Double Sunrise Young Women's Health: early teen to college years

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GeneralHealth Info

What is a Pelvic Exam?

A "pelvic examination" is also called a "GYN exam" (gynecological exam), a "woman's exam" or simply an "internal". (Perhaps someday they'll be a better term, as none of these sound very reassuring, do they). It is a physical exam for woman where the health care provider (nurse practitioner, midwife or doctor) can examine external, as well as internal reproductive organs.

When should I have my first pelvic exam

You and your health care provider can decide when you should have your first pelvic exam. The American College of Obstetricians and Gynecologists (ACOG) recommend that you have your first pelvic exam if:

  • You are sexually active or plan to be. (This is important even if you have been sexually active even once.)
  • You are 18 years of age or older.
  • You have vaginal discharge.
  • You have menstrual problems such as unusual pain or abnormal bleeding.

What is the purpose of a pelvic exam?

The purpose of a pelvic exam is to assure that your reproductive organs are normal, and that you are free of cellular changes and infection that could become serious if left untreated. In addition, it often provides time to do other physical screenings including a breast exam as well to discuss your health and health issues in general.

But, I'm afraid to have a pelvic exam.

Many young women who are sexually active avoid a pelvic exam because they are afraid. That is very understandable, but it's important to understand that having a pelvic exam at a time you choose, with a practitioner you choose and at a time when you are feeling well is far better than possible alternatives.

For instance, chlamydia is the most common sexually transmitted disease (STD) of young women your age. (1:4 sexually active teens get a STD) A young woman can have chlamydia for weeks without any symptoms. But chlamydia multiplies and grows, and eventually it develops into a full infection causing many symptoms including severe pain. A scenario that is best to avoid is having your first pelvic exam in the emergency room with a pelvic infection and in pain.

It is better to have a pelvic exam to find problems before they cause symptoms. Chlamydia is easily tested for at every pelvic exam and can be diagnosed and treated with specific antibiotics before a woman and her partner ever have any symptoms at all.

Another very common sexually transmitted disease for high school age is Human Papilloma Virus (HPV). HPV can sometimes be found on the external genitalia At other times HPV is found only internally on the cervix. At times it can be found on both. HPV can be diagnosed by another test that all women receive during a pelvic exam, the Pap smear. Although HPV can be invisible to the naked eye, this test can pick up cellular changes that the virus causes.

Other problems can be diagnosed during the pelvic exam, but chlamydia and HPV are of particular importance to a young woman who is sexually active.

Remember: There are many problems in life that we cannot control, but serious consequences of these common, high school problems can be prevented. STD's, pregnancy and emotional upsets that come with them can be best prevented by abstinence (not having sex). But if you are sexually active or have been even once, a visit to your health care provider and having a pelvic exam are very important ways to prevent problems.

What happens during a pelvic exam? The pelvic exam is often in conjunction with a complete or partial annual "head to toe" physical exam. Besides what you remember about physical exams from when you were younger, as a young woman you will also have a breast exam. Prior to the pelvic exam, the practitioner will do an abdominal exam like the ones that you are familiar with from physical exams that you had in the past. Then you will "scoot down" toward the bottom edge of the table with a sheet or drape over your lap, and place your feet in special holders called "stirrups". As you "scoot down" to the edge, you will setting yourself into the "lithotomy" position which is needed for the practitioner to do an adequate exam in a timely fashion.

What you can do: To make the pelvic exam more comfortable and less stressful, you can take slow, deep breaths. Practicing relaxation will lessen the discomfort and the tension that you feel. Try to breath into your stomach, and when you exhale, let the area relax and go loose. Breath out, very slowly. This is opposite of what is natural. It is natural to tighten up, but your practitioner can do an adequate exam, in less time when you "let go"....and overall, it will be better for you.

There are three parts to the pelvic exam. The practitioner examines the external genitalia, uses an instrument called a speculum to examine externally and to do tests as the Pap smear and cultures for STDs, and then the "bimanual" where using gloves, the practitioner palpates the cervix and presses the other hand on top of your abdomen. In this way the practitioner can examine the shape and position of the uterus and surrounding reproductive organs.

Does this exam hurt? Most young women describe this exam as awkward, embarrassing and "odd" more than painful. At times parts of the exam may be briefly uncomfortable, and occasionally a young woman may be a wince with a second of pain, but overall most young women say, "That wasn't as bad as I was afraid of."

"Fear of the unknown" can make young women "on edge" or "jumpy" during the first pelvic exam. For example, a noise like a click of the plastic speculum, can send you're imagination flying rather swiftly. The exam will be easier for you if you can:

  • Ask your practitioner questions ahead, and share any "frightening stories" you have heard about pelvic exams.
  • Breathe relaxation breaths into your tummy, slowly exhaling.
  • Ask questions that you have at any point during the exam.

The best way to prevent pain during an exam is to have a pelvic exam if you've been sexually active even once, (or as your practitioner recommends). It can be painful to have an exam when you have an infection that has spread into the reproductive organs. The best way to avoid that is to be examined before problems develop.

The best scenario. The best scenario is for you is to make the decision to get a pelvic exam before or after sexual activity (even once). Then you can make an appointment with a practitioner that you choose, at an office that you feel comfortable at, when you do not have pain from a developing infection.

Where to go for help You can have a pelvic exam and a pap smear by contacting your doctor, nurse practitioner or clinic. Planned Parenthood has a list of a clinic closest to you. For immediate help call 911 or your operator, or go to the nearest hospital Emergency Room. When in doubt, follow instructions for immediate help, or call the hospital emergency room and speak to the triage nurse.

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