Sex Advice

Dear Dr. Locker: What goes on at an annual gynecologist exam? I have my first appointment for my first pelvic exam, and I am not sure what to expect.

Answer from Dr. Locker

During a routine annual exam, a gynecologist will perform a breast exam, a pelvic exam, (including a Pap smear which tests for cervical cancer, and other tests for sexually transmitted diseases), and will assess your general sexual health and well being. It is also a time to discuss birth control (and get prescriptions), and to talk about pregnancy, and any other questions about sexual health.

While it varies for every doctor, here is more-or-less what you can expect. When you enter the exam room, you will be asked to undress completely (bra, panties and all) and to put on an exam gown. If the room is really cold, most doctors don't mind if you keep your socks on.

Usually before the doctor comes into the room, a nurse will record your weight, height, and blood pressure, and ask you: “What was the first day of your last period?” (If you know that date in advance then it will save you from struggling to remember when you are in the exam room.)

When the doctor comes in, he or she will have you open the top of your exam gown and will examine your breasts by feeling them for any lumps or abnormalities. The doctor may feel them with you sitting up, and/or with you on your back on the exam table.

Then the vaginal exam will be next. You will lie down on your back an examination table. Your gown will open from the bottom, and the top usually can stay closed. The doctor will say the standard line, “Slide down,” and you will slide down until your butt is at the edge of the table. As you do this, you’ll bend your knees up and put your feet in “the stirrups,” which are just really foot holders that help you keep your legs spread. You should breathe and try to let your body relax completely.

Then the doctor will start the vaginal exam. How long does a vaginal exam take? Well, the entire vaginal exam usually only takes about three minutes. First, the doctor will do a vaginal-digital exam by inserting a gloved, lubricated finger inside your vagina to feel for any abnormalities. He or she will also push on your abdomen from the outside to feel your uterus. Remember to relax and breathe during the exam, and tell the doctor if you feel uncomfortable. Then the doctor will insert a speculum into your vagina. A speculum is a narrow metal instrument that holds the vagina open. It is not very big, and does not hurt when it goes in, but you may feel a little bit of pressure. By using the speculum, he or she can see your cervix, search for any cervical infections, and take a Pap smear, a sample of cells. Because there are not many nerve endings near the cervix, a Pap smear should not hurt; yet you may feel a cramp or some pressure. The doctor collects cells from the cervical walls by gently rubbing them with a long, very thin flat wooden implement that is like a skinny version of a tongue depressor, or something that looks like a long Q-tip, or a narrow plastic stick with a tiny brush on the end. Some doctors may scrape the cervix in way that there is a tiny bit of blood, but not usually. Collecting the cells for this test only takes a few seconds, and as I said, it will not hurt. The cells are smeared across a glass slide and ultimately (later) checked under a microscope for abnormalities. If the doctor is checking you for some other STDs, then he or she may take more cell samples. That is the end of the vaginal exam. For women who are 40 or over, the doctor may do a rectal exam, inserting a gloved lubricated finger into the anus for just a couple of seconds.

Be sure to talk to your doctor about any other concerns—such as STDs—so that appropriate tests can be taken and diagnosed. Also, ask about the HPV vaccine. In addition, make sure you discuss birth control, and what method is best for you. Your doctor is the only one who can prescribe certain birth control methods, like birth control pills and diaphragms. Asking questions and providing complete answers to the questions that the doctor may ask you about drugs, alcohol, weight patterns, diet, sex, and your relationships may seem personal or even embarrassing, but it’s the best way to get the advice, treatment, and counseling that’s right for you. Don’t worry—the conversation is confidential. Your doctor has heard it all before.

Good luck with your first GYN exam!

Copyright © Dr. Sari Locker