Pelvic Exams

Michele Van Vranken, MD

Your just made an appointment for your first gynecologic exam and you're feeling: Totally panicked.
You start praying for an avalanche, four flat tires on the car, anything to avoid that appointment.
Pretty calm.
You don't really mind going to the family physician that much, and if your friends can handle it, so can you.
Confused.
You don't feel sick at all. Why waste time going to a family physician when you're OK? These are just some of the feelings that women may have before their first gynecologic (or "gyn") exam, and it's not surprising. You might be asking yourself "Why me? Why now?" The answer is that you're older and have gone through puberty, so you need to have a physical exam appropriate for a woman.
That's where pelvic exams come in.

Why You Need These Exams
We recommend that a women make her first visit to a gynecologist when she is between the ages of 13 and 15. Not all women will need a pelvic exam during this initial visit, though. Many gynecologists will just do a regular health exam and talk to the women about her health.
Yearly gyn visits are important for a number of reasons, including:

as a routine check.
You'll want to be sure you're developing normally.

to prevent pregnancy or infection.
If you have ever had sex, you are probably going to need a pelvic exam. Women should have a pelvic exam before having sex to discuss methods of birth control and preventing sexually transmitted diseases (STDs).

to deal with a problem.
There may be a number of concerns that lead to a pelvic exam. For example, if you have problems with your periods, missed periods, pain, signs of infection, and worries about development, it's a good idea to see a family physician.

Choosing the Right Family Physician
If you're going to be involved in deciding who you'll see for your pelvic exam, you have a few choices. Many family physicians perform pelvic exams and advise teens on birth control and STD prevention. So you may be able to see a family physician you already know and feel comfortable with for your first pelvic exam. Your family physician should be able to explain these issues to you.
The most important thing is that you feel comfortable with the person who is examining you. You want to be able to talk with him or her about important personal health and relationship issues.

What Happens When You Go for Your Pelvic Exam
You don't need to do anything special before going for your exam. When you make the appointment, try to schedule the exam for a time when you won't have your period. For many women, that can be hard to predict, though - lots of women have irregular periods. Ask the family physician's office or clinic when you make the appointment what you should do if you get your period.
Some family physicians say it's OK to come for an exam if your period is just beginning or just ending and it's very light, but everyone has a different policy.
When you arrive for your appointment, you may be asked to answer questions about any illnesses or conditions you have, your health habits (like whether you drink or smoke), any family illnesses that you know of, and your history regarding sexual activity, pregnancy, and birth control. You might also be asked for the date of your last period.
A nurse will do a few things that your family physician has probably done a million times before, such as recording your weight and taking your blood pressure. If you're ready, he or she will come in and start the exam. The family physician may start by going over anything you answer or you may talk about these things later.
If this is your first gynecologic exam, let the family physician know. That way, he or she will know to go slowly and explain everything that's going on. Now is also the time to ask about birth control or sexuality if you need to. Some family physicians like to discuss these things before the exam, and some like to do it after. Your aim is to make sure you get your questions
answered.

The Pelvic Exam
During the pelvic part of the exam, the family physician will ask you to move down so your behind is at the end of the table. You'll bend your knees and rest your feet in two stirrups, which are metal triangular loops that stick out from the end of the table. These might look a little scary, but they're just there to rest your feet in and keep you more comfortable. The family physician will ask you to relax your knees out to the sides as far as they will go. It might feel a little funny to be lying with your legs opened like this, but everyone feels that way at first.
The family physician will put on gloves and examine the outside of your vagina to make sure that there are no sores or swelling and that everything looks OK on the outside.
Because the ovaries and uterus are so far inside a woman's body that they can't be seen at all, the family physician will need to feel them to be sure they're healthy. While your feet are still in the stirrups, the family physician will put lubricant on finger (while still wearing the gloves) and
slide them inside your vagina/anus. Using the other hand, he or she will press on the outside of your lower abdomen (the area between your vagina and your stomach). With two hands, one on the outside and one on the inside, the family physician can make sure that the ovaries and uterus are the right size and free of cysts or other growths.
During this part of the exam, you may feel a little pressure or discomfort. Again, it's important to relax your muscles and take slow, deep breaths if you feel nervous.
Next, if you have had sex, the family physician will want to look at the inside of your vagina and will do so with the help of a speculum (pronounced: speh-kyuh-lum) . A speculum is a thin piece of plastic or metal with a hinged piece on one end that allows it to open and close. The family
physician will warm the speculum with water (some offices keep the speculum warmed in a drawer with a heating pad). The family physician will then slide the speculum into your vagina. Usually the family physician will tell you when he or she is about to place the speculum inside you so it doesn't come as a surprise.
Once the speculum is in the vagina, it can be opened to allow the family physician to see inside. Putting in and opening the speculum should not be painful, although some women say that it can cause a bit of pressure and discomfort. Naturally, if this is your first exam, you might feel a little
tense. Because the vagina is surrounded by muscles that can contract or relax, the exam can be more comfortable if you try to stay calm and relax the muscles in that area.
If you feel like you're tensing up the muscles in your vagina, try breathing deeply or doing some breathing exercises to help you stay relaxed. Sometimes humming your favorite song or making small talk can distract you and allow you to feel more relaxed. After the speculum is in place, the family physician will shine a light inside the vagina to look for anything unusual, like redness, swelling, discharge, or sores. He or she will then do a Pap smear, which involves touching the cervix to pick up cells from that area.
The cervix is the opening to the uterus, and it's located at the very top of the vagina. The Pap smear should not hurt, but it might be uncomfortable, especially if this is your first pelvic exam. The good news is this part of the exam is over quickly.
The cells that have been collected are sent to a laboratory where they are studied for any abnormal cells, which might indicate infection or warning signs of cervical cancer. (Like breast cancer, cervical cancer is very unusual in teen girls.)
The family physician may test for STDs. He or she will swab the inside of the cervix with what looks like a cotton swab. The speculum is then slid out of the vagina. As with the Pap smear, the sample is sent out to a laboratory where it is tested for various STDs.
Talk to your family physician or about how you want to be contacted with results, and what they should do if they are unable to reach you. Again, family physicians will do their best to maintain confidentiality, but they need to be able to reach you.
Because the ovaries and uterus are so far inside a girl's body that they can't be seen at all, even with the speculum, the family physician will need to feel them to be sure they're healthy. While your feet are still in the stirrups, and after the speculum is removed from the vagina, the family
physician will put lubricant on two fingers (while still wearing the gloves) and slide them inside your vagina. Using the other hand, he or she will press on the outside of your lower abdomen (the area between your vagina and your stomach). With two hands, one on the outside and one on the inside, the family physician can make sure that the ovaries and uterus are the right
size and free of cysts or other growths.
During this part of the exam, you may feel a little pressure or discomfort. Again, it's important to relax your muscles and take slow, deep breaths if you feel nervous. At this point, the physical part of the exam is usually over. Your own family physician may do the exam in a different order, but it will probably include all these steps.
Talk to your family physician or about how you want to be contacted with results, and what they should do if they are unable to reach you. Again, family physicians will do their best to maintain confidentiality, but they need to be able to reach you.

After the Exam
Although reading this article may make it seem long, the entire pelvic exam (the parts involving your vagina, cervix, uterus, and ovaries) really only takes about 3 to 5 minutes.
If you haven't discussed your questions before the exam, now's the time. Don't be afraid of questions that sound stupid or silly - no question about your body is stupid, and this is the best time to get answers. If for any reason the family physician needs to see you again, the office or
clinic will let you know. Unless you notice any health problems, you won't need to go for an exam for another 6 months to a year.
It's very important to go for pelvic exams on a yearly basis - even when you're feeling good - because they help detect any problems early on. If you don't want to return for another exam because you didn't like the family physician, look into finding a new family physician or clinic.
And if the physical discomfort of the exam left you not wanting another, remember that each time it gets easier and easier to relax. Naturally, no one loves getting an exam, but having a family physician you trust can really help. (AAFP)
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Pap Smears: What They Are and What the Results Mean

What is a Pap smear?
A Pap smear is a test your family doctor does to check for signs of cancer of the cervix. The cervix is part of your uterus (womb). During a Pap smear, your family doctor takes a sample of cells from your cervix to be tested. To take the sample, your family doctor will put a special instrument called a speculum into your vagina. This helps open your vagina so the sample can
be taken. Your family doctor will gently clean your cervix with a cotton swab and then collect a sample of cells with a small brush, a tiny spatula or a cotton swab. This sample is put on a glass slide and sent to a lab to be checked.

What is the sample checked for?
The cells on the slide are checked for signs that they're changing from normal. Cells go through a series of changes before they turn into cancer. A Pap smear can show if your cells are going through these changes long before you have cancer. Cervical cancer is not life-threatening if it's caught early. This is why getting regular Pap smears is so important.

What do the results mean?
A negative Pap smear means that your results are normal. A positive Pap smear means that your results aren't normal. A positive Pap smear can be a sign of a number of changes in the cells on your cervix:
Inflammation (irritation) . This can be caused by an infection of the cervix, including a yeast infection, infection with the human papillomavirus (HPV) or herpes virus, or many other infections.
Very early signs of cancer. These changes are called dysplasia. More serious signs of cancer. These changes affect the top layers of the cervix but don't go beyond the cervix. This is called "carcinoma in situ." More advanced cancer.

When should I have Pap smears?
You should have your first Pap smear when you start having sex or by age 18. Continue having a Pap smear once a year until you've had at least 3 normal ones. After this, you should have a Pap smear at least every 3 years, unless your family doctor thinks you need them more often. Keep having Pap smears throughout your life, even after you've gone through menopause.
Certain things put you at higher risk of cervical cancer. Your family doctor will consider these when recommending how often you should have a Pap smear.
If you're older than 65, talk with your family doctor about how often you need a Pap smear. If you've been having Pap smears regularly and they've been negative, you may not need to keep having them.

How reliable is the test?
No test is perfect, but the Pap smear is a reliable test. It has helped drastically lower the number of women who die of cervical cancer. Sometimes the test may need to be redone because there were not enough cells on the slide. The lab will tell your family doctor if this happens. ThinPrep, PAPNET and FocalPoint are ways to make Pap smears more accurate.
ThinPrep is a way of preparing the sample of cells that makes it easier to spot abnormalities. PAPNET and FocalPoint are computer systems that help lab technicians find abnormal cells. These options may not be available in all areas, and they may increase the cost of a Pap smear.

What should I do before the test?
Plan to have your test done at a time when you aren't having your menstrual period. Don't douche, use a feminine deodorant or have sex for 24 hours before the test.

What happens if I have a positive Pap smear?
If the results of your Pap smear are positive, your family doctor may want to do another Pap smear or may want you to have a colposcopy. A colposcopy gives your family doctor a better look at your cervix and allows him or her to take a sample of tissue (called a biopsy). Your family doctor will use an instrument called a colposcope to shine a light on your cervix and magnify it. Your family doctor will explain the results and discuss treatment options with you.

What puts me at risk of cervical cancer?
Risk factors for cervical cancer:

• Starting to have sex early (before age 20)
• Having had many sexual partners
• Being infected with an STD or having had a sex partner who has an STD
• Smoking
• Using birth control pills and/or giving birth to many children when also
• Infected with HPV
  

The main risk factors for cervical cancer are related to sexual practices. Sexually transmitted diseases (STDs) may make your cells more likely to undergo changes that can lead to cancer. STDs include HPV, herpes, gonorrhea and chlamydia. HPV is the virus that can cause genital warts. It seems to be very closely connected with these changes.

Is there anything I can do to avoid getting cervical cancer?
You may be able to reduce your risk of cervical cancer if you:

• Delay sexual intercourse until you're 20 years of age or older.
• Have only 1 sex partner who doesn't have an STD and is only having sex withyou.
• Limit your number of sex partners.
• Always use latex condoms (rubbers) to protect against sexually transmitteddiseases (STDs). (Remember condoms aren't 100% effective.)
• Avoid smoking
  

(AAFP)