Lady-bits doctor

[ArcticChicken]

I have no female friends to ask, so I'm turning to the good women of CS for help.

Long story short, I've got insurance now, and, having never been, it's time and past I found myself a gyno.

I'm terrified. I know I need to do this for my health, but the idea of a complete stranger messing about in my junk squicks me out.

I was wondering if y'all have any advice about how to pick one, and anything I might need to know before going.

[Seshat]

Okay. A good lady-bits doctor will be happy to have a session where she just talks with you, and doesn't do a physical exam.

(Whether your insurance would be happy with that is another matter.)

You can start by talking about less personal things if you want. Perhaps practicalities. Or ask their advice on general feminine health, safer sex procedures, contraceptive options, self-examinations. (Heck: ask their opinion on labioplasty!)

All of these are not so much about /you/ as about general medical concerns common to their field, but you can learn a bit about their personality by how they answer them.

Now...

To properly help you, the following are relevant:
* previous conceptions, miscarriages, births (vaginal or caesarian), lactation, breastfeeding.
* injuries to the relevant areas. Also, previous illnesses of those areas.
* sexual history (names are not relevant unless there's a contagious illness involved, then the CDC might become interested).
This need not be an involved sexual history - mostly, she will need to know if you're likely to have illness, and if she needs to use her smallest speculum.
* contraceptive history & what you've liked, hated, & why.
* whether you currently want contraceptive advice.
* your menstrual history and current situation. Including how light or heavy your flow is, whether you get cramping, mood swings, etc. Whether you spot. Whether you get headaches, bloating, or other symptoms.
Anything you suspect might be abnormal about your flow - or anything you just want to be told is normal.

With this information, she can help you with menstrual problems, help you become pregnant or avoid pregnancy, diagnose stuff like uterine fibroids or endometroisis, help protect you from cancers, etc.



Now, as for the examination itself...

My experience is that they will do a breast exam for you as well. This is just like the breast self-examinations, except with the doctor doing it. Yes, they use gloves. Talk to them about any lumpiness you've found - and yes, if they find a lump (when!), they will feel it for a bit until they're either sure it's a normal duct or normal bit of fibrous tissue, or decide to get it checked.
They see - and touch - every type of breast there is. Literally. Their only concern is the health of your breasts.

The pelvic exam...
The doctor will do a visual check of the exterior, and probably a tactile one. It's all very medical.
(The visual check led to a doctor discovering that my skin is unusually sensitive: I now use baby 'nappy rash' ointment, and my skin there is much healthier. Before that, the normal daily irritations were leaving me constantly low-level sore.)

If you're virgin, particularly a young virgin, you might not need a cervical test (aka 'pap smear').

Pap smear:
If the doctor doesn't know you well, he or she will probably lightly test how 'open' you are, before choosing a speculum size.
The doctor will warm the speculum to lukewarm-ish. If it's already hot in the building, she probably won't need to. Otherwise, she may heat it with her body, or by running it under warm water. If not, get up and walk away!
She'll lubricate the speculum, and very slowly work it inside you. It goes in just far enough to open the pelvic floor muscles. Those are the tight muscles right in the entrance.
She will open the speculum: just widely enough to get the smear stick in. This stick is - well, like a very long Q-tip.
She may need to play a bit with the angle of the speculum, or get you to shift your hips. She needs to see and reach the cervix with her 'Q-tip'. Once she can, she'll swipe the Q-tip across the cervix, then bring it back out. This is a lot like the images you see of people swabbing their cheeks for DNA samples.

Then she gets the speculum out, and you're done.

[AdminAssistant]

Seshat is right, except after the pap smear they will usually gently insert their hand and press up with that hand and down with a hand on your belly and somehow this checks your ovaries or something.

My current Gyno (a specialized NP, but a very nice lady), did a rather involved sexual history, but that's because I'm at a college and they try to keep a very, very close eye on STD's there.

And please, please, please - GO. It's one of the most important things you can do for your health.

[RecoveringKinkoid]

Just find someone you're comfortable with. When I was shopping around for a doc many years ago, I thought I'd be more comfortable with a woman. Turned out, didnt like her much, and after shopping around a bit, decided to go with a man who was recommended by my mom and a bunch of my friends. I'm still seeing that guy, I was comfortable with him.

It's not fun going to the lady bits doctor at all. But it helps if you like and trust the doctor and have a relaxed relationship with whoever you choose. A sense of humor is a must.

[MaggieTheCat]

Seshat and AA nailed it. I just had my annual exam last month and a second pap yesterday so the process is very clear in my mind. If you read any of my posts on Off-Topics or the big long one in Sightings, don't let it discourage you. My experience is very much NOT the norm. Most "well woman" exams are very fast and easy.

A couple of other things to note, since this is your first time going and I assume you are completely clueless (I know I was when I first went):

Usually the nurse will call you back and take your vitals: height, weight, temperature, blood pressure, pulse. She will ask you when your last menstrual cycle was, so be ready to know that date or tell them something like "three weeks ago yesterday" or something so they can get that. Also, DON'T go during your menstrual cycle. This may be obvious, but it's worth pointing out. If there is any blood present on the pap smear, it can interfere with the results the lab gets, so don't make the appointment for even a few days before/after your normal cycle in case you're spotting.

Once the nurse/aid takes your vitals, they will take you to an exam room (or they may take you directly to an exam room and take your vitals there.) There will be an exam table where you will be sitting eventually, but usually they tell you to just sit in one of the normal chairs first, and the dr. will come in and talk to you.

There will be a wait, I guarantee it. Drs. are usually way backed up. It could be upwards of 20+ minutes. I usually give them half an hour before I start wandering around asking where my provider is. This is generous. I wouldn't blame people for poking their head out the door after 15-20 minutes.

The dr. will come in and ask you questions and get your medical history filled out. After you've talked for a while, she will pull out a gown and a sheet and tell you get undressed and put the gown on. Depending on the clinic and the doctor, they may have you put the gown on with the ties in the back or the ties in the front; I've had to do both. It doesn't matter much 'cuz the gown doesn't cover much anyway. This is embarrassing but normal. The doctor will leave the room and ask you to get undressed. You will have to take all your clothes off, top and bottom (except socks. I always leave my socks on 'cuz it makes me feel MARGINALLY more modest, plus my feet freeze if they're bare.)

Then you will sit on the exam table and wait till the doctor comes back. Hopefully s/he will just have stepped outside the room and will come back in a minute or two. You can cover yourself up more with the sheet; I use it like a blanket till the doctor comes back and starts the exam.

For the breast exam, you will lie back on the table and the dr. will have you put your arms over your head and relax. S/he will expose your breast and gently starts pressing around your breast in a circular motion. It doesn't hurt at all; the breast exam, for me, is by far the easiest and least unpleasant part of the exam. After the dr. is done with one side, they SHOULD cover you back up with the sheet or your gown and move on to the other side to do the other breast. If they don't cover you, cover yourself if you want to. I once had a dr. who didn't cover me back up after finishing the breast exam and I wanted to smack her.

Then you will have to sit up briefly so you can scoot aaaaaaaaaall the way down to the end of the exam table. You will feel like you are about to fall off. Really. They need your bottom right at the very edge of the table so they have full access to your pelvic area. The dr. will pull out the "stirrups" from the end of the table, which is where you put your feet. You will lie back, the dr. should keep your legs covered with the sheet, and you will let your legs fall "outward." Yes, it is very exposing, embarrassing, and awkward. It's normal.

Then the dr. will proceed with the exam as Seshat and AA described. Usually first they just sort of prod gently for a moment and examine the outside of the labia. Then they insert the speculum, view the cervix, and take the pap swab (and STD test swab, at least mine do.) After getting the samples, they will remove the speculum and do the pelvic exam (where they insert fingers and put pressure on your abdomen to feel your organs.)

The most important thing here is to RELAX. I know this is hard but it makes things go much faster and easier for you the more you can relax your muscles. Take deep breaths, wriggle your toes, stare at the ceiling (if they have a mobile or a picture on the ceiling, focus on that), think about ice cream and puppies.

For some people, the speculum is the worst, for others, the pelvic exam is the worst. Personally, I hate the speculum the most. It is uncomfortable, but it shouldn't hurt. You may feel some cramping after they swab your cervix, and you may also have some slight spotting or discharge after the exam. They should give you a sanitary napkin or tampon for this, if you want them. If they don't offer either of these, ask for one.

After that, the dr. will leave the room again, you can get dressed, and that's it. The entire thing, from the time you lay back for the breast exam to the time you sit up after the pelvic exam, should take about 10 minutes. It's not very long once you get going. Also, I really like it when the dr. talks to me the entire time and explains what she's doing, what I should be feeling, what she's seeing or gathering now, etc. You can ask her to do this if she doesn't, or ask her to not talk at all if it makes you more uncomfortable.

Like AA said...go. I know it sounds unpleasant. It is. But it's important. You will feel good about yourself after you're done, knowing that you are taking care of yourself.

As far as locating a provider...I wish I could help. Hell, I wish I knew how to locate one myself so I could find a new one, after the complete fiasco at my current clinic. The best thing might be for you to call a clinic (usually either the family/general care area, or the women's health department), explain to the receptionist that it's your first exam and you're scared shitless, and ask for a recommendation. I would highly suggest a female provider, I would NEVER let a guy (besides my husband) touch me down there. I also prefer nurse practitioners over actual drs, but I have just had really shitty luck with MDs and better experiences with NPs.

*big hugs* I know it's scary. I was really scared when I went to my first exam, but the NP was super nice and gentle and reassuring. She hugged me when I freaked out and started crying. Just try to relax...I know that's really hard, but the more tense you are, the harder it will be for them to do the exam and the more uncomfortable it will be for you.

[AdminAssistant]

Just to expand on what Maggie said, you also shouldn't have sex for a few days before the exam. Apparently that can also screw up test results.

[Eisa]

Also, I'm pretty sure if you wear a skirt, you don't have to take that off.

That helps me.

[blas]

Oh, I most certainly agree, no sex (at the very least, not unprotected!) at least 3 days before a Pap smear. Sperm lingering around can and do mess up Pap tests.

[Seshat]

Yes - if you want to be more 'clothed', a loose tshirt and a skirt can be worn. Then you just have to take off the underwear, not the outerwear. They need access, they're not actually after your embarassment!

If your menstrual cycle is as irregular as mine can be, tell the receptionist that when you're booking your check. That way if you happen to be bleeding when the appointment rolls around, the gyno can be prepared for either the pap exam OR a discussion of why your cycle might be so irregular.

Irregularity is usually a symptom of something, after all. Best to find out what!

[42_42_42]

I know it's hard, but try to relax as much as possible during the exam itself. It's much less uncomfortable if you relax. It's usually over pretty quickly. My OBGYN is usually done with the whole shebang in less than 3 minutes, and that includes the breast exams, pelvic exam, and pap smear.

[ArcticChicken]

Thanks guys, I'm feeling less nervous about this now.

I've given myself permission to skip school tomorrow so long as I get a bunch of stuff done that needs doing, and one of those things is making an appointment for a physical. While I'm on the phone I'll ask them for a few recommendations, and if they get back to me in time I'll make an appointment with someone on the list.

[Sapphire Silk]

Seshat is right, except after the pap smear they will usually gently insert their hand and press up with that hand and down with a hand on your belly and somehow this checks your ovaries or something..

It's call the Bi Manual exam, and yes she's feeling the ovaries to see if there are any masses or tender spots that could indicate a problem. Sometimes they'll feel through the rectum as well . . . sounds gross, is not painful, just feels odd.

Lots of excellent information and advice from everyone. Routine Paps usually start around age 20 even if the woman is not sexually active (we never take anyone's word for it).

If the OP has never been sexually active, tell the provider and ask for a smaller sized speculum. And relax . . . definitely the most important thing you can do.

Trained OB/GYNs are usually the best at doing pelvic exams. Non OBs tend not to be very good at it, so I try not to get a pelvic at my regular doctor's office. OB GYNs do tons of them, so they understand it is uncomfortable and are practiced at reducing that discomfort.

I get a Pap every other year without fail. I have a great OB who's never hurt me.

Ask around your female friends for recommendations. That's how I found my OB.

[ArcticChicken]

Ask around your female friends for recommendations. That's how I found my OB.

I don't have any female friends, otherwise I would.

[MaggieTheCat]

I get a Pap every other year without fail. I have a great OB who's never hurt me.

Sorry this is a little OT, but why only every other year? I've always been told by every doctor I've seen that I need to get them every year, at least if I want to get my BC pills refilled.

[trailerparkmedic]

You can have less frequent Pap smears if you're older, haven't had weird Pap smears, you're in a monogamous relationship, and you don't have a weird family history. I want to say the magic age is 30, but I could be completely wrong and you should talk to your doctor. Even if you don't get a Pap smear every year, you are supposed to get annual pelvic exams, I'm pretty sure. They recently changed the recommendations and some people are using the new ones and some are using the old ones, so it's kind of weird.

If you can't get recommendations for your annual exam, look for a large practice of OB/GYNs. They are probably big because people are happy with them. I'm another person who prefers nurse practitioners. I feel like they are more patient, but maybe that's just a reflection on the doctors I've had.