Health Info & Services

• Preparing for Your Office Visit
• Your Medical History
• Which Birth Control Method is Best for You?
• Talking with Your Clinician
• Sexually Transmitted Infections
• The Urine Test
• The Breast Exam / Mammography
• The Pelvic Exam / Pap Test
• Other Procedures
• After Your Exam

1. Schedule your routine GYN exam for a time when you will not have your period - unless you have bleeding problems 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 these:
   • vaginal discharge
   • spotting between periods
   • heavier than usual flow
   • bleeding after sex
   • pelvic pain or other problems
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.

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?
• What method do you use to prevent sexually transmitted infections?

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.

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?

Your clinician can provide you with the information you need to make the best choice for you.

Don't let embarrassment become a health risk. You needn't worry that your clinician will be able to tell if you've had vaginal, oral, or anal intercourse, how many partners you have, or if you masturbate.

Be precise about your sexual health risks and questions about your sex life. Being clear will help your clinician suggest the best solutions. 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. STI's can cause sterility, birth defects, and cancer. Some can cause death. Great harm can be done even when there are no symptoms. Very often, women have no symptoms. It's very important to let your clinician know whether or not you are at risk for sexually transmitted infections. Previous pregnancies or STIs may be detected during the exam.

You may be asked for a urine sample to test for pregnancy as well as for Gonorrhea and Chlamydia. It can also detect diabetes, kidney infections, and other diseases.

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 with your knees up. Your clinician will examine your breasts for lumps, thickening, irregularities, and discharge. Many clinicians continue the medical 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 a BSE once a month. The best time for a BSE is just 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 it is important to report anything unusual to your clinician as soon as possible.

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

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 have your reproductive organs identified for you. A mirror may be positioned so you can see.

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 redness, irritation, discharge, cysts, genital warts, or other conditions.

Step 2: The Speculum Exam
The clinician inserts a sterile metal or plastic speculum into the vagina. The speculum is opened to separate the walls of the vagina, which normally are closed and touch each other. It holds the walls apart 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 STIs may be taken by collecting cervical mucus on a cotton swab. It is possible to have all of these STIs without symptoms. The tests may not be done unless you have a concern about infections and ask for STI testing. Be sure to talk with your clinician if you have symptoms or concerns about your sexual partner(s).

The clinician will take a smear for a Pap test. Usually a small spatula or tiny brush is used to gently collect cells from the cervix. The cells are tested for the presence of pre-cancerous 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 redness, irritation, injury, and any other problems.

The Pap Test

Pap tests can screen

• the presence of abnormal growth in the cervix
• infections and inflammations of the cervix
• thinning of the vaginal lining from lack of estrogen

Interpreting Pap Tests:

Cytologists (technicians who examine Pap tests) are very careful about interpreting Pap tests. 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 label test results as "ASCUS" (atypical squamous cells of unknown significance).

If your test results are labeled ASCUS, your clinician may schedule more frequent testing that may include colposcopy and biopsy. As with mammography, fewer cancers are overlooked with these precautions. But waiting while more tests are done can lead to more anxiety, as well as expense. It is reassuring that all precautions improve the chance of finding abnormal growths before it is too late.

A number of different treatments may be prescribed If you have abnormal results. If you have an abnormal Pap test:

• Be sure to complete the prescribed treatment and repeat the test as advised if noncancerous abnormalities and infections are found
• You will need treatment and follow up if early pre-cancerous or suspicious growths are found. You may be advised to:
  • Repeat the test in a few months
  • Treat the cervix with antibiotic cream
  • Have a colposcopy and biopsy

Moderate to severe pre-cancerous growths require colposcopy and biopsy. They usually need to be removed with cryotherapy, laser surgery, or electrocautery. You will need to discuss your options with your clinician and/or consult a gynecological oncologist if cancer is found.

Pap tests need to be repeated if there is too much blood present for an accurate reading or if there is not enough tissue to be examined.

Remember:

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

More information on Pap tests.

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:

• the 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

The bimanual part of the exam causes a sensation of pressure. You may find it somewhat uncomfortable. Deep breathing through the mouth helps. If you feel pain, tell the clinician.

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 complete the rectovaginal exam with 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 exam procedures may include checking 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.

Mammography

Annual breast exams and monthly breast self exams (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 cancerous tumors. Mammography can detect a lump up to two years before it can be felt. While Planned Parenthood of the Rochester/Syracuse Region does not perform mammograms in our health centers, we are happy to give you a referral.

Women over 50 should have mammograms every year. Women between 40 and 49 should have mammograms every year or two, depending on the history of breast cancer in their families. 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 Planned Parenthood clinician can refer you to a mammography facility near you.

At a mammography facility, a 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 are very careful about interpreting mammograms. 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 take further x-rays and ultrasounds. They may ask for more follow-up and recommend further 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 before it is too late.

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, STIs, 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 three to 14 days. Your clinician will tell you how long you'll have to wait. Be sure your clinician has your current address and phone number.

It is a matter of teamwork - you and your clinician working together and maintaining good communication.

top of page

Adapted from PPFA (www.plannedparenthood.org) and Planned Parenthood Golden Gate (www.ppgg.org)