No one is excited for their first visit to the gynecologist. My first visit was for terrible cramps I’d been having ever since I first got my period. My mom made an appointment for me to see a friend of hers from college, a male gynecologist in his late 40s. I was terrified; I had never been sexually active and now I was sitting in his office in a paper gown. He talked to me about my symptoms first at his desk while I was dressed, but when it came to the exam I was completely freaked out. I remember being poked and prodded including, eek!, a rectal exam that I wasn’t warned about ahead of time! When he was done, he handed me a prescription for birth control pills and and the nurse walked out. I pulled on my clothes and drove home in tears. The KY lubricant they used for exams squishing in my underwear making me cry harder. I didn’t know there were towels available to clean myself off afterwards. Fast forward ten years later, and I’m finishing medical school and deciding what kind of a doctor I want to be. Once I made the decision to be an obstetrician-gynecologist (ob-gyn for short), I was determined that no one would leave my office in tears. In my opinion, a big key to that is knowing what to expect. Trust has to be developed between you and your doc, but we can try to help out here with what to expect. A trip to the gyno, while not anyone’s idea of a fun afternoon, should also not be a traumatic or scary appointment.
BEFORE YOU GO:
1. Be Prepared: Know your medical and family history. One of your parents may be coming with you to your appointment, but it’s always good to know as much as possible about your family medical history since sooner or later, you’ll definitely be on your own at the doc. You will be asked about any medical problems, hospitalizations, surgeries, and medications. We will also ask about family history, so know if your siblings, parents, grandparents, aunts or uncles have any medical issues. If they have passed away we will want to know what they died from to help us make sure you are not at risk for any genetic diseases. If so, we can work on early prevention strategies.
2. Make a list of questions that you want to ask. Sometimes when you are stressed or nervous during an appointment you can forget your questions. Write them down ahead of time! We will talk to you about anything you want, sex, periods, hormones, birth control, even other health concerns like asthma. We will also talk to you about nutrition and if you have concerns about an eating disorder.
3. Grooming v. Hygiene: I get asked about this a LOT. To shave or not to shave? Your doc isn’t going to care about how you groom. And I get patients that are very concerned if they haven’t shaved their legs. We don’t notice or care about that either, I promise. Hygiene is a different story. I had a patient come to her appointment immediately after spending a day at the beach. She was covered in sand and left it on my exam table, the floor, and even worse, she had sand all over the parts I needed to see when I went to examine her. A quick rinse off, or even using the moist towelettes we provide in the bathroom is appreciated.
4. Abstain from sex for 24 hours prior to your visit. If you need an exam or a pap, semen can make results difficult to interpret and friction or redness can mimic an infection.
At The Appointment:
1. Arrive 20 minutes early for your first visit to any doctor. This will give you time to fill out your paperwork.
2. Ask the front desk when you check in if you are going to need to give a urine sample. We use urine for many tests, to check for pregnancy, screen for sexually transmitted infections, and test for UTIs (urinary tract infections that can make peeing painful!). If there is a possibility of any of these conditions (and if you are sexually active, chances are very good we will check for pregnancy and STIs) it is best to leave a sample when you get there. A lot of women pee when they arrive not realizing we will need a sample, then have to wait around and drink water to be able to pee again.
3. We do NOT have to do a pelvic exam with every visit. I don’t usually do one at the first visit unless you request that I look at a problem. The new guidelines don’t require a pap smear until the age of 21. If you are coming to talk to us about birth control, you do not necessarily need a pap too. We still want to see you for annual check-ups, but you get to skip that part until the age of 21. Yay! We WILL do a pelvic exam if you have any complaints of lumps, bumps, pelvic pain or strange discharge.
4. I recommend asking your doc to show you what the steps of a pap smear exam are before you ever need one. We use an instrument called a speculum to take a look inside your vagina. The speculum is what scares everyone the most. It looks kind of like a duck bill with a handle. Only the small narrow part (the beak) goes inside you while it is closed. We gently open it once it is inside so we can see the cervix and make sure there are no precancerous changes. Try blowing out your cheeks with your mouth closed, see how they stretch without hurting? That is the same as the inside of your vagina, we can gently look without hurting you. The whole speculum exam takes only a minute or less, it’s pretty quick. After the speculum we do an exam called a bimanual, in Latin that means two hands. We use a lubricant and gently put two fingers inside your vagina, we put our other hand on your belly. This lets us feel your uterus and your ovaries between our two hands to see if we feel any cysts or abnormalities.
5. At a routine annual, you will get a breast exam. If you don’t do your own exams, ask your doc to teach you how it’s done. They will show you with their hands, then have you try. It’s best to know your own body so that you know if something is unusual.
6. You’re also going to get a heart and lung exam with a stethoscope, the normal check-up type of stuff that you get with any doctor.
7. Prepare to be HONEST. You are going to be asked a lot of personal questions. We really do need to know about sensitive subjects like if you are having sex, are you using a condom, and how many partners you’ve had. Don’t be embarrassed, we see a lot of women a day and we ask them too. It’s our job to talk about this stuff. We also need you to be honest about things like alcohol, tobacco and drug use. They can interfere with a lot of treatments or birth control options we have. Also, let us know if you’ve had problems with depression or severe mood swings, some types of birth control aren’t great under those circumstances and make your moods worse. Others can help.
8. Your visit with us is completely confidential. We want you to feel like you can talk to us about anything in a safe environment. There are some things that we are required to report to the authorities though, sexual assault or rape in a minor, domestic violence, or suicidal plans. This is to protect you from anything bad happening.
9. In many states we can provide birth control and counseling for teens without parental consent, check the laws in your state. The age restrictions are different in each state. We will also talk to you in private without your parents in the room too, just to make sure there is nothing you want to tell us or ask that you might have been embarrassed to bring up in front of your mom.
After the Appointment:
1. We have tissues on the counter and paper towels next to the sink. Feel free to use them to get the goop off. We use a lot of gel so that the exam doesn’t hurt you, but it is the icky equivalent to stepping on a wet floor in socks if you put your underwear on with gel. Trust me on that one.
2. If you did have tests run, make sure you know how you will get the results. We can give you the results of a pregnancy test immediately and sometimes a UTI check. STI checks and blood tests take more time. Make sure you know whether the office will call you with the results or if you should call them.
3. It’s ok to call the doctor if questions come up that you forgot to ask.
4. You don’t have to stick to the same doc if you felt uncomfortable or like you couldn’t “connect” with them. A gynecology visit is very personal and you need to make sure you have a doctor that you feel comfortable discussing your problems with and performing your examination. A doc you like makes all the difference in the world!