You should have your first gynecological exam when you are around the age of 18 years old (recommended earlier than 18 if you are sexually active or have a medical problem requiring a pelvic exam). After the first exam, you should continue to have exams once a year, especially if you are sexually active. A yearly exam can detect any abnormalities which may have developed and thus ensure early treatment.
- Have itching, redness, sores or swelling in the genital area
- Have an unusual odor and/or increased vaginal discharge
- Suffer from abdominal pain or painful intercourse
- Had sex with a person who might have an infection
- Need a contraceptive method
Preparing for the Exam
- Schedule the exam for a time when you don't expect to have your period.
- Do not douche 24 hours before your visit (douches are not necessary for healthy hygiene).
- Use a condom if you have vaginal intercourse less than 24 hours before your exam.
- Write down your questions so you won't forget to ask them.
- Be prepared to tell your provider the date your last period started and how long it lasted.
Prior to the Examination
Before beginning the pelvic exam, the staff at the Clinic will ask for information concerning your medical background and menstrual and contraceptive history. Be sure to mention any genital symptoms you have had and ask questions about any special concerns. The pelvic examination provides an opportunity to talk with a clinician about safer sex and/or birth control methods. If you are not sexually active, this is an opportunity for you to become well informed before having to make decisions. If birth control is your primary concern, a contraceptive program will be tailored to meet your individual needs. If you are concerned about sexually transmitted infections, you can ask your provider to discuss your concerns.
During the Examination
You will be given a private room in which to remove your clothing, put on an examination gown, and drape body with a sheet. After your lungs, heart, breasts, and abdomen have been examined, you will be asked to place your feet in the foot rests ("stirrups") at the end of the table. This position makes it easier and quicker for the examination to be done. The health care provider may use a lamp during this part of the examination. You may ask for a mirror if you want to see the exam. Generally, the examiner will place an arm or elbow on your leg or thigh before touching the outer genitals. This is to avoid startling you, in which case your genital muscles might involuntarily contract and make the examination more difficult. The clinician will use a latex glove to examine the entire vulva area.
After external genitalia has been inspected, your clinician will gently insert a plastic speculum. The speculum holds open the vaginal wall. You will feel some pressure when the speculum is inserted but it is done slowly and carefully. If you do feel tenderness or pain, tell the provider so that the speculum can be adjusted to make you feel more comfortable. You should also try taking deep breaths and relaxing as it is inserted.
Once the inserted speculum is opened the wall of the vagina and the cervix will be in view. Cells will then be taken from the cervix and vagina with a small flat stick, a cotton swab, or a small cervical brush. The cells will then be smeared on a glass slide and sent to a laboratory for analysis. This simple procedure, called the Pap smear, allows for early detection of precancerous cells. It is very important to avoid the use of douches, vaginal creams or vaginal medications for at least 48 hours prior to your pelvic exam because these substances can distort the appearance of the cells to be studies in the Pap smear. Pap tests should also be avoided when you are having your period. With the speculum still in place, your provider may also take appropriate samples to determine the presence or absence of vaginal infection.
After gradually removing the speculum, the examiner will do a digital examination. This is also referred to as a bimanual examination because both hands are used - one internally and one externally on the abdomen. The provider will insert two gloved fingers into the vagina and place the other hand on your abdomen, applying slight pressure. The provider may also insert a gloved finger into the rectum while applying slight pressure on the abdomen. This exam permits the detection of any growths, abnormalities, swellings, or areas of tenderness in the pelvic area. The entire exam takes but a few minutes.
After the Examination
You and your provider will discuss the findings of the examination. You'll be told when to expect the results of your pap smear. Your provider will also advise you when to come in for your next pelvic exam and Pap smear. Sexually active women should have a yearly exam because of the importance of early detection of infections and disease.
What is the Pap Smear?
A Pap smear is done to check for abnormal changes in the cells of the cervix (the lower opening of the uterus). A Pap smear can detect cervical cancer early, while it is still curable. Usually health care providers recommend that women have a Pap smear annually beginning at age 18 or within six months of first sexual intercourse.
An abnormal Pap smear result may indicate an infection, a precancerous condition or cancer. However, a Pap smear is just a screening; it is not 100% accurate. It may suggest a precancerous condition when in fact everything is normal. Sometimes it fails to detect cancer that is there. Further testing through additional Pap smears, colposcopy, biopsy or specific STI screening may be necessary to accurately diagnose and properly treat the condition.
Dysplasia is one term that has been used to describe abnormal cells seen in a Pap smear. In dysplasia, normal cervical cells undergo a series of changes in their appearance. It is not cancer, although if left untreated it may develop into an early cancer of the cervix.
Check out this site for more information about pap smears.
Health Needs of Lesbian and Bisexual Women
All women should follow the same recommendations for maintaining their health. Pelvic exams, Pap smears, and breast self exams are important for detecting problems at an early stage regardless of sexual orientation. Usually, lesbians run a lower risk of getting a STI, although all women are susceptible to STIs. Furthermore, although lesbians may have a lower risk of various cancers associated with sexual intercourse, they may have an increased risk of ovarian and breast cancer. For more information about lesbian sexual health, visit the Clinic's Other Sexual Health Issues page.
Breast Self Exams
In addition to obtaining yearly pelvic examinations, all women over the age of 18 should conduct monthly breast self exams. Don't know how to do this? Go to our page on How to Conduct a Breast Self Exam.
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or check out Sexual Health Services.