Gynaecology is health care for the female body, focusing on the sexual and reproductive organs. Proper gynaecological care helps prevent many undesired cancers, diseases and other illnesses by allowing for early detection. Early detection is essential for effective preventative measures and treatment.
Regardless of your age, marital status, sexuality or level of sexual activity, gynaecological care is important. Listen to your body when it signals that something may be wrong. Don’t hesitate to approach a health care professional with any questions regarding your body or changes it might be going through. It is important to choose a doctor you’d be comfortable speaking with confidentially and asking questions of a personal nature that might be of concern to you.
Women should start seeing their gynecologist at least once every year when they turn 18 years old, or when they start being sexually active.
You may need to have checkups even more often if you have:
- Plans to become pregnant
- A sexually transmitted disease (STD) or a sex partner with an STD
- A history of sexual health problems
- A sexually-related illness
- A mother or sister who developed breast cancer before menopause
- A history of abnormal Pap test results
- Additionally, women and girls of any age need to visit their gynecologist if they notice irregularities in their breasts, genitalia, menstrual cycles, or if they become pregnant. You should consult your clinician if you have any of the following symptoms:
- Unusual vaginal or pelvic pain
- Abnormal vaginal bleeding or discharge
- Severe pelvic or lower abdominal pain
- Pain, swelling, or tenderness of the vulva or vagina
- Sores, lumps, or itching of the vulva or vagina
- Growths or thickening of the breast or armpit
- Puckering, dimpling, or other changes in the skin of the breast
- Newly retracted nipples or bleeding or discharge from the nipple
- Changes in size or shape of the breast
- Increased pain or discomfort before your period
Preparing for the visit may help you relax and get the most out of your appointment.
- Make sure that you will not have your period during your scheduled exam. Bleeding can affect the accuracy of the results and make it difficult for the clinician to perform some of the tests. You should inform the examiner before you come in for the exam if you think you might have your period during that time — you might be asked to reschedule your appointment.
- Don’t douche for at least 24 hours before the appointment. Don’t use any other vaginal preparation, either. They can mask many vaginal conditions.
- Since the first part of the exam consists mainly of conversation, you should know what you want to discuss before going in to the exam room. Make a list of all the concerns and general questions you want to discuss, don’t forget to include problems you might be having. It’s generally a good idea to have these questions written down going into the exam because they are easy to forget when you are nervous.
Remember, anything you discuss with your gynecologist about sex, birth control, pregnancy, STDs, or drug or alcohol use is private and confidential.
The Urine Sample
Pregnancy, kidney infections, diabetes, and some other diseases can be detected by testing your urine. You most probably will be asked to give a urine sample.
The Breast Exam
For the remainder of the physical exam, you will need to be fully unclothed. You will be provided with an examination gown, a drape sheet, or both. The examiner will ask you to lie back on the exam table. The clinician will examine your breasts with his/her hands for any irregularities such as lumps, discharge, and thickening. To make you a bit more comfortable, the examiner might ask you some more questions during this part of the exam. This would be a good time to ask your examiner to teach you how to do a Breast Self Exam (BSE) which should be done at least once every month. The best time for a BSE is just after your period, when your breasts are not swollen or tender (11). Since most breast lumps are discovered by a woman or her sex partner it is important to pay special attention to your BSE. Most lumps are not cancerous, but should not be taken lightly; report anything unusual to your clinician as soon as possible.
The Pelvic Exam
The Speculum Exam
The clinician inserts a sterile metal or plastic speculum into the vagina. The speculum is opened to separate the walls of the vagina, which normally are closed and touch each other. It holds the walls apart so that the cervix can be seen.
You may feel some degree of pressure or mild discomfort when the speculum is inserted and opened. You will likely feel more discomfort if you are tense or if your vagina or pelvic organs are infected. The position of your cervix or uterus may affect your comfort as well. If a metal speculum is used, you may feel the chill of the metal. Most clinicians lubricate the speculum and warm it to body temperature for more comfort, but you should talk with your clinician about any discomfort you feel.
Once the speculum is in place, the clinician checks for any irritation, growth, or abnormal discharge from the cervix. Tests for gonorrhea, human papilloma virus (HPV), chlamydia, or other STDs may be taken by collecting cervical mucus on a cotton swab. It is possible to have many of these STDs without symptoms. The tests may not be done unless you have a concern about infections and ask for STD testing. Be sure to talk with your clinician if you have symptoms or concerns about your sexual partner(s).
The Pap Smear
The clinician will take a smear for a Pap test. Usually a small spatula or tiny brush is used to gently collect cells from the cervix. The cells are tested for the presence of precancerous or cancerous cells. You may have some staining or bleeding after the sample is taken.
As the clinician removes the speculum, the vaginal walls are checked for redness, irritation, injury, and any other problems.
Pap tests can detect:
- The presence of abnormal growth in the cervix
- Infections and inflammations of the cervix
- Thinning of the vaginal lining from lack of estrogen.
- Interpreting Pap Tests:
- Cytologists are very careful about interpreting Pap tests. They don’t want to overlook any abnormality. They are also aware that failure to detect early cancers can lead to serious and even deadly consequences. Their caution may lead them to label test results as “ASCUS” (atypical cells of unknown significance).