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Pregnancy / I've never been to a gynecologist before. What should I expect?

A woman's first gynecological exam can be an intimidating experience. Having a clear understanding of what will happen can help to alleviate the anxiety.

You should begin having regular gynecological exams when you become sexually active or when you turn 18, whichever comes first. You should schedule your exam for a time when you are not menstruating, because the blood will interfere with viewing the cells needed for a pap smear. You should also refrain from sexual intercourse for 24 hours before your appointment.

You should make an appointment immediately if you experience any of the following: severe pain in the abdomen or pelvis, unusual pain in the vagina, unusual discharge, itching or bumps in or around the vagina, exposure to a sexually transmitted disease, severe pain during menstruation, abnormal periods, breast discharge, changes in the size or skin of the breasts, or pain during intercourse.

The appointment will begin with your personal and family medical history. Some of the common questions you should be prepared to answer include: Is there any history of breast disease or cancer of the reproductive organs in your family? At what age did you begin menstruating? When was the first day of your last period? How long does your period usually last? Do you have a light, medium or heavy flow? How many tampons or pads do you use the first day of your period? Are you sexually active? Do you have multiple partners?

Some of these questions can be extremely personal and you may feel embarrassed, but it is essential to your care that you be honest with your physician. You should also feel comfortable asking your doctor questions. Some of your questions may be embarrassing for you to ask, but remember that your doctor is a professional gynecologist- to him or her, these questions are perfectly normal. Some women find it helpful to write down their questions ahead of time so that they don't forget anything.

After you and the doctor have discussed your medical history and addressed your questions, you will begin the exam. The doctor will conduct a breast exam and show you how to perform a self exam. Women should have a professional breast exam once a year and perform self exams monthly after age 18.

Next you will be given a pelvic exam. The most important thing to know about this prior to your visit is that it doesn't hurt.

The doctor will examine the external genital area for signs of irritation, discharge, cysts, genital warts or other problems. Next the doctor will insert a speculum to separate the walls of the vagina. The speculum can feel a little strange as it stretches the walls of your vagina, but relaxing and breathing normally will minimize any discomfort. Once inserted, the doctor can examine your cervix and vaginal walls.

If you are being tested for any sexually transmitted diseases, the doctor will collect a sample of cervical mucus on a cotton swab. You will also be given a pap smear. This involves collecting, with a small brush or spatula, cells from the cervix. This may feel a little uncomfortable, but it is done very quickly. A pap smear is used to detect the presence of pre-cancerous or cancerous cells, cervical infections and the thinning of the vaginal walls due to hormonal imbalance. It is recommended that all women have a pap test every year and experts say it is one of the most important things women can do to protect their health.

The speculum will be removed and the doctor will examine your internal organs, the uterus, fallopian tubes and ovaries, by inserting two fingers into your vagina while pressing down on your abdomen. Your doctor may also examine the muscles between the vagina and the rectum by inserting a finger into the rectum.

The entire physical exam only takes a few minutes.

The results from your pap smear are usually ready in a week or two. If the results are normal, you won't need another exam for a year. If there are any problems detected, your physician will contact you and schedule a follow-up for further testing.

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