During the recent rush of sports physicals our office has performed this summer, many of our young women were somewhat dismayed to be asked to put on a paper gown for their physical examination. As I walk into the room, I am always conscious of this discomfort and assure the girls that this is just a subtle gesture towards what in the next few years will be their first “womanly” exam. With this comment I am most often met with a knowing look from an older sister or mother, and a bewildered eye squint from the patient as simultaneously they ask, “when do I/does she have to do that?” Transitioning from the pediatrician’s office to the OBGYN’s office can be an intimidating process. I believe strongly that girls should be well prepared for what to expect during this first visit, in detail, in order to ensure their return visit in the following years.
The institution of annual routine OBGYN visits has been one of the largest improvements in public health in recent memory. Prevention of cervical cancer is a major benefit and goal of these yearly visits. For most women, these yearly visits are as close as they come to taking an active approach to their general health. It is often during this time that general health concerns are raised that may or may not be specific to the OBGYN specialty. The obstetrician often acts as a referral nucleus to other types of medical specialists. Information that is particularly pertinent to this yearly visit relates to any family history of female cancers, which may have a genetic basis; any menstrual irregularities; any vaginal abnormalities, and finally any complaints related to intercourse.
The first OBGYN visit should take place when a female turns eighteen or becomes sexually active. Whichever milestone is reached first should be honored. If a girl is having trouble with irregular or extraordinarily heavy menstrual cycles she may receive the recommendation to begin hormone supplement in order to regulate these abnormalities. If these things occur before the above parameters of age and activity have been met, oral contraceptive pills may be initiated without an invasive exam being performed.
I find that in addressing this first visit brief specific information is the most helpful. I generally approach the situation by describing exactly what will happen from the moment the teen enters the office. After signing in, generally teens will be weighed and their blood pressure measured prior to being asked to change into a paper gown that is open to the front. In addition, a paper sheet will be given to cover the teen’s legs and vaginal areas during the exam.
As the physician enters the room, typically the first part of the visit is regarding the patient’s past medical history including any sexual activity, any sexually transmitted disease, and any medicines that the patient may be taking. Following this information gathering, the physician usually will begin by performing a breast exam. This should include instruction for the teen, as they should be performing monthly exams on their own to provide early detection of any potential lumps or bumps.
The breast exam is followed by the external genital exam during which the practitioner looks for any discharge, redness, lesions, or swelling that might be present in the vulvar or labial area. At this time the patient is positioned with the feet in stirrups and legs covered. During the entire exam process the physician should precede his actions by an explanation of what will follow, and the opportunity for the patient to ask any questions that may arise.
The internal exam is usually the portion of the exam that generates the most anxiety. An instrument called a speculum that may be either plastic or metal is used to visualize the cervix. The cervix is where the physician will use a wooden spatula appearing tool and a pipe cleaner appearing tool to collect outer and inner cervical cells respectively. This is called the Pap smear. These cells are placed onto a microscopic slide that will be reviewed by lab technicians for any evidence of abnormality. Finally the obstetrician will palpate the ovaries for size and texture, and subsequently perform a rectal exam to assure there is no abnormal tone or communication between the vaginal and rectal canals.
The microscopic results are generally available approximately seven to ten days after their collection and are communicated to the patient verbally by the physician or as a written result. Any abnormalities may require a repeat Pap smear or possibly a more in depth exam that may involve other procedures. If everything looks good, the patient is cleared for the year, until the next annual exam is due.
This is routine health maintenance for every woman. There are virtually no exceptions to the need to have this exam annually. There are both men and women gynecologists; most teens are usually comfortable at least initially with a woman physician. Some gynecologists have more experience than others with younger patients. This may be worth noting for this first exam. Your pediatrician may be able to direct you to a gynecologist that can be particularly sensitive to the concerns of a young teen.