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Going to the Gynecologist: What to Expect
by eunoia January 12th 2009, 06:53 PM

Going to the Gynecologist: What to Expect
by Jessie

This guide contains answers to the following questions:
- When should I start to see a gynecologist?
- What should I expect during my first visit? (A step-by-step discussion on what happens before, during, and after the exam room.)
- How do I choose the right doctor?
- What do I do, if I’m not insured?
- What if I don’t want my parents to find out?
- What do I do if I think my doctor crossed the line of personal boundaries or has sexually harassed or harmed me?


When should I start seeing a gynecologist?
Many people agree that there are three wonderful times to make your first gynecologist appointment. They are: 1) when you are eighteen years old, 2) when you become sexually active and 3) when you think there may be a problem. Whichever of these times comes first is the best time to begin seeing a gynecologist.

It is most often best to schedule an appointment for one week after your period. Although there is no wrong time, a week before your period is sometimes considered the worst, as your breasts tend to feel lumpier during this time. While it is embarrassing to go while on your period, it is possible. If you have an irregular period and don’t know when to schedule in advance, ask the office what their policy is on cancelled or changed appointments, so you know how much time before you have to cancel your appointment, in case you get a surprise period.

You are eighteen or over. Yep, that’s reason enough to go to the gynecologist! Even if you don’t have sex and you don’t think you have any problems, many experts agree that women should begin seeing a gynecologist at or around the age of eighteen, since their periods are pretty regular. Although what you hear will vary depending on who you talk to, the normal age many doctors suggest you begin seeing a gynecologist is between 18 and 21. Another common suggestion is that a girl begins to see a gynecologist when she beings to menstruate, but menstruation does not signify a need to visit the gynecologist.

You are sexually active. If you are sexually active you should be having routine check-ups.
You might think that having sex isn't reason enough to go, but it is. Because you can get a sexually transmitted infection (STI) even if you are careful when sexually active, being tested routinely is the best course of action. A gynecologist can also be a good source for education about birth control, infections and other issues.

You think there may be a problem. If you think there’s something wrong with your health it is always best to get it checked out by a trained medical professional. Don’t wait until it’s a huge problem that isn’t easy to fix—a lot of times, if you catch it early, infections and other problems aren’t the end of the world. Seeing a doctor when you think your health is at risk is a must.



What should I expect during my first visit?
This guide is arranged chronologically—in the order events are most likely to happen—and goes into detail about each part of the visit.

One: The waiting room. So you built up the courage to go to the gynecologist for the first time. You called, scheduled an appointment, and now the day has come. It might be scary. It might feel like no big deal. Maybe you’re confused or anxious. But walking into the office may turn out to be the most difficult part of your visit. Building up the courage to do this might be easier if you go with a trusted friend or family member. When you get to the office you will most likely be asked to fill out a whole bunch of paperwork. If you are under the age of eighteen, in some countries, a parent may need to sign, so you may want to ask them to come. Make sure you take your insurance card, if you have insurance, because the receptionist will need to make a photocopy of it for their records.

Two: The exam room. Most likely a nurse or receptionist will call you back to the exam room. Stay calm! Nothing will happen right away, so just relax. All the normal things will likely happen—a nurse will record your weight, perhaps height, and take your blood pressure. You may be asked to change into a gown now, or maybe you will wait. You will be given total privacy while changing, so no worries. You most likely will have to undress completely, but ask your nurse. They may allow you to keep underwear on until it is time for the pelvic exam. Remember to take off your bra for the breast exam!

Let the doctor know this is your first exam, so they know to take the appropriate measures. The doctor will want to talk to you before they begin an examination, so be prepared with the correct information. Don’t worry, everything you tell the doctor will be confidential, so be honest! Your doctor will need to know your family medical history, your own history of sexual activity and gynecological history, what medications you are on (including birth control), if you are at risk for STIs, if you have ever had unprotected sex, if you have ever had forced intercourse, if you have any discomfort, itchiness, or suspect you may have an infection or disease, and if you have experienced any unusual bleeding or discharge. Remember that doctors are professionals and they’ve heard it all before—you won’t shock them with honesty, but a lie or missing information could negatively impact your treatment.

Now is when you should feel free to ask questions. Make sure your doctor has answered in ways you understand—if you need them to clarify, let them know!

There should always be a female nurse present during the exam, particularly if your doctor is male. Don’t hesitate to ask for a female presence if there is not one. If this doesn’t seem to be the case, ask for someone to come before the exam begins. And always know that if, at any time during your exam you feel uncomfortable, you can tell your doctor.

Three: The breast exam.
The breast exam may come before, or after, the pelvic exam. For the breast exam you will be asked to lie on your back, on the table. Your body will be covered and your doctor should only expose the area of your body being examined. The doctor will palpate, or lightly press, on various parts of your breast, spending about thirty seconds on each breast. After finishing they may show you how to examine your own breasts. If they do not and you do not know how, you should ask for their help. Doing self-exams helps you to become comfortable with your own breasts and how they feel.

Four: The pelvic exam. The pelvic exam is, perhaps, the scariest part of your appointment. Your doctor will begin by examining the external surface of your vagina. This is to feel for inflammation, bumps and sores, which may indicate a blocked gland, herpes, genital warts or another problem.

Next your doctor will insert a speculum. A speculum is a thin plastic or metal device which holds the vaginal walls open. They will then examine the vaginal walls for sores or inflammation and your cervix for discharge, signs of damage, or infection. Your doctor will then, most likely, take a Pap smear. A Pap smear is a small scraping of cervical cells which checks for infection, abnormal cervical cells, or cervical cancer. This should not hurt you, although it may feel strange.

The manual exam is next. Your doctor, wearing gloves, should insert two lubricated fingers into your vagina while pressing gently on your abdomen. This is how she examines the surface of your uterus, ovaries and fallopian tubes. If it hurts, let your doctor know.

Last comes the rectal exam. While this may be embarrassing and uncomfortable, it is very important. For the rectal exam one finger will be inserted in the vagina and one in the rectum. Rectal exams help to detect problems that cannot normally be found during a routine vaginal exam, such as endometrioses, cysts and other problems with pelvic organs.

Five: Before leaving. Usually your doctor will describe what they are doing, while they are doing it. If they don’t, ask. Afterwards they will likely repeat what they found, summarizing your exam. Ask when you can expect the results of your Pap test and how to get them—will you have to come to the office, call, or will they be mailed to you. If you get a prescription, ask for information about it from your doctor. You can also discuss the prescription with your pharmacist.

Before you leave you should make your next appointment. Your doctor should tell you when your next appointment needs to be. Drop your chart off at the front desk and set up your next appointment date and time. If your doctor needs to see you again before that time, to discuss the results of a Pap smear, the office will call you to schedule a new appointment.



Deciding who to see.

Doctor, Nurse, or Who? Gynecologists are, perhaps, the most obvious choice, when considering who to see for routine gynecological check-ups. But there are other options that many women don’t know about. For example, adolescent doctors (primary care physicians), are trained to help teens deal with reproductive health issues. Nurse practitioners are also trained to give breast and pelvic exams, and may be an option. Call a local practice or you own doctor to see what options they offer and what they suggest.

Deciding on a male versus a female. If you know you won’t have any problems undressing for a male, then it might not matter, for you. Maybe your mom wants you to see the doctor she has always seen, but you know you won’t be comfortable seeing him. That’s okay. If you are going to a group practice, feel free to call and ask for the name of each female doctor there, and then make an appointment based on a recommendation or just by choosing a name. If you have any suspicion you may be uncomfortable seeing a male doctor, it is probably in your best interests to simply begin with a female. You can always switch, later.

There should always a be female nurse present during the exam, particularly if your doctor is male. Don’t hesitate to ask for a female presence if there is not one.



Other information:

What if I live in the USA, or a country with privatized health care, and don’t have insurance or don’t want my parents to find out?
In these cases it will be best to take advantage of free or reduced-rate clinics, like Planned Parenthood or other services. These clinics have fully-trained staff who charge much less than a private practice, and are legally bound to confidentiality—this means that they cannot tell the guardians of a minor that they provided services to their child.

What do I do if I think my doctor crossed the line of personal boundaries?

If you EVER feel that your doctor has crossed their professional line and touched you inappropriately, do not hesitate to notify the police. You may also want to ask for the support and help of a trusted adult. It may be scary, but if this has happened to you, you are likely not the only one. This is not your fault and you should not suffer alone. Telling won’t get you in trouble, but if caught the doctor can never do this to another woman again. A good guide is as follows: Breast exams, reliable ones at least, should not take much more than thirty seconds per breast, unless there is a problem.



Sources:

TeensHealth. August 2006. Michele Van Vranken, MD. January 10, 2009.
http://www.kidshealth.org

Kotex. Kimberly-Clark. January 10, 2009.
http://www.kotex.com

About.com:Women's Health. June 18, 2007. Tracee Cornforth. January 10, 2009.
http://womenshealth.about.com
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