What to Expect at Your First Gynecologic Exam

As adolescent girls begin to mature and menstruate, their doctors will begin to focus on their reproductive health and their health care visits to the pediatrician may include a gynecologic evaluation. Your doctor will also be able to provide you with answers to questions you may have on menstruation, puberty and, if necessary, contraception. Do not be embarrassed if there is a lot you do not know about sexuality and reproduction. Speaking openly with your doctor is the best way to get the information you need to protect your health and well-being.

Alternatively, once their periods have begun, many girls begin seeing a gynecologist, a doctor whose specialty is the female reproductive system. Specialists certified in adolescent medicine are also capable of providing care for the female reproductive system.

If you are sexually active or considering becoming sexually active, your doctor can advise you on contraceptive methods to prevent pregnancy and on the precautions you need to take against sexually transmitted infections (STIs). The doctor will advise you to have an annual Pap smear (a screening test named for its inventor, Dr. Paponicolaou) to check for early signs of cervical cancer. This is a normal part of a healthy woman's preventive care. Some experts recommend a semiannual Pap smear for sexually active teens.

Teens who are not sexually active and have normal menstrual periods may not need a pelvic exam until they reach age 18. If you are not sexually active and are experiencing no pain or other problems in the pelvic or genital areas, a checkup that includes a Pap smear every other year after age 18 will help to protect your reproductive health. However, if you suspect that you have a vaginal or urinary tract infection, you should be seen and treated by a doctor.

What Will the Doctor Do?

Since many pediatricians now incorporate gynecology into their practices, your doctor will begin by reviewing your medical history and expanding on it regarding gynecologic and reproductive issues. If you are seeing a new doctor, she will review your entire medical history with you. You may feel uncomfortable at some of the questions your doctor may ask, but answer them as thoroughly and honestly as you can. Your doctor will ask, "Do you have sex with boys, girls or both?" The doctor will also ask if you have any questions about the specifics of reproductive health.

If you are sexually active, your doctor will counsel you on birth control and preventing STIs.

After your history is taken, you may have blood drawn and you may be asked to provide a urine specimen. Emptying your bladder may make your exam more comfortable.

You will then be asked to undress completely and put on a hospital gown. When you are given the gown, ask the nurse whether it should open to the front or the back -- a detail most patients find impossible to determine on their own. Standard measurements such as height, weight, pulse and blood pressure will be recorded. A nurse may perform many of these preliminary steps.

You will be asked to lie on an examining table. If your doctor is a man, a female nurse will always be present during your examination, and you will never be completely uncovered. The doctor will examine your breasts, feeling for any signs of abnormality, and show you how to perform a breast self-exam. The examining table will have stirrups on the two corners nearest your feet; you will be asked to place your heels in the stirrups. This helps you to lie in a position that allows you to be examined internally.

The Pelvic Exam

Your doctor will palpate your abdomen, pressing gently around your belly to ensure that everything is in its proper place and that none of your organs are swollen or painful. Your doctor will then examine your external genitalia to make sure that all is normal – that, for example, you have no sores, lesions, ulcerations or inflammation. Then your doctor will perform an internal exam of the organs of your reproductive tract. She will be on the lookout for any kind of sores, discharge or ulceration – anything out of the ordinary. Your doctor will also look at your cervix, which is the opening to your uterus, using an instrument known as a speculum. Made of either metal or plastic, a speculum allows your doctor to open your vagina gently enough to be able to look inside. The vagina is quite elastic, and this should not be painful. If it is, or if you are quite young or quite small, your doctor may at your first visit insert only a gloved finger to perform a what is called a digital exam. She may also simultaneously insert a gloved finger into your rectum to palpate your organs from the rear.

The Pap Test

With the speculum in place, your doctor will probably insert a swab that looks a bit like a cotton swab with soft bristles and rub it against your cervix to obtain cells for a Pap smear. The tiny amount of cervical tissue removed will be sent to a lab for examination to ensure that there is no abnormal cell growth. Although it is highly unlikely that there would be any abnormal growth at your age, cervical cancer is very treatable, and Pap smears are an extremely efficient, low-cost method for stopping this disease before it starts. It should be noted that sexually active teens are frequently infected with the human papilloma virus, which causes genital warts and is a known risk factor for cervical cancer. A Pap smear will be a regular, integral part of your annual checkups. Like any other sort of checkup, the purpose of regular pelvic examinations is to detect small problems before they become big problems.

Last Updated: 9/17/2003
The Johns Hopkins University 1996-2003.  All rights reserved.  This information is not intended to provide advice on personal medical matters, nor is it intended to be a substitute for consultation.