Annual (Gynecological) Exam
When to go for your Annual Exam
Have you ever been to an Obstetrician / Gynecologist or Ob / Gyn for a pelvic exam and Pap test? If your answer is "No." and you are 21 or older, pick up your phone today and make an appointment with a local Ob/Gyn or a family planning clinic in your area. The American College of Obstetricians and Gynecologists or ACOG recommends that Pap smear testing begin within three years of sexual intercourse, or by age 21.On the other hand, if your answer is "Yes," then how long has it been since your last Pap smear and pelvic exam? If you haven't seen your gynecologist for a year or longer it's time to make an appointment. Even young women who have not become sexually active need to visit a gynecologist by age 21. The ACOG further recommends yearly Pap smears until age 30 when healthy women who have had at least three consecutive normal Pap smears may begin to have the test every two or three years, or as often as their gynecologists suggest.
You should always see your gynecologist if you experience:
- any unusually and/ or persistent vaginal discharge
- bleeding between periods
- or bleeding after sexual intercourse
Did you know that with each new sexual partner your risk of getting HPV increases by 15 percent? This means that having multiple sex partners raises your risk of HPV substantially.
What to do before your Exam?
Before your visit, write down a list of questions you may have so the doctor can address the issues that are most concerning you. It is also a good idea to get a referral for a gynecologist through someone you trust. Ask your female friends whom they trust for their gynecological check-ups. You can also ask your general internist or student health center for a referral.
What Can I Expect at my Exam?
Once you are in the examination room, you will be given a gown and sheet to cover your torso. The doctor will ask general questions about your health and then do a brief external physical exam.
The doctor will examine your breasts for any lumps or any pain, then teach you how to do a monthly self-exam. Before beginning the pelvic exam, you will be asked to lie down and place each foot in a foot holders, called stirrups, at the end of the table. It helps to relax your knees and pelvic muscles to facilitate the exam.
In the beginning of the pelvic exam, the doctor will examine the external parts of the vagina, checking for any abnormalities in the skin. He should then inform you when he is ready to perform the internal exam. A speculum — a plastic or metal tube-shaped instrument that opens slightly once inserted — is gently inserted into the vagina. The doctor will inform you before he opens the speculum to better visualize your cervix. As the speculum opens, you will feel a light pressure in your pelvis. Occasionally, if the pelvic muscles are clenched too tight, you might experience pain. If this occurs, inform the doctor. He will probably use a smaller speculum and ask you to take deep, slow breaths and relax your pelvic muscles.
The speculum is locked to keep your vaginal walls open. At this time the cervix will be inspected to check for any abnormalities. The healthy cervix is pink in color and often resembles a small donut. A small brush or spatula is used to collect cells from the outer and inner portions of the cervix. During this time you may experience slight discomfort. These cells are collected in a vial and sent to the laboratory for a Pap smear (Papanicolau smear).
In the lab, the cells are examined for a HPV (human papillomavirus), a sexually transmitted disease and an indication of possible cancerous or pre-cancerous cells. Various types of HPV have been shown to be responsible for pre-cancerous or cancerous changes in the cervix.
After the speculum is removed, the doctor will perform a "bi-manual" exam. The doctor will insert two gloved fingers into the vagina and will then apply light pressure on your abdomen with the other hand. This exam is done to determine the size, shape and position of the uterus and to examine the ovaries. A rectal exam may be performed to check for any rectal abnormalities and to examine the back of the uterus and ovaries.
The doctor may not check automatically for sexually transmitted infections such as Gonorrhea and Chlamydia. Most insurance companies will not reimburse the provider if there are no symptoms that warrant these tests. If you want to be tested for any sexually transmitted diseases, it is important to address these concerns at the beginning of the visit. If you want to have an HIV test, the doctor will offer HIV counseling and obtain your consent before conducting the test.
What is a Pap Smear?
The Pap test, also called a Pap smear, checks for changes in the cells of your cervix. The cervix is the lower part of the uterus (womb) that opens into the vagina (birth canal). The Pap test can tell if you have an infection, abnormal (unhealthy) cervical cells, or cervical cancer. According to the ACOG guidelines for Pap testing women diagnosed with HIV or other diseases or conditions that lower immunity should continue having annual Pap smears after age 30.
Fact: The greatest single reason for the occurrence of cervical cancer is not having Pap smears according to recommended guidelines.
The majority of women diagnosed with cervical cancer have not had a Pap smear in five or more years. Sadly, these women are usually at an advanced stage of cancer when they receive diagnosis.
Want a specific question answered? Then visit our website at and look for the Ask a Health Educator link
Sources:
(2003). Pap tests and cervical health: A Healthy Habit for you. National Cancer Institute. Retrived January 6, 2009 from http://www.cancer.gov/cancerinfo/pap-tests-cervical-health
(2006). What is a Pap Test?. The National Women’s Health Information Center. Retrieved January 28, 2008 from http://www.4women.gov/faq/pap.htm
Information updated 1/6/2009
