The American College of Obstetricians and Gynecologists (ACOG) recommends girls have their first ob/gyn appointment between the ages of 13 and 15, with a yearly wellness visit after that. Girls should be clear about understanding why they are seeing a gynecologist. That way, they can make sure to discuss everything that is important to them and be more in control of the exam.
The doctor will normally perform a standard physical exam before the pelvic exam. This will include looking at the eyes, ears, and mouth. A breast exam is also part of a normal women's physical exam.
A typical pelvic exam consists of three parts, according to the ACOG. The first is an external genital exam to look at the vulva, which includes everything on the outside including the labia, clitoris, and the vaginal opening.
The doctor will also perform a vaginal and cervical exam with a speculum, which is a device that will be inserted into the vagina and expand to get a better view of the vaginal walls and cervix. While the speculum is inserted, the doctor will use a soft brush or a flat scraping device to take samples for a Pap test and to test for certain STD's.
The doctor will conduct a bimanual exam to study the internal reproductive organs. With a hand on the lower abdomen, one or two gloved, lubricated fingers are inserted into the vagina to feel the uterus and ovaries. A recto-vaginal exam may be done with one finger in the vagina and one in the rectum. In some cases a separate rectal exam may be performed.
The results of our survey indicate that many girls were not properly prepared for their first experience. Relying on the internet or their friend's accounts often leads to unfounded worry about what will happen. Parents need to discuss what will happen during the exam, but should leave the decision to be in the exam room up to the patient.
Equally at fault for causing undo concern are health care providers that don't understand the fears that a first time pelvic exam patient may harbor. Age specific learning is very important when dealing with a patient's first time experience. Extra care may be required by the provider to make the patient feel more comfortable and answer questions.
It is very important for the provider to talk to the patient and explain everything that is happening. Our survey reveals that many girls had no idea what was going to happen and felt violated.
The individual recollections provided by our survey were mildly edited for grammar, but are essentially unchanged. Some patients wrote of bizarre things happening like enemas and proctoscope exams, but readers should know that these are not a normal part of pelvic exams.
