreading it my whole life, and I don't ever want to do it again. But the most important thing is that it MUST be done, and I would rather have it done and know my health status than to never know. It is a big relief to hear everything come back good (even if you aren't expecting anything bad) and if something does come back, it's important to know and treat right away. However, I must say, it is unfortunate that my first and only time I got fingered was by a middle-aged lady.
As far as Im concerned a pelvic should NEVER hurt... There si no reason for it anyway
I have had both male and female ob/gyn's and top me Ive found no gentleness difference and my FAVORITE ob was a male. I started my period VERY early.. right before my 9th birthday and had to get a pelvic then cause my mom was afraid there was something wrong.
As for being shy.. dont. Easy to say I lknow.. but its something women have to do for their lifetime.. so its best to just relax and get over the anxiety. ANd as a dunny side note.. I was shy when I had my first baby.. By the second one I coul;dnt have cared less if the Doc invited a marching band in to help deliver her... you WILL get used to it and see that your "private parts" are just like all your other parts!
I am 23 and havent had one yet. I am kinda scared about it because I am so shy at times. But I know I have to go in very soon to get on birth controle. I am glad this topic was put up, it has made me feel a bit better about it.
I'm a 21 year old virgin (found the right guy once but he wanted to wait until marriage and haven't found the right guy since..)
Anyway, my first exam was in bootcamp. I'll tell you what I was scared to death! But the doctor there and the female corpsman were both very friendly and it didn't hurt at all! I was so relieved after it was over though because I knew I was due for one.
I haven't went for mine yet, but i have to.. i got no choice... but One doctor i went and i was going to get one done.. i was... 16? yea.. and she told me she wouldnt do it because i wasnt 18.. yet i was active since i was 13..?? that didnt make sense.. but Now.. after sex.. since ive been on depo-vera, i've been kinda bleeding.. only when the drug is wearing off... like... only within the last month at the end of it.. it happens.. or it has... and now.. it turns out that isnt a sideeffect.. or so the doctor i go to said.. but now.. turns out i gotta go to a specialist, so they can test the cells in my uturus...so.. something could be seriously wrong? i duno im pretty scared about it. Brandye.. what do you think it could be? cause the doc never really told me.. WHY? or what it could be.. or what could happen.. or anything.
...please dont wait.. like i did.. mind you i tired to getto go to one.. but thats the response i got from that doctor. but just dont wait for it.. go for it!! because somethign could be wrong.
whats 'the pinch'??
My first pap wasn't too bad. My doctor explained everything to me. I hadn' t had sex yet, so having something that large (compared to my b/f's 2 fingers) shoved in me--while not being aroused--was quite unpleasant. Then there was "The Pinch." How I will never forget "The Pinch." It wasn't that bad, but when you're not expecting it, damn.
Then I saw my b/f that night and told him all about it!
He coddled me...I love him soo much. and i miss him. 
Hi. I actually went to the nurse this morning, and asked her about whether I need a pelvic exam.
I am 22 and waiting until I get married to have sex.
My nurse told me that as 'i have never had sex, it can be a very difficult exam' and that i dont need to have one done until i have had sex. everything on these boards indicates otherwise, and i am not really sure what to do now?
Green,
Your story is all too common and inexcuseable to my profession. Find another gyn. MM points out that both male and female doctors can be good and you discovered that even women can be insensitive.
Remember the importance; keep up the checks. Encourage others to do the same.
Your next exam WILL be better.
Have to go for my first exam on March 9th. Anything anyone can say to make me feel less nervous?
My 40 something year old male doctor was not the first man I wanted down there. My two friends said they would both come with me, just in the waiting room, and I know they'll try to take my mind off of it.
But when I'm alone I have time to think, and I'm scared.
I wish I had a female doctor, but at the same time I wouldnt want to switch now because I've know this doctor my whole life. Either way I wish he was a she.
To top it off, the next night I'm going over to my boyfriends place for a nice three night stay. Only problem is, if I'm still weirded out by the doctor touching me, which chances are I will be... then I know I wont want my boyfriend touching me. And that sucks.
"To top it off, the next night I'm going over to my boyfriends place for a nice three night stay. Only problem is, if I'm still weirded out by the doctor touching me, which chances are I will be... then I know I wont want my boyfriend touching me. And that sucks."
Well for me I am like this for at least that same day. I am usually ok by the next day but yea, no touching me the same day I go to the gyno lol. You do get kinda weirded out. But its ok. You just have to think to yourself, "your's isn't the first one they've ever seen. They look at them all day... so its no big deal to them"
good luck
Twenty-four hours is plenty of time to "recover."
lol I'm hoping it just for the one day. I told my boyfriend that and he was kind of upset because he thought that meant that he couldnt hold me. I dont think I'll mind being held, I didnt mean that. I just meant like nothing else.
lol no big deal to them, maybe, but to me it still is.
Thanks though. Glad to hear someone else would be uncomfortable being touched by others the same day. Told my sister and she was like, What? No I'm fine afterwards.
i was okay with being touched probably like the next day too.
dont worry about it, the first one is always the weirdest. but just dont think baout it while you're there, think about something else. its not that bad, its more nerves then anything that make it seem so bad at first. but afterwards you'll realize that it was really nothing
im not saying you'll ever be comfortable with going, i know im still not and i've been going for the last three years but its something thats important to do
I am 17 years old, adn am leaving for university this summer (summer baby) and I still haven't had my first 'gyno' visit yet. The fact that I've been with my boyfriend for several years and we have been doing "things" but not having sex makes me a little bit uncomfortable about it. I know my doctor wont tell anyone, but I still have al the anxiety about opinions, and fears, etc. I actually have a close family history of breast cancer and miscarriages, as well as slightly unusual periods that leave me a little bit worried about it. I know it;s important that I see a gyno, but as yet, I have none, and am a littl bit nervous. Ummm..I don't really have a question, except can you get a prescription for birth control from your doctor at the time of a gynocologist visit? Because that will hopefully happen in the summer if I can get to my father's where I have a family doctor (who will hopefully) take me back for that.
By age 17 it is certainly time for your first gyn exam. I am glad that you are aware of your risk factors because simply knowing about them makes it more likely that you will either sidestep them or discover problems early. Yes, you can ask for a prescription for birth control at that visit. It is often helpful to be seeing a doctor who is accessible because it is not unusual to have to adjust the pill you are on initially.
is there usually a smaller size of speculum that they have available to use? for instance at planned parenthood. and in what cases would they use the smaller rather than the bigger?
also, how long might the actual physical exam take? like not including the questions asked beforehand. also how long would the speculum be in there? i'm really afraid to go because of the stories i've heard about how "uncomfortable" it can be, and to me that sounds painful.
Planned Parenthood does not generally do gyn exams but that is a good place to start. They may have a free clinic. Yes, there are smaller speculums. I have three different sizes and your weight, more than anything, will determine which the doctor may use. Because of the amount of tissue in overweight women, a larger speculum may be required. I often do not use a speculum with virgin teens; once they become sexually active, a smear needs to be taken and that requires the use of a speculum.
The exam itself takes only several minutes. Your breasts and surrounding tissue will be palpated; abdomen pressed and an internal, with a finger, will be done while pressing the abdomen. The speculum shoulod not be inside more than a minute or two. It is not "comfortable" but need not be painful. The pain is generally caused because the patient does not relax sufficiently, so you can really control that part.
ok, Brandy- I'm scared because i dont want my doctor to tell my mom that i'm sexually active.. Can doctors tell your parents? how can the doctor tell when i have been active? i am 16, and i have only had sex 5 times, but I play a ton of sports and i own horses and ride them often....will this have any effect? With the size of my boyfriend matter too? I have to go for my first examt next week and i am scared out of my mind.... now that i've read this, i'm not as scared... but the feeling is still there...
I don't know if this has been covered, (probably has, sorry) but I'm really self conscious about my lower regions, and only like my BF to see them. Obviously, he can't give me a pelvic exam, and I trust my doctor, it's just....weird.
I shave my vaginal area, and I wonder if I should let the hair grow back before a visit, or just keep it shaven...and is there any advice for women as to what to do before the visit (ie-washing techniques, or time limit on sexual contact beforehand). If it's been posted, just a link or direction would be greatly appreciated. Thanks to anyone who replies...this just isn't something I want to ask my mom...
And sweetness, I'm pretty darn positive it's illegal for your doctor to tell your parents anything at all. (Doctor/patient confidentiality).
No doctor should tell anyone anything. I do not allow mothers in the exam room when I am doing first gyn exams. Pisses some off but the rest know their daughter is getting a good education and will have a purse full of hidden brochures when she leaves.
With riding, sport, tampons and other activities, hymen went long ago. I rarely find more than the slightest hint of of one any more. No assumptions are possible about sexual activity based on the absence of the hymen. If it is intact, then we assume virginity. In short, your doctor will not "know." The first exam rarely involves insertion of anything other than the doctors finger. It is probing but need not be painful. If you have had a penis in there, the finger will not be a challenge. Just relax.
Shaving is irrelevant. Cleanliness is appreciated but DO NOT douche. If any swabs need to be made, they need to capture the natural flora and fauna of the vagina. Douching upsets the balance and renders tests irrelevant. If you are not using condoms, you may want to avoid sex for about twenty-four hours.
yes, but isnt it a neccesity to break the rule if the patient if it is something the parent needs to know (like if you was diagnosed with some sort of contagious sickness or something)???
or whatever...:P
OK, we use discretion but as a rule nothing between a doctor and patient should be discussed with anyone else. For a minor with a disease, of course the guardian would be told.
The stuff you are concerned about should not leave the exam room.
I'm 23, based in the UK & have never had a pelvic exam...because, & this may indeed sound really stupid, I did not know I was supposed to!
I asked about a smear test when I registered at my new Doctors after moving home & I was told that they do not do them now until patients are 25.
Should I be worried?!
First of all, don't worry. WORRY never solves anything. As others have said here, it is highly recommended that any adult female get "regular" gyn exams regardless of whether she is sexually active or not. Just part of routine health care. "Regular" will depend on age, activity, family history, etc. For example, there is no history of breast cancer in my family so I get a mammogram only once a year based on age. Women with a family history have the exam more often.
I'm not sure about the privacy from parents issue. This may depend on the laws where you live. Most big cities have Women's Clinics that if not free, only have nominal fees.
On a related note, I once read that a lot of men have untreatable testicular cancer because they don't have genito-urinary exams as frequently as women do.
The smear test is in NHS guidlines for over 25. I give them younger and take the heat. Irrespective of doing a smear, you should have a complete gyn exam. Nothing to worry about; this is just good practice for one taking care of her body.
Thanks for this info, I'll try to find out about access to such exams in my area...I honestly don't think any of my friends of similar age have ever had one either though. Maybe Americans are just more proactive about looking after their women than us reserved Brits!
Hey, honey, the NHS I refer to (and work for) is the one you use!!
Oh right, haha! I figured this would be something that I would have to pay for, seeing as it is definitely not standard procedure to have these kinda exams in the area I come from (maybe this is because I was brought up in a very working class area & many health services are pretty restricted/non-existent/non-advertised there).
Um.... >>' I'm very shy with my southern regions, but I've been having problems with itching and such for a few years now..... I got up the courage to tell my mother a year ago and she's only now getting me an appointment with the doctor for September (she wants me to get a full physical and our doctor has a very full schedule). I'm a 17 yr old virgin and I've already tried the yeast infection creams, so I'm a little anxious to get it checked out and find out what the problem is (only seems to get worse now, cuz I can't stop rubbing from time to time)... I'm gonna try to get mom to take me to a gyno while waiting for the doctor appointment, but she keeps making excuses with the car and not having the time (No offense to my doctor, but he comes off as a tad clueless in my opinion). -___-' Should I be more demanding in going to a gyno?
I would.
It could be that you just have reoccuring bad yeast infections.. and need something that is prescription not just something that is OTC.
September is a loooonng way away.
I have had a yeast infection before and it is no fun!!!
I wouldn't want to suffer and itch till Sept. Especially.... you probably need someone who is more experienced in Women's health... not just a GP.
Well, any decent GP deals with these issues commonly. If it takes so long to get in, even the immediate care clinics will either take care of it or get you on a fast track to see the right doctor. If you have been living with this for a year, your mother is just plain insensitive. Certainly, she has had a yeast infection in her life and knows what misery you are in.
If you have a school nurse, go talk to her. She will be able to bring some appropriate pressure and you deserve care right now. Otherwise, simply go to an immediate care clinic - free standing or in a hospital - and get what you need.
What is a yeast infection??
There are various fungi (yeast) that live on and in the body. They are always present but when the vaginal chemistry gets out of whack, they proliferate and will live in the dampness between the vulva - everywhere. They itch, burn and generally drive one to distraction. Fortunately they are easily driven into submission but will not do it on their own.
I cannot imagine any woman (mother) telling another woman (daughter) to live with it for a while. We all get the opportunity but none enjoys it.
Oh, it's definitely been more than a year. I'm dying. I think I've made my point to mom though and I told my sisters, who were horrified that I hadn't been able to see anyone yet. :P
I also waited too long.... 18 & I'd been having sex since I was 13 :eek: The only reason I went in is because I had an infected abcess :( I had a female Dr. & she was horrible - I've tried 2 female Drs. since & they've also been very rough ... the 2 male Drs. I've seen have been MUCH gentler, asking me if I'm OK, letting me know what is going to happen. I don't agree with the bias against male OBGYNs at all based on my personal experiance (also, my boyfriend is an OBGYN & is very empathetic towards his patients) :o :)
oh this has helped me a lot!!
im getting my first pap smear next week.
I feel better now.
Goog!!!! That is what we are here for!
I know this will sound naive but should i go 4 a smear test now? im 21 and hav been sexually active for 2 years. I have got 2 go back 2 my docs after having problems with lumps in my breasts. He told me i did not need a smear until i was 25 is this correct? thanks in advance.
The medical standard is an annual test after 25. Based upon patient history, general health as well as sexual activity, it is often indicated younger. I do hope that you have had a complete gyn and if the lumps were malignant, the pap would be indicated.
So, yes, your doctor is correct. I resist any hard and fast rules that delay preventative care.
i was not taken seriously 2 years ago when i went about the lumps. and now im getting severe pain. nt had gynae exam either.
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