Routine Care & Wellness

First pelvic examination

A few pointers for scheduling and preparing for your appointment:

• Tell the scheduler that this is your first time having a Gyn examination.
• Give a reason for your appointment – problem visit, seeking birth control, STD counseling, wishing to establish as a new patient, etc.
• Let the scheduler know if you have a preference for a male or female physician, or nurse practitioner/midwife (if you are pregnant).
• Ask if a new patient meets the health care provider in their office first (fully clothed) or already undressed in the exam room. If you have a preference, let them know.
• If you prefer to have someone accompany you, ask about the office’s procedures regarding chaperones or attendants during exams.
• If this is a non-emergency visit, try to time it to your mid-cycle. Pap tests done around the time of your period may be difficult to interpret because of shedding cells.
• For 2 days prior to the exam, do not use tampons, douches, or insert anything into the vagina. (avoid intercourse or other penetration)
• Write down your questions ahead of time. This may help if you tend to get nervous with new doctor visits. Be prepared to discuss your medical history, bring old records if you can. Have a list of your current medications (including vitamins and herbals).

Pre-examination routine
Typically, a nurse or medical assistant will ask you to use the bathroom and leave a small urine sample. This may be used to check for a urinary tract infection, sugar, protein or blood in the urine, or pregnancy. Next, you will be shown to the exam room for checking weight, pulse and blood pressure. You may be asked a few questions regarding your age, last menstrual period, past pregnancy, miscarriage or abortion, use of birth control, surgeries, and family or personal history of breast, uterine, ovarian or cervical cancer.

You may be escorted to the provider’s office for more history taking or asked to change into a gown (paper or cloth). The top usually opens in the front, and a little sheet may be given to place across your lap. You will be given privacy to change, and then wait for the physician or women’s health clinician (midwife, nurse practitioner or physician assistant).

External examination
Many well-woman examinations start with a mini physical exam. While you’re in a sitting position, your heart, lungs, thyroid, and part of the breast exam may be completed. Lying down, the rest of the breast examination will be performed and your abdomen may be gently palpated (or pressed with slight pressure).

After this part of the exam, you will be asked to put your feet in the footrests (stirrups), and slide your bottom down to the edge of the table. You remain covered up by the sheet until your clinician is ready to begin the exam.

The first part of the exam is checking the outside or external genital area for sores, lesions, discharge, color/tone, etc. If you have any questions/problems, ask for a mirror and you can show the physician/clinician the area of concern.

Internal examination
The next part of the examination uses an instrument called a speculum. The speculum is moistened with water and inserted into the vagina in order to spread and hold back the vaginal walls, so that the cervix can be seen. A Pap test follows this, which is a collection of cells from the cervix to test for cervical cancer. This is a little uncomfortable, but not painful. There is sometimes slight spotting after the cervix has been scraped for the collection of the Pap test.

Sometimes, if infection is suspected, other swabs or cultures may be taken at this time as well. Some women’s health providers routinely screen for sexually transmitted diseases, but most often this is done when the patient has a concern or there is an indication of STD from the physical examination.

The speculum is removed, and then the bimanual examination begins. For this, the clinician lubricates his/her gloved fingers, and inserts two fingers into the vagina. At the same time, with the other hand he/she presses against the abdomen, in the area above, to the right and to the left of the pubic bone. This examination is done to estimate the size of the uterus, to check for pain when the cervix is moved, to feel the ovaries, and to locate any abnormalities in the pelvic area. Some clinicians may perform a rectal exam after the pelvic examination is complete, but this is not always done.

After the examination is complete, the patient should place their feet together on the exam table extender (which should be pulled out for you) and push back, so that their bottom is backed away from the edge of the table. You will be helped back into a sitting position and left alone so that you can change. Sometimes, the vaginal area feels a little squishy from the lubricant – wipes should be available for a quick clean up, before dressing.

When your clinician returns, the details of the appointment will be wrapped up. You should be told if the findings were normal or abnormal on the examination, what routine tests are being done and when to expect results, any additional testing or referral if needed, when to schedule a follow-up appointment, any new prescriptions, confirm birth control method and information.

Don’t forget – ask any questions you may have and leave feeling satisfied that you have covered everything you came in for.