First Pelvic Exam

As women we have specific needs in health care – especially for our reproductive systems. During adolescence, and preferably before becoming sexually active, a first visit to a gynecologist to talk about sexual health is a good idea; an internal pelvic exam usually isn't needed until your twenties, unless you have symptoms. From 21 on, a pap smear is done every three years (or an HPV test every five years from 25 or 30), with a pelvic exam when there's a reason for one. Because our genitals are internal, and mostly hidden from view and touch, maladies of all sorts can develop with no apparent symptoms. Even diseases that may be little threat, but very noticeable, to men can have devastating effects on our bodies. Your male friend with a case of clap (gonorrhea) may know it almost immediately - it can burn terribly during urination - but some guys have no symptoms at all. 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, and for the rest of our lives.

We each await and typically 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 might be about time. This usually isn't needed until your twenties, unless you have symptoms or concerns, and becoming sexually active doesn't by itself mean you need one. 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 when you go for your first exam?

It is actually quite simple, usually not painful (though you may feel some brief discomfort) and only takes about ten minutes. Most of the time that you are with the doctor will actually be spent talking. Each doctor has their own way with this exam, but they all accomplish the same things. Speaking as a doctor, my exams 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 privacy, the same as any other woman. 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? 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. Most breast lumps are benign, but you should know that 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 onto your back. I will begin at the bottom of the rib cage and press firmly from several angles right down to the mons veneris (pubic area). 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 the vulva (external genital area). I only use the stirrups 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. I am mostly checking to ensure 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, and masturbation can all stretch it, and many hymens are thin or stretchy to begin with. If your hymen is unusually thick or blocks tampons, we can talk about whether a minor procedure is needed. 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.