Sexual Health Exam - Women

Gynecologic Exam

You should have a routine GYN exam every year if you are sexually active or over age 18.

You may need to have checkups more often if you have:

• plans to become pregnant
• an STI or a partner with an STI
• a history of sexual health problems
• a sexually related illness
• a mother or sister who developed breast cancer before menopause
• a history of abnormal Pap test results
• a breast lump

You should visit your clinician, no matter how old you are, if you have:

• Unusual vaginal or pelvic pain
• Abnormal vaginal bleeding or discharge
• Severe pelvic or lower abdominal pain
• Pain, swelling, or tenderness of the vulva or vagina
• Sores, lumps, or itching of the vulva or vagina
• Growths, or thickening of the breast or armpit
• Puckering, dimpling, or other changes in the skin of the breast
• Newly retracted nipples or bleeding or discharge from the nipple
• Changes in size or shape of the breast
• Increased pain or discomfort before your period

Many women worry about having a GYN exam – especially if it's the first time. You will be more comfortable if you know what to expect.

Regular GYN exams include:

• Talking about your personal, family, sexual, and medical history
• Laboratory tests and screening for STIs and other conditions (at your own or your clinicians request)
• A breast exam
• A pelvic exam

MEDICAL HISTORY
Before your exam you will be asked to fill out a questionnaire. You will be asked about past illnesses, allergies, surgery, and pregnancy. You may be asked if you smoke, or if you drink alcohol or use other drugs. Your clinician will review your contraceptive needs and will provide you with the information to make the best choice for you.

It is very important to be frank and honest about your sex life. One out of four women has an STI in her lifetime. Don't let embarrassment become a health risk. Be precise about your sexual health risks and questions about your sex life. Being clear will help your clinician suggest the best solutions.

TESTS and SCREENING
You may be asked for a urine sample. The test can tell if you are pregnant. It can also detect diabetes, kidney infections and other diseases. Your clinician may also want to take some blood for a variety of tests.

Your blood pressure, temperature, and weight will also be taken.

BREAST EXAM
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 examination table with your knees up. You clinician will examine your breasts for lumps, thickening, irregularities, and discharge. You clinician will ask you if you have noticed any changes in your breasts since your last exam and will show you how to do a breast self exam.

PELVIC EXAM
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.

You will 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 is being done as it's happening

There are four steps to the pelvic exam:

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.
   
   
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 are normally 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 there is an infection present. Talk to 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. Test for gonorrhea, human papilloma virus, chlamydia, or other STIs may be taken by collecting cervical mucus on a cotton swab.
   
   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 precancerous or cancerous cells. You may have some staining or bleeding after the sample is taken.
   
   The Pap test can detect:
   1. The presence of an abnormal growth on the cervix
   2. Infections and inflammations of the cervix
   3. Thinning of the vaginal lining from lack of estrogen
      
      
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 check the internal organs (uterus, ovaries, and fallopian tubes) of the pelvis. 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.
   
   
4. Rectovaginal Exam
   Many clinicians complete the bimanual exam by inserting a gloved finger into the rectum to check the condition of the 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. During this procedure you may feel as though you need to have a bowel movement. This is normal and lasts only a few seconds.

AFTER YOUR EXAM
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.

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