Routine gynecological care:

• prevents illness and discomfort
• allows for early detection of cancers of the breast and cervix when they are more curable
• detects sexually transmitted infections and other conditions before they cause serious damage
• prevents sterility
• promotes healthy pregnancy and childbirth

Staying healthy is important. Whether you're young or old, married or single, sexually active or not, or whether you're straight, lesbian or bisexual - good gynecological care is the key.

It takes teamwork to have good health. Your job is to learn how your body works and what is normal for you. Watch for changes in your body and its rhythms that may signal problems. Your clinician's job is to help you identify problems before they become serious and to provide care if you become ill. Team up with your clinician for routine gynecological (GYN) exams. Learn how the GYN visit and exam can work for you.

You should have a routine GYN visit and exam every year if you have ever had sex or are over age 18.

You may need to have checkups even more often if you have:

• a sexually transmitted infection or a sex partner with an infection
• a history of sexual health problems
• a sexually related illness
• a mother or sister who developed breast cancer before menopause
• a history of abnormal Pap test results
• a breast lump

You should visit your clinician, no matter how old you are, if you have:

• unusual vaginal or pelvic pain
• abnormal vaginal bleeding or discharge
• severe pelvic or lower abdominal pain
• pain, swelling, or tenderness of the vulva or vagina
• sores, lumps, or itching of the vulva or vagina
• growths or thickening of the breast or armpit
• puckering, dimpling, or other changes in the skin of the breast
• newly retracted nipples or bleeding or discharge from the nipple
• changes in size or shape of the breast
• increased pain or discomfort before your period
• any concerns about your sexual or reproductive health

Many women worry about having a GYN exam - especially if it's the first time. You will be more comfortable if you know what to expect.

Regular GYN visits and exams include

• talking about your personal, family, sexual, and medical history
• laboratory tests and screening for sexually transmitted infections and other conditions (at your own or your clinician's request)
• counseling
• a breast exam
• a pelvic exam

1. Schedule your routine GYN visit and exam for a time when you will not have your period, unless you have bleeding problems that your clinician wants to observe. Menstrual fluid can affect the results of some lab tests. Let your clinician know if it turns out that you will be having your period during the exam. You may want to reschedule.

2. Make a list of all the questions and problems you want to talk about. Include
   • vaginal discharge
   • spotting between periods
   • heavier than usual flow
   • bleeding after sex
   • pelvic pain or other problems
   • It's easy to forget these things during your appointment.

3. Don't douche for at least 24 hours before the appointment. Don't use any other vaginal preparation, either. They can mask many vaginal conditions.

4. Don't have vaginal intercourse or insert anything into your vagina for between 24-48 hours before your visit.

Before you are examined, you will be asked to fill out a questionnaire. It will include some of these questions:

• When was your last period?
• How often do you have periods?
• How long do they last?
• Do you have any bleeding between periods?
• Do you feel any pain when having sex?
• Is there any bleeding after sex?
• Do you have any unusual genital pain, itching, or discharge?
• Do you have any other medical conditions?
• What medical problems do other members of your family have?
• Are you using birth control?
• Do you suspect you are pregnant?
• Are you trying to become pregnant?

You will be asked about past illnesses, allergies, surgery, and pregnancy. You may be asked if you smoke, how much you smoke, or if you drink alcohol or use other drugs. You may also be asked if you have problems holding your urine.

Your clinician will review your contraceptive needs. If you are using birth control, you will be asked if you've had side effects.

Your contraceptive needs change throughout your life. To decide which one to use now, consider how well each method will work for you:

• How well will it fit into your lifestyle?
• How effective will it be?
• How safe will it be?
• How affordable will it be?
• How reversible will it be?
• Will it protect against sexually transmitted infections?

It is very important to be frank and honest about your sex life. One out of four women has a sexually transmitted infection in her lifetime. These infections can cause sterility, cancer, as well as problems with pregnancy, childbirth, and infant health. Some can cause death. Great harm can be done even when there are no symptoms. Very often, women have no symptoms. That's why it's important to let your clinician know whether or not you are at risk for sexually transmitted infections.

Previous pregnancies or sexually transmitted infections may be detected during the exam. But your clinician will not be able to tell if you've had vaginal, oral, or anal intercourse, how many partners you have, or if you masturbate. So don't let embarrassment become a health risk. Be precise about your sexual health risks and questions about your sex life. Being clear will help your clinician suggest the best solutions.

You may be asked for a urine sample. The test can tell if you're pregnant. It can also help screen for health problems.

Urinating before a pelvic exam to empty your bladder may also make you more comfortable during the exam. It will also be easier for the clinician to examine you, your cervix and uterus are located behind your bladder.

You will change into an examination gown or be covered with a drape sheet. Some clinicians provide both. You will be asked to lie back on the examining table. Your clinician will examine your breasts for lumps, thickening, irregularities, and discharge. Many clinicians will continue to talk to you about your health history during the breast exam.

Your clinician will ask if you have noticed any changes in your breasts since your last exam. If you need to learn how to do a breast self-exam (BSE), your clinician can teach you. It is important to do it at about the same time in your cycle each month. The best time for a BSE is one week after your period, when your breasts are not swollen or tender. Breast lumps are often discovered by a woman or her sex partner. Most are not cancerous. But report anything unusual to your clinician as soon as possible.

Four-Step Breast Self-Exam
 

1. Stand up and place one hand behind your head. Hold the fingers of the other hand flat. Gently touch every part of the breast below the raised arm. Feel for lumps, bumps, or thickening. Now do the other breast.

2. Stand in front of a mirror. Place your hands on your hips. Inspect each breast for changes in size, shape, and form. Do it again with your arms raised above your head

3. Lie back with a pillow or folded towel under your right shoulder. Place your right hand behind your head. Examine every part of your breast with the fingers of the left hand held flat. Gently press in small circles. Start at the top outermost edge and spiral in to the nipple. Feel for lumps, bumps, or thickening. Now do the other breast. Be sure to follow a consistent pattern. You may want to use one of the following patterns:
   Do not miss any part of the breast.

4. Rest your arm on a firm surface like the top of a bookshelf. Examine the underarm. Feel for lumps, bumps, or thickening in the same way. Now do the other underarm. 

Mammography
Annual breast exams and monthly BSEs are only two of the three important ways women can protect themselves from breast cancer. The third is mammography, x-ray photographs of the breasts that can detect abnormalities, which can help make early diagnosis of cancer possible. Mammography can detect a lump up to two years before it can be felt.

Women over 40 should have mammograms every year. Younger women whose families have a history of breast cancer should consult with their clinicians about whether or not mammograms would be of value to them.

Most often, clinicians who provide GYN exams do not have the special equipment and training for mammography. Your clinician can refer you to a high-quality mammography facility.

The mammography technician will

• place and slightly compress each breast between plastic plates
• take x-rays of each breast from the top and the side

The procedure takes about 15 minutes. Any discomfort will last no longer than 30 seconds. Additional x-rays or ultrasound examination may be needed if you have dense breast tissue or small cysts.

Interpreting Mammograms
Radiologists and clinicians are very careful about interpreting mammograms and recommending follow-up care. They don't want to overlook any abnormality. They are aware that failure to detect early cancers can lead to serious and even deadly consequences. Their caution may lead them to advise you to have further x-rays and ultrasounds. They may ask for more follow-up and recommend breast biopsies.

Fewer cancers are overlooked with these extra precautions. But waiting while more tests are done can lead to more anxiety, as well as expense. It is reassuring that all precautions do improve the chance of finding abnormal growths as early as possible.

After your breasts have been examined, you will be asked to place your feet in the footrests at the end of the table. Some tables have knee rests instead of footrests.

Slide your hips down to the edge of the table. Let your knees spread wide apart and relax as much as possible. If your buttocks and abdominal and vaginal muscles are relaxed, you will be more comfortable and the exam will be more complete. You can cover your lower abdomen and thighs with the drape sheet to feel less exposed and more comfortable during the procedure.

You'll feel less tense if you:

• Breathe slowly and deeply with your mouth open.
• Let your stomach muscles go soft.
• Relax your shoulders.
• Relax the muscles between your legs.
• Ask the clinician to describe what's being done as it's happening.

If your clinician is a man, you may request having another woman in the room. Her presence may help you feel more relaxed. She may hold your hand or just talk to you to ease your tension. Ask in advance if you want to see what's going on and/or know what your vagina and cervix look like. A mirror may be positioned so you can see.

Sexual Abuse and Other Concerns
Some women are very anxious about having a pelvic exam because of difficult experiences that may include sexual abuse. You may have more pelvic pain, fear, and discomfort during your pelvic exam if you've been sexually abused in the past; or if you've heard alarming stories about the gynecological exam; or if you've had other uncomfortable experiences. Remember that the exam is not emotional or sexual for your clinician. Talk with your clinician about

• your fears
• any pelvic pain you may have
• your experience of abuse

Talking with your clinician about the abuse will help your clinician:

• tailor the exam to your special needs
• help you feel as comfortable as possible
• understand how your physical and emotional health may be affected

Usually, the exam lasts just a few minutes. There are four steps:

Step 1. The External Genital Exam
The clinician visually examines the soft folds of the vulva and the opening of the vagina to check for signs of irritation, discharge, cysts, genital warts, or other conditions.

Step 2. The Speculum Exam
The clinician inserts a metal or plastic speculum into the vagina. When opened, it separates the walls of the vagina, which normally are closed and touch each other, so that the cervix can be seen.

You may feel some degree of pressure or mild discomfort when the speculum is inserted and opened. You will likely feel more discomfort if you are tense or if your vagina or pelvic organs are infected. The position of your cervix or uterus may affect your comfort as well. If a metal speculum is used, you may feel the chill of the metal. Most clinicians lubricate the speculum and warm it to body temperature for more comfort. Talk with your clinician about any discomfort you feel.

Once the speculum is in place, the clinician checks for any irritation, growth, or abnormal discharge from the cervix. Tests for gonorrhea, human papilloma virus, chlamydia, or other sexually transmitted infections may be taken by collecting cervical mucus on a cotton swab. These tests may not be done unless you have a concern about infections and ask for testing. Be sure to talk with your clinician if you have symptoms or concerns about your sexual partner(s).

Usually a small spatula or tiny brush is used to gently collect cells from the cervix for a Pap test. The cells are tested for abnormalities the presence of precancerous or cancerous cells. You may have some staining or bleeding after the sample is taken.

As the clinician removes the speculum, the vaginal walls are checked for irritation, injury, and any other problems.

Pap tests can detect:

• the presence of abnormal cells in the cervix
• infections and inflammations of the cervix (Pap tests cannot identify specific sexually transmitted infections, but they may detect symptoms.)
• thinning of the vaginal lining from lack of estrogen commonly related to menopause

The cell sample will be sent to a laboratory. The results will be sent back to your clinician within a few weeks. Pap tests need to be repeated if there is too much blood present for an accurate reading or if there are not enough cells to be examined.

Interpreting Pap Tests
Cytologists and clinicians are very careful about interpreting Pap tests and recommending follow-up care. They don't want to overlook any abnormality. They are also aware that failure to detect early cancers can lead to serious and even deadly consequences. Their caution may lead them to request re-doing the Pap test, or doing other tests. In some cases, the cytologist is unsure about whether or not there are precancerous changes. In such a case, your clinician will recommend repeat testing or other tests to be more sure.

As with mammography, fewer cancers are overlooked with these precautions. But having more tests done can lead to more anxiety, as well as expense. It is reassuring that these precautions improve the chance of finding abnormal cell changes as early as possible.

If you have abnormal results, your clinician will advise you on follow-up care:

• If noncancerous abnormalities and infections are found, be sure to complete the prescribed treatment and repeat the tests as advised.
• If early precancerous or suspicious growths are found, you will need careful follow-up. You may also be advised to
  • Repeat the Pap test in a few weeks or have them at more frequent intervals.
  • Have a colposcopy and biopsy.
  • Have growths removed with cryotherapy, laser surgery, or electrocautery.
  • Have other tests or treatments.
• If cancerous growths are found
• Discuss your options with your clinician.
• See another provider or specialist.

Remember:

• Most abnormalities that are detected are not cancer.
• Early treatment of precancerous growths can prevent cancer from developing.
• Follow-up examinations are necessary if an abnormal condition is found.

Step 3. The Bimanual Exam
Wearing an examination glove, the clinician inserts one or two lubricated fingers into the vagina. The other hand presses down on the lower abdomen.

The clinician can then feel the internal organs of the pelvis between the two fingers in the vagina and the fingers on the abdomen.

The clinician examines the internal organs with both hands to check for

• size, shape, and position of the uterus
• an enlarged uterus, which could indicate a pregnancy or fibroids
• tenderness or pain, which might indicate infection
• swelling of the fallopian tubes
• enlarged ovaries, cysts, or tumors

Step 4. Rectovaginal Exam
Many clinicians complete the bimanual exam by inserting a gloved finger into the rectum to check the condition of muscles that separate the vagina and rectum. They also check for possible tumors located behind the uterus, on the lower wall of the vagina, and in the rectum. Some clinicians insert one finger in the anus and another in the vagina for a more thorough examination of the tissue in between.

During this procedure, you may feel as though you need to have a bowel movement. This is normal and lasts only a few seconds.

Blood Pressure. It's important to have blood pressure measured on a regular basis, since you can have high blood pressure and not have any symptoms. Detecting and treating high blood pressure can reduce the risk of problems such as heart attack and stroke.

Weight. Rising or falling weight can give important clues to overall health. You should discuss any significant change with your clinician.

Other areas the clinician may examine include the abdomen, the thyroid gland in the neck, the heart, and the lungs. In some cases, a blood test may be necessary to check for anemia. Be sure to point out to your clinician any abnormality in your body that you have seen or felt.

This is a time for further consultation with your clinician. You will discuss the results of your exam, arrange for any follow-up or consultation that may be needed, and ask any further questions you may have. This is another opportunity to discuss your concerns about sex and sexuality, birth control, pregnancy, abortion, sexually transmitted infections, loss of urine, inherited disorders, infertility, cancer signals, breast self-exam, and menopause. Don't let embarrassment become a health risk. Speak up.

If the lab tests indicate anything unusual, you will be contacted when the results are completed. Pregnancy test results are usually ready during your visit. Other test results may take a few days or weeks. Your clinician will tell you how long you'll have to wait. Be sure your clinician has your current address and phone number.

Remember for good health:

• Eat properly.
• Get enough sleep.
• Drink eight 8 oz. glasses of water a day.
• Exercise.
• Avoid taking health risks with your mind and body.
• Have routine GYN visits and exams.

• Source: Planned Parenthood

• Last Updated: 2002