How To Prepare For A Gynaecological Exam

Visiting a gynaecologist can be a daunting experience, especially if it is your first visit. Although it is perfectly normal to feel nervous or embarrassed, there is no reason to feel anxious. Gynaecologists talk to hundreds of women every year about their intimate issues and are committed to making you feel comfortable throughout the visit.

It is recommended that you have your first gynaecologist appointment at the age of 16 or earlier if you are sexually active. It is important to have an open and honest conversation with your doctor so that they are best able to advise you about your current and future fertility and to treat any conditions you might have.

During your appointment, your gynaecologist will take a full medical history and do a general check-up, including a breast exam. Depending on your age, and whether you are sexually active, your doctor might also perform a pelvic exam or a pelvic ultrasound.

Preparing For Your Appointment

You should schedule your appointment in the middle of your menstrual cycle (period) in case your gynaecologist needs to do a physical examination. You should not be menstruating (having your period) when you attend your appointment but should rather reschedule if necessary.

For two days before your exam, you should not have sex, douche, use any powders or creams or insert any objects (including tampons) into your vagina. It is not necessary to shave around your vagina or groom your pubic area.

You might also want to think about or make a list of questions you would like to ask your gynaecologist.

Discussing Your Full Medical History

To begin with, your gynaecologist will take your full medical history. This involves asking questions about your health, sexual activity, and anything else related to your reproductive wellbeing. Typical topics your gynaecologist will talk to you about include:

• Your family’s medical history of diseases, including high blood pressure, thyroid disorders, cancer, heart problems and diabetes.
• Your lifestyle, including exercising, diet, and smoking, or drinking habits.
• If you are pregnant or trying to conceive.
• Urinary or faecal incontinence (not being able to control your bladder or bowels). Many women will experience these symptoms after childbirth which may worsen during menopause.  
• Diseases and conditions you have or have experienced including mental, physical, and sexually transmitted infections (STIs).
• Issues relating to your menstrual cycle including unusual flow, clotting, spotting, irregular or painful periods and cramping.
• When you started having periods (menstruating).
• Low libido (sex drive) which may be affected by medications you take, or an underlying medical condition or a side effect of a known condition.
• The date of your last period.
• If you have any uncomfortable itching or discharge.
• If you are sexually active.
• Sexual discomfort which may include vaginal dryness or pain during sex.
• What kind of contraceptive (birth control) method you are using.

General Check-Up

The general check-up can include taking your blood pressure, doing a urine test, weighing you, listening to your lungs and heart, feeling the glands under your neck and arms and in your groin area, and possibly a haemoglobin test, which requires a finger prick. If you are sexually active your doctor might also screen for HIV or other sexually transmitted infections (STIs).

If you are under 21 and not yet sexually active, your first visit will usually not involve a pelvic exam.  Young women over 21 who are not sexually active and use tampons can usually have a pelvic exam. 

Physical Examination

After your gynaecologist has completed your general check-up, they will most likely perform a physical exam. Although this exam will require you to be fully undressed, you will be given a gown to wear, and your doctor will only expose the areas they need to see while examining you. You should never be fully exposed during the appointment.

The physical examination usually begins with a breast examination. You will then have a pelvic examination, depending on your age. You might also have a pap smear if you are older than 21. A pap smear is sometimes done by a nurse in a separate appointment.

Breast Exam

During the breast exam, your gynaecologist will feel your breasts for any lumps or abnormalities. They will also guide you on how to do your own breast checks in the future.

Pelvic Exam

During a pelvic exam, your gynaecologist starts with an external genital check, which examines the vulva (the area around the vagina) for any abnormalities. The inside of the vagina is then examined with the help of a tool called a speculum. The speculum opens your vagina and enables your doctor to clearly view your cervix.

Finally, your doctor will perform a bimanual pelvic exam. During this exam, your doctor will place two lubricated fingers into your vagina while checking your abdomen with the other hand. This enables your doctor to feel your uterus and ovaries and check for any growths or cysts. This may feel slightly uncomfortable but should not hurt.

Pap Smear

A pap smear can be done during your visit to the gynaecologist although it is sometimes done by your surgery’s nurse (as with the NHS). A pap smear is the main method used to check the cells on your cervix to find changes that can lead to cancer. A pap smear is generally performed on a woman over the age of 21.

During the procedure your healthcare practitioner will insert a speculum into your vagina and swab some cells from your cervix using a small brush and tiny spatula. The sample is sent to the laboratory to determine if it is normal or abnormal.

Women who test positive for the presence of HPV will be closely monitored with regular testing or further investigations, dependent upon the results. This is because HPV (a sexually transmitted disease) is the leading cause of abnormal pap smears and can cause cervical cancer. 

Pelvic Ultrasound

If you have concerning pelvic symptoms, your gynaecologist may perform a pelvic ultrasound. This procedure may be done during your appointment, or you may be referred for a separate scan. 

A pelvic ultrasound is a non-invasive diagnostic exam that allows quick visualisation of the organs and structures within the female pelvis. It produces images that are used to assess your uterus, cervix, vagina, fallopian tubes, and ovaries.

A pelvic ultrasound can be performed either through your abdomen (transabdominally) or through your vagina (transvaginally). It may be used to assess issues such as uterine bleeding, assess infertility issues accurately, diagnose possible endometriosis, polycystic ovaries or the cause of pelvic pain. It is also used for monitoring foetal development.