Annual Gynecological Visit/Exam
Staying healthy is important. Whether you’re young or old, married or single, sexually active or not - good gynecological care is the key to good health. Routine gynecological care prevents illness and discomfort, allows for early detection of cancers of the breast and cervix, and detects sexually transmitted infections and other conditions before they cause serious damage, prevents sterility, and promotes healthy pregnancy and childbirth. Unless you are having problems, gynecology exams should occur annually.
You may need to have more frequent checkups if you have:
- A history of abnormal pap test results
- A history of sexual health problems
- A mother or sister who developed breast cancer
- A sexually related illness
- A sexually transmitted infection or a sex partner with an infection
Many women worry about having a GYN exam — especially if it’s the first time. You will be more comfortable if you know what to expect. Periodic GYN visits and exams may include:
- Talking about your personal, family, sexual, and medical history
- A breast exam
- A pelvic exam
- Cancer screening
- Pap smear
Prepare for your office visit
Schedule your GYN visit and exam for a time when you will not have your period — unless you have bleeding problems that your provider wants to observe. Menstrual fluid can affect the results of some lab tests. Let your clinician know if it turns out that you will be having your period during the exam. You may want to reschedule.
Make a list of all the questions and problems you want to talk about. Please include:
- Bleeding after sex
- Heavier than usual flow
- Pelvic pain or other problems
- Spotting between periods
- Vaginal discharge
- Unpleasant vaginal odors
Women shouldn’t douche. If you do, however, don’t douche for at least 24 hours before the appointment. Don’t use any other vaginal preparation, either. They can mask many vaginal conditions.
Don’t have vaginal intercourse or insert anything into your vagina for between 24-48 hours before your visit.
Your Medical History
Before you are examined, you will be asked to fill out a history on our patient portal. Typical questions include:
- When was your last period?
- How often do you have periods? How long do they last? Do you have any bleeding between periods?
- Do you feel any pain when having sex? Is there any bleeding after sex?
- Do you have any unusual genital pain, itching, or discharge?
- Do you have any other medical conditions?
- What medical problems do other members of your family have?
- Are you using birth control?
- Do you suspect you are pregnant or are you trying to become pregnant?
You will be asked about your history of allergies, illnesses, pregnancy, risks for sexually transmitted infections, and surgery. Your provider will review your contraceptive needs. If you are using birth control, you will be asked if you’ve had side effects.
The Breast Exam
During your visit your provider will examine your breasts for lumps, thickening, irregularities, and discharge. Many providers will continue to talk to you about your health history during the breast exam. You will be asked if you have noticed any changes in your breasts since your last exam.
Women over 40 should have mammograms every year. Younger women whose families have a history of breast cancer should consult with their clinicians about whether or not mammograms would be of value to them. The Pelvic ExamAfter your breasts have been examined, you will need to have a pelvic exam. You will be asked to place slide your hips down to the edge of the table and to place your feet in the footrests. Spread your knees wide apart and relax as much as possible. If your buttocks and abdominal and vaginal muscles are relaxed, you will be more comfortable, and the exam will be more complete.
Usually, the exam lasts just a few minutes. The four steps include:
- Step 1. The external genital examThe clinician visually examines the soft folds of the vulva and the opening of the vagina to check for signs of irritation, discharge, cysts, genital warts, or other conditions.
- Step 2. The speculum examThe provider inserts a metal or plastic speculum into the vagina. When opened, it separates the walls of the vagina, which normally are closed and touch each other, so that the cervix can be seen.
You may feel some degree of pressure or mild discomfort when the speculum is inserted and opened. You will likely feel more discomfort if you are tense or if your vagina or pelvic organs are infected. Once the speculum is in place, the clinician checks for any irritation, growth, or abnormal discharge from the cervix. Tests for gonorrhea, human papillomavirus, chlamydia, or other sexually transmitted infections may be taken by collecting cervical mucus on a cotton swab.
Usually a small spatula or tiny brush is used to gently collect cells from the cervix for a pap test. The cells are tested for abnormalities — the presence of precancerous or cancerous cells. You may have some staining or bleeding after the sample is taken.
As the clinician removes the speculum, the vaginal walls that were covered by it are also checked for irritation, injury, and any other problems.
- Step 3. The bimanual examWearing an examination glove, the clinician inserts one or two lubricated fingers into the vagina. The other hand presses down on the lower abdomen. The clinician can then feel the internal organs of the pelvis between the two fingers in the vagina and the fingers on the abdomen.
The provider examines the internal organs with both hands to check for:
- Size, shape, and position of the uterus
- An enlarged uterus, which could indicate a pregnancy or fibroids
- Tenderness or pain, which might indicate infection
- Swelling of the fallopian tubes
- Enlarged ovaries, cysts, or tumors
- Step 4. Rectovaginal examMany providers complete the bimanual exam by inserting a gloved finger into the rectum to check the condition of muscles that separate the vagina and rectum.
They also check for possible tumors located behind the uterus, on the lower wall of the vagina, and in the rectum. Some clinicians insert one finger in the anus and another in the vagina for a more thorough examination of the tissue in between.
During this procedure, you may feel as though you need to have a bowel movement. This is normal and lasts only a few seconds.
After Your Exam
This is a time for further consultation with your provider. You will discuss the results of your exam, arrange for any follow-up or consultation that may be needed, and ask any further questions you may have.
This is another opportunity to discuss your concerns about sex and sexuality, birth control, pregnancy, abortion, sexually transmitted infections, problems holding your urine, inherited disorders, infertility, cancer signals, changes in your breasts, and menopause.
If the lab tests indicate anything unusual, you will be contacted when the results are completed. Pregnancy test results are usually ready during your visit. Other test results may take a few days or weeks.