Your Yearly Visit to the GynecologistWhat to expect at your annual gynecological exam
We want you to be comfortable at Woman’s, especially during those not-so-comfortable procedures. Part of putting you at ease is helping you know what to expect. So read on, take a deep breath, and take control of your health!
Why is it important to schedule an annual exam?
Many women have the misconception that the main purpose of an annual exam is “the Pap,” which checks for cervical cancer. However, your yearly visit to the gynecologist is a great time to take care of many other concerns surrounding your health. Everything from breast lumps to sexually transmitted infections (STIs) may be addressed during the annual exam.
Your gynecologist may even be able to diagnose some conditions that have no symptoms, but if treated timely, could save your future child-bearing. The annual exam takes only 10 minutes out of your year, and it could save your life.
When should a woman have her first annual exam?
Your first annual exam should occur by age 18, but some other reasons for visiting the gynecologist even sooner include the following:
- Not having a menstrual period by age 16
- Vaginal bleeding that lasts longer than 7 to 8 days or requires more than one pad per hour
- Menstruation that occurs less than every 21 days or more than every 32 days
- Menstrual problems that cause significant interruption in work, school or personal activities
- Missed periods, especially if you are sexually active
- Pain in your lower abdomen or genital areas
- Sores, cuts, bumps or unusual discharge in the vaginal or genital areas
- Breast abnormalities (lumps, nipple discharge, skin changes)
- Sexual activity of any kind
- Look at your calendar to make sure you will not have your period during your appointment. If you think you may be on your period, you may want to reschedule. Bleeding may affect your level of comfort during the exam and may also make an accurate diagnosis of some problems more difficult.
- Make a list of any questions or concerns you may have to discuss with your doctor. These may include:
o Unusual vaginal discharge
o Heavier menstrual flow
o Spotting between periods
o Bleeding after sex
o Painful sex
o Any pain or period irregularities
o Birth control
- Avoid douching, tampons or vaginal creams for 24 to 48 hours before your appointment.
- Do not have sex for 24 to 48 hours before your appointment.
- Ask your gynecologist or her nurse before emptying your bladder. You may be asked to leave a sample of your urine as part of the exam.
- Leave your schedule flexible and allow anywhere from 2 to 4 hours for your visit. Most gynecologists are also obstetricians and may have to leave the office one or more times during the day to deliver a baby. In addition, depending on your specific health concerns, you may be required to complete bloodwork or other radiologic testing (like mammograms or ultrasounds).
- Get comfortable! Be ready to be freely open with your gynecologist about your questions and concerns.
The annual exam, step-by-step
1. Personal history questions
Your doctor and/or nurse will ask you a complete list of questions about your personal and family medical history. Some of these may include:
- When was your last period?
- Do you have regular periods, and how long do they last?
- Have any of your relatives been diagnosed with cancer?
- Are you using birth control?
- Have you ever been sexually active?
- Do you think you may be pregnant?
- Do you smoke, and if so, how much and for how many years?
- What medicines do you take?
- What medical conditions do you have?
- What surgeries have you undergone?
- Have you ever been pregnant or had a miscarriage?
2. Breast exam
Your gynecologist will leave the room to allow you to undress and put on an examination gown and drape sheet. The gown opens to the front of your body like a jacket, and the drape sheet fits over your lap.
The gynecologist will ask you to lie on the exam table as she palpates your breasts for any lumps, skin changes or discharge. She will then teach you how to do a breast self exam, which should be done at least once a month, preferably just after your period.
3. Abdominal exam
Your doctor will gently press on your abdomen or “belly” to examine for scars, masses or other abnormalities.
4. Speculum exam and Pap smear
At this point, it’s important to relax. Take a deep breath and relax your abdomen, shoulders and legs. Inform your gynecologist of any past health or personal experiences that may have been uncomfortable or even painful.
Your gynecologist will then ask you to put your heels in the foot rests and slide to the edge of the exam table. This position will be the most comfortable for you while allowing the best angle for the pelvic exam.
Your gynecologist will check the genitals, vaginal opening and anus (opening for bowel movements) for abnormalities like genital warts, atypical discharge or irritation. The gynecologist will insert a sterile metal or plastic speculum into the vagina. If it is too cold, she may run the speculum under warm water to make it more comfortable for you.
The speculum opens slightly to separate the vaginal walls so that the vagina and cervix can be inspected for irritation, masses or abnormal discharge. A cotton swab may also be used to collect cervical fluid, which will be tested for STIs like herpes, gonorrhea and chlamydia.
For the Pap smear, a small brush will be used to collect cells from the cervix and the endocervix (the opening canal of the cervix). The cells will be tested for signs of infection, dysplasia (abnormality) and cancer.
5. Bimanual exam
Your gynecologist will insert one or two lubricated fingers into the vagina and use the other hand to press down on the lower abdomen. This is done to check the internal pelvic organs, including the uterus, ovaries and fallopian tubes.
After the exam
Phew, it’s done! Give yourself a pat on the back for doing the right thing for your body. The next step is waiting for your test results, which can take up to two weeks to process. Many doctors’ offices have arranged for Pap results to be mailed directly to the patient. Otherwise, your doctor or his nurse will inform you before you leave on how to access your Pap and any other results.
A Normal “Negative” Result. If your results come back normal, you should schedule another exam in 12 months.
An ASCUS Result. ASCUS (Atypical Squamous Cells of Unknown Significance) test results may be no cause for alarm. This label means that cells in your cervix have undergone mild changes and you are probably not at immediate risk for cervical cancer.
Mild infection or inflammation is usually the culprit in an ASCUS test result, causing the cervical cells to temporarily look abnormal. However, ASCUS test results can also indicate changes in the cervical cells due to human papilloma virus, or HPV. If your pap result is due to HPV, you may be required to undergo a colposcopy.
An Abnormal Result. If your results come back abnormal, you will need a colposcopy, which is done using a special microscope to give the gynecologist a closer look at the genitals, vagina and cervix. A small tissue sample, or biopsy, may then be taken from these areas.
If the tissue samples from the biopsy are determined to be pre-cancerous, you may be required to repeat your Pap again in six months or the cells may need to be treated using cryotherapy, laser surgery or electrocautery. If cancer is found, your doctor will help to coordinate care with a gynecologic oncologist, a specialist in cancers of the female organs. Rest assured, Woman’s Hospital has the Baton Rouge area’s only board-certified gynecologic oncologist on our staff to treat you.
Remember, no question is too embarrassing. We’ve been doing this since 1968, so we’ve probably heard your question many times before. We’re always here for you, not just once a year for your exam. Get in tune with your body, and if you ever have any questions – or if something about your body just doesn’t seem right – please let us know.