By Annie Heath, CNM
A young woman's first gynecological exam can be filled with anxiety and fear.
This is often based on embarrassment or inaccurate information about what the exam feels like and what testing will be done.
With proper planning, however, the exam can be a time when a young woman learns about her body and how to care for it. She can establish a relationship with a health care provider that is confidential and specific to her needs.
The first step in planning a successful visit is to find a health care provider that the woman feels she can talk to and work with. Many types of providers offer gynecological care: physicians such as family practice doctors, pediatricians and internists, as well as obstetricians/gynecologists. Nurse practitioners, physician assistants and nurse midwives also provide women's health care and may offer longer visits with more attention given to education.
The first visit can occur at any age when the young woman has questions or concerns about her reproductive health, including puberty, menstruation, sexuality, birth control or infection. This visit can also be a proactive way to establish a relationship with a women's health care provider, a time to learn about gynecologic health and how to access gynecologic services when they're needed.
This first visit often includes a lot of talking and discussion. The provider will take down a complete health history and ask questions about the young woman's lifestyle, nutrition and exercise habits. The provider will also ask about any concerns she might have.
A physical exam may be done, which typically includes measuring height, weight, blood pressure and pulse rate, and examining the heart, lungs, breasts, thyroid and abdomen. A pelvic exam may be offered. This involves inspecting and palpating the external and internal reproductive organs. It is helpful prior to the exam for the provider to explain in detail exactly what the procedure is and what anatomical parts will be examined. The patient can see a speculum, if she likes, and learn how it is used to inspect the cervix and vagina.
The exam may be uncomfortable, with a feeling of pressure, but it should not hurt. A thorough explanation and gentle touch can help alleviate fears and encourage open communication between the provider and patient.
During the first exam, many young women like to have a support person present. This can be a mother, sister, friend or other understanding person in her life. This support person, however, will be asked to leave while personal questions are asked. Even though the young woman may be under the age of adulthood, 18, she has the right to confidentiality and privacy. Information cannot be shared with her parents or other family members unless she gives her consent.
A Pap smear is no longer recommended for women under 21. Other testing, however, may need to be done. Screening for infection and sexually transmitted diseases and urine testing are some of the most common laboratory tests.
The provider may spend quite a bit of time on health education, depending on the issues identified during the interview and exam. If needed, birth control options can be discussed. It is important to ask specific questions about birth control choices - how to use the various methods, possible side effects, etc.
The appointment can take anywhere from 30 to 60 minutes. The woman will need another exam in one year, unless a health issue is identified that must be followed up on prior to that time.
Cooley Dickinson Hospital • 30 Locust St. (Route 9), Northampton, Mass. • (413) 582-2000