Feb 15, 2018

Interview Transcript

Dr. Jones: So now you're in the gynecologist office, and this is your first exam. Oh, well, let's talk about that. This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health, and this is The First Exam, on The Scope.

Announcer: Covering all aspects of women's health. This is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: So, what's going to happen at your first visit? You'll have a chance to meet your doctor or nurse practitioner or a PA, who will ask about your concerns and how they can help you. They will ask about your health and medications, your periods, your sexual activity, your alcohol, tobacco and drug use. It is best if you're in the room without your parents, if you feel comfortable with that. You need to be completely honest when the clinician asks you about your sexual relations and sexual activities so they can take good care of you. Of course, if you want a family member with you, we're completely supportive of that. Your information is confidential, of course, and if you're given a prescription, your mom may want to know why, the clinician should ask your permission to talk with your mother after the fact. Of course, this is the chance for you to ask questions that you might not comfortable asking any other person. And remember that advice from the web or your girlfriends may not be the best. An experienced clinician is a professional, and has heard many questions and will not judge you. They want you to have access to good information.

The clinician may ask for urine sample before your exam or even if you aren't having an exam. This sample can be tested for pregnancy, and gonorrhea, and chlamydia. If you're having pain with your urination, they may ask for urine sample. You may need a female exam called a pelvic exam. If you're coming in for birth control, you do not need a pelvic exam, unless you're going to get an IUD, which must be put in your uterus during a pelvic exam. Birth control pills, patches, shots, and rings, and implants, can be provided without a pelvic exam. Even tests from most sexually transmitted diseases can be done without a pelvic.

The first pelvic exam is the most anxiety provoking part of the first GYN visit. The clinician will tell you what they're going to do in advance, should show you the instruments that they're going to use, and go slowly to try to let you relax. Remember, there may be good reasons for this exam, but you control the process even though you don't feel like it. If you absolutely say no, it will not be done. The pelvic exam is done with your panties off, and you will be given a gown and a sheet to cover your lower body.

The clinician and their assistant may ask you to put your feet in footrest so that you can relax your legs to allow them to check your vaginal area. You can help ease this exam if you can relax your legs, breathe slowly, and relax your abdominal muscles. If necessary, and possible, they may place an instrument that looks like a long narrow duckbill into the vagina so they can see where the problem might be. There are different sizes of this instrument called a speculum, and this clinician can pick a size that's best for you. Lubricant is often used to make this part of the exam more comfortable.

If your problem includes an uncomfortable discharge, your clinician may collect some vaginal fluid out with a swab to look into a microscope. If a Pap smear's done, some cells will be collected from your cervix with a small plastic swab. All this can be uncomfortable if you haven't had intercourse yet and even if you have had intercourse, but it doesn't last long. Almost every woman in the United States has had a pelvic exam at some time in their life and they've all survived it. If you have a problem that requires a look but you haven't had intercourse and the vaginal opening is too small, the hymen, to allow the speculum, then often an ultrasound can be used, as sound waves to look through your abdomen to your uterus.

After the speculum is removed, the clinician may perform a bimanual exam. This means that one or two fingers of the clinician's left hand are covered with lubricant jelly to be placed in your vagina, and the other and will be placed on your lower belly. Then this clinician can feel the uterus and ovaries between their hands and see if they're enlarged or painful. Occasionally, but not commonly, the clinician will put one finger in your rectum, your bottom to feel for lumps. This is embarrassing to most young women and older women, but if you relax the rectal muscles -- it's hard to do when you're embarrassed -- this can be over quickly.

After the exam you'll be given tissues and a washcloth and some privacy to get yourself and your clothes back together. Your clinician or your nurse should return, let you know what they found and what they think is going on, and explain some other tests if they need it. You may have a little vaginal discomfort or cramping after the exam, but it doesn't last long.

All this may sound intrusive or traumatic for the young woman about to have her first GYN exam, but the reality is that, it's usually tolerable and done for a good reason. We're doing fewer and fewer pelvic exams just for routine these days. You can get most forms of contraception without a pelvic exam. Many sexually transmitted diseases can be tested without an exam. However, in many cases, when there are problems, the pelvic exam is an important part of helping us help you. You'll be fine. And thanks for joining us on The Scope.

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