Getting Your First “Annual Exam”

Monday, January 26, 2015

The Oregon Clinic

Annual exams (aka gyn exams or well-woman visits) are an important part of taking care of your health. Whether or not you are sexually active, these visits are a chance to get a physical check-up, make sure you are up to date on your immunizations, perform preventative health screenings, and learn ways you can optimize your health.  They’re also a great opportunity to ask all those questions you’ve been too embarrassed or afraid to ask elsewhere!

When should I (or my daughter) start coming in for annual exams?

I encourage young women between ages 13 and 21 to come in periodically for a visit if they have questions about their changing body, have problems with their period, are considering becoming sexually active, want to get tested for vaginal infections or STIs, or have any other concerns about their reproductive health. These visits are mostly just talking, and do not usually require a physical exam unless specific issues come up. Once you turn 21, I recommend an annual exam, which may or may not include a pelvic exam or Pap smear.

What happens during an annual exam?

First, you will have your weight and blood pressure checked. Then, its mostly a conversation between you and your provider. Your provider will ask you questions about your physical and emotional health, as well as any illness that run in your family. You will be asked questions about your periods and sexuality. While some of these questions may seem very personal, discussing your health openly and honestly with your healthcare provider is important for ensuring you get the best care possible. These visits are confidential!

The rest of the annual exam is tailored to your specific needs. You may be offered  immunizations if you’re not up to date. You might be asked to leave a urine sample or have blood drawn for lab testing, depending on your needs. You’ll have a chance to ask questions.  If you need it, you might get a prescription for birth control. For the physical exam, you’ll be asked to get undressed, and your provider will do a head-to-toe exam, which might include a breast exam (pressing their fingers across your breasts to check for lumps/breast cancer) and/or pelvic exam (more on that, below).

What the heck is a pelvic exam?!?

A pelvic exam consists of a healthcare provider looking at and feeling your reproductive organs, including your vulva, perineum, vagina, cervix, ovaries and uterus.  First, your will be asked to lie down with your knees bent and open. Some providers will put your feet in pedals (“stirrups”) to help support your legs during the exam. Your provider will look at the outside of your vagina to look for any abnormalities. Then a speculum (a special device for looking inside the vagina; it looks like a duck’s bill) is inserted into the vagina, which allows the provider to see your vaginal walls and cervix (you can look, too, with a mirror!). Sometimes your provider will use a small brush to take a sample of cells from your cervix (called a Pap smear) to screen for cervical cancer, or they might take a swab to test for infection. Then the speculum is removed, and the provider may do a “bimanual exam”: this involves a provider inserting one or two fingers of one hand into your vagina, while the other hand is on your lower stomach. This allows your provider to check the size and position of your uterus and ovaries, as well as check out any areas of pain.

The pelvic exam is nobody’s favorite part of their day, but it only takes a few minutes. Women often experience a sensation of pressure or fullness during the exam. Some parts of the exam may be uncomfortable, but it shouldn’t hurt. If it hurts, be sure to tell your provider, so they can see if they can adjust anything to make you more comfortable. Don’t be afraid to speak up!   It helps to relax your stomach, buttocks, and vaginal muscles during the exam, and take slow deep breaths.

Do I need a Pap smear every year?

It used to be recommended that women get a Pap smear every year, but times have changed! For low-risk young women, you only need a Pap smear every 3 years; for women over 30, you may be able to go as long as 5 years between Paps. You should still come in for a annual exam each year for a breast exam and pelvic exam, but it may not include the Pap smear test.

What should I do (or not do) before my annual exam?

Avoid putting anything in your vagina for at least 24 hours prior to your pelvic exam (that includes sex toys, penises, douches, etc). Try to schedule your visit when you’re not on your period; menstrual blood can affect the results of certain tests. Write down any questions so you can address them with your provider. Don’t be afraid to ask “stupid” questions (there’s no such thing) or embarrassing questions;  it takes a lot to shock us! If you’re nervous, feel free to bring a trusted friend or family member into the room.