Advice for the first visit to the gyno?
September 29, 2009 2:30 PM   Subscribe

First-ever visit to the gynecologist approaching, and I'm kind of nervous. What should I expect?

Since I'm in my early twenties, I decided it was probably (far past) high time for me to schedule my first visit to the ob-gyn for a general check-up, pap smear, etc.

I've never been sexually active, so I'm unaccustomed having people who are not me poking around down there. While I know the appointment will probably not be a big deal, I still find myself -- probably irrationally -- a little nervous.

What can I expect of the visit? Is there anything I ought to do to prepare myself beforehand? Should I come with questions (if so, which ones)?

Thanks in advance for your help and advice.
posted by gavagai to Health & Fitness (40 answers total) 11 users marked this as a favorite
Be prepared to know when your last period was, and how long it was. Also have a list of any drugs you have been taking in the past 90 days, especially if you are going in for birth control script, since most antibiotics will screw up birth control effectiveness.

Also, be prepared to strip from waist-down, and if you're not really comfortable with this, perhaps wear a skirt or dress so it isn't so much a "I'm taking my pants and underpants off in a strange room" and you can just take your skivvies off when needed, plus you'll be able to "cover" yourself quickly after the doctor is done.

Oh, and last thing - please don't hesitate to tell your doctor that you're nervous. If you feel uncomfortable with the doctor, ask for a new doctor. Oh, and relax during the speculum part - PAP smears hurt a LOT more if you tense up.

Good luck!
posted by banannafish at 2:36 PM on September 29, 2009

Haha, I went through this not that long ago. I remember being really nervous.

It's really not that bad, if you have a good gynecologist. They probably asked you if it's your first appointment when you scheduled it, right? The GYN will first talk to you a little bit in her office about your sexual history, your needs and concerns, etc. etc. etc. This is the time to talk about birth control if you are thinking about getting a prescription.

Then an assistant will take you into an exam room and you'll put on a paper robe (in my office, the robe is slit up the front, which is a little disconcerting at first - I thought I had it on backwards).

Then the doctor and assistant return. The doctor will probably do a breast exam. She'll press down really hard and massage your lower abdomen (which made me really need to pee! So pee right before your appointment!), then she'll do a pap smear. The smear is the scariest part but my gynecologist was talking and asking me questions through the whole thing, and I hardly noticed it.

As for preparation, definitely pee before-hand, and I take an anti-inflammatory like Aleve because I know some women get a little crampy after a pap smear.
posted by muddgirl at 2:38 PM on September 29, 2009 [2 favorites]

Take along a napkin because you may experience some bleeding after the pap. Also all three doctors that I have been to have asked me to completely undress; not just 'from the waist down' so be prepared for that. Nthing the peeing just beforehand too.
posted by stubborn at 2:42 PM on September 29, 2009

They will gain access to your girl bits with a device called a speculum. Tell them to use the smallest they have available. I was not sexually active for my first couple of pap smears and it was only after a new doctor suggested trying a smaller one that I even had the nerve to say it was uncomfortable. Once I was sexually active, it was no big deal.
posted by eleslie at 2:43 PM on September 29, 2009

First off, tell them it's your first pelvic exam. Hopefully your doctor will then take it slowly and explain everything he/she's doing.

Secondly, if you haven't had, y'know, anything large in your vagina before, you might want to ask the doctor to start with a small speculum (technically it's called a "pediatric" speculum but I loathe that name). They can do the pap smear just as well with the smaller speculum -- I think they default to the standard size because it's easier or affords more visibility or something -- and if you're unaccustomed to having your PC muscles stretched it will be more comfortable for you.

Thirdly, if you're nervous, just remember that you are the one in control of the situation; you can tell your doctor to stop or slow down or explain what she's doing at any point. Can you explain more about what you're nervous about -- are you worried it will be uncomfortable or painful, or are you nervous about being in such intimate contact with a stranger?
posted by pluckemin at 2:45 PM on September 29, 2009

I'd try not to pee beforehand unless you really have to go, since the doctor may want you to take a pregnancy test. At least at my gynecologist, that seems to be the usual starting procedure if you say you're not on hormonal birth control (even if you're not sexually active, which makes the testing seems a bit silly).
posted by mesha steele at 2:45 PM on September 29, 2009

Here's an excellent guide from Scarleteen: Your First Gynecologist Visit. It's no-nonsense and very comprehensive.
posted by DarlingBri at 2:46 PM on September 29, 2009 [2 favorites]

Damn, forgot to make that last reference to the doctor gender-neutral. She or he!
posted by pluckemin at 2:46 PM on September 29, 2009

Like they said, make sure the doctor knows that this is your first time "in the stirrups." You should expect nothing less than a recognition that you're nervous and appropriate sensitivity to this, including going slowly and telling you what to expect and what's about to happen. I also found that I could handle the exam more easily with a plastic speculum rather than the chill of the metal one, so you could ask if they have plastic ones available. They also come in different sizes, and since it's your first time ask if they can use a smaller one to make it a little easier and get you accustomed to the sensation. And if you have any questions, bring a little notepad with you: it's easy to forget what you wanted to ask when there's such an intense physical exam involved.

And good on you for going.
posted by foxy_hedgehog at 2:47 PM on September 29, 2009

Just an extra data point, my pap smears never hurt at all. They feel a little weird, like you're tugging on an invisble tampon or something, but with me there has never been pain. I'm sure this is a your mileage may vary situation, but I just wanted to chime in. My doc always was okay with me taking my pants off and keeping my shirt on. This varies considerably. Most OB-GYNs that I have been to are good about being calming and explaining what they are doing while they are doing it. If yours isn't, it's totally okay to ask "Hey I haven't done this before would you mind telling me what you're doing?" because it's usually just an oversight if they're not doing that.

On the off chance you find your doctor off-putting or otherwise unpleasant, remember that it's okay to be assertive about your own health care and that sometimes a doc visit doesn't go perfectly, and figure out what you can do better next time. Sometimes "what you can do better" involves finding another doctor, so keep in mind that this is always on the table. By and large the visit will not be very long and is unlikely to be very unpleasant though it may be confusing and/or odd if you haven't been before.

As far as what questions to ask, it's really up to you. Have there been any things you've noticed, changes you're uncertain about, anything about your periods or fertility or breasts or general female health that you're concerned about? Are you interested in birth control or getting advice about it? If you're feeling pretty okay about it all, think of this visit as a chance for the doc to establish your sort of baseline health so that they will know if something has changed dramatically when you go in again. Best of luck and good for you for making the appointment, it's too easy to just let this stuff slide.

Oh, also, since you are under 27 you may want to talk to your doc about the HPV vaccination. It costs money but it's great preventative care against cervical cancer.
posted by jessamyn at 2:49 PM on September 29, 2009 [2 favorites]

Definitely be up-front with the doc about it being your first time and being nervous.

If you're finding the speculum part too uncomfortable, tell them -- there are different sizes of speculums (specula?), plus some are made of metal (cold!) while others are made of plastic.

Discuss with your doctor what the recommended schedule is for Paps/exams if you're not sexually active. Once you've gotten the baseline exam, they may not need to see you again (or may not need to do the Pap) every year if you're not active.

If you haven't gotten the HPV vaccine, ask about it. I had to push to get it started before I aged out (I was about to turn 27) so my insurance would cover it.

A good doc will talk you through most of what they're doing, so you don't get the random and shocking finger-up-the-bum without warning. This website is also good for info on your first pelvic.
posted by katemonster at 2:50 PM on September 29, 2009

nthing plastic speculums. A million times!
posted by pearlybob at 2:55 PM on September 29, 2009

Don't pee right before your appointment; the gynecologist almost always wants a urine sample. Even if you've never been sexually active. Find out right away if you need to do the urine sample, because if you don't you should take muddgirl's advice and pee before your exam.

They will probably ask you to undress completely once you're in the exam room, and to put on a paper robe and lie down on the exam table. You'll be asked to put your feet into metal stirrups at the end of the table, and to scoot your butt down as far as you can to the very edge. Most doctor's offices have little stirrup socks nowadays, but if not you may want to keep your own socks on. The doctor will do a breast exam; if you don't know how to do a self-exam, you may want to ask about that at your appointment.

When the doctor inserts the speculum it will probably pinch a little but should not be super-painful. (Though banannafish is right that it's more painful if you tense up.) The feel of the metal speculum will definitely be cold and a bit uncomfortable, but it only lasts a few minutes. After she has inserted the speculum, the doctor will use a cotton swab to take a pap smear. You'll hardly feel that part; it's a little ticklish at the most. The doctor will also do the pressing-on-your-abdomen thing, which is again a bit uncomfortable but not painful.

If your period is irregular or unusually painful, let your doctor know.

There's nothing much to worry about. Visits to the gynecologist are always a little awkward, but the assistant and the doctor will probably go out of their way to put you at ease and walk you through the process since this is your first time.

My doctor is really good about carrying on a conversation while doing the exam. It helps to take your mind off the fact that someone you hardly know is looking around your nether regions.
posted by brina at 2:57 PM on September 29, 2009

My first visit was when I was 18.

Nurse: Oh, you're a virgin! You know, that's so nice, we just had another girl your age in here the other day who was a virgin, too.
Me: ...I think that was my twin sister.

Later, the gyno puts the speculum in and I am obviously in pain.

Gyno: Oh, that's right. (yelling down the hall) We need the teeny-tiny virgin speculum!!

So...make sure she uses the teeny-tiny virgin speculum.
posted by granted at 2:57 PM on September 29, 2009 [3 favorites]

The most important this is just to breathe and relax. It's usually over before you know it, but it can be awkward the first time.

nthing asking the nurse/doctor about peeing beforehand. If they want a specimen for something, try to give that before they go poking and pressing around down there. Just like a baby, having your drawers off usually makes you want to pee immediately.

This might sound weird, but this might be an occasion for granny panties. After it's over, I usually want to be as covered up as I can get for a little while. Also, lubricating jelly is usually used, and who wants that all over your pretty panties?
(Maybe take purse-sized baby wipes so you can properly clean yourself up down there, especially if you're not going straight home after)
posted by Joannalaine at 3:10 PM on September 29, 2009

If you aren't sexually active, do you need to go to a gynecologist? My understanding was that the reason one would go and get pap smears and all is that sexual activity raises the risk of cervical cancer, etc. I only went after becoming sexually active, and it really does hurt if you have a hymen (or even part of one).
posted by jb at 3:23 PM on September 29, 2009

Definitely say that it's your first pelvic and that you are nervous, if they have any bedside manner at all they will talk you through it. They ask you to slide down the end of the table so your ass is basically hanging over empty space, which feels really precarious but is not. The speculum doesn't hurt but does feel weird and YES ask for the little one. The only thing that hurts even in the slightest is when they actually do the pap smear - where they take a little scrape-y swab and swirl around your cervix opening to get cells for the microscope - and I personally find that placing my hands on my lower stomach, directly over the uterus, and pressing down a little bit with my hands helps this a lot. I have no idea if that is psychological or not, and I don't care.
The whole vaginal part of the exam really only takes a couple of minutes, and that includes the ovary check. They usually do a boob check, which is another couple of minutes. and if they find any lumps do NOT freak out since most of us have them, especially during pms.

The most important thing to remember is for afterward, when you are changing from the gown back into your clothing: Take the paper gown and the paper sheet they give you to place over your lap, wad them into a giant fluffy paper ball, and use the entire thing to wipe off the half gallon of lube that they use during the exam. (If you forget this step you can squat, give a heave-ho and slide home afterwards. They really do use that much.)

Good luck!
posted by 8dot3 at 3:27 PM on September 29, 2009 [1 favorite]

There will be two people in the room with you - the doc and an assistant who's there to be sure there's no hanky-panky.

jb, I was always told the guideline was "over 18 or sexually active" for who should have gyn appointments.

Also, the doctor's office will probably have little individually-wrapped moist towelettes to help you wipe off after.
posted by LobsterMitten at 3:54 PM on September 29, 2009

Another thing that is tough to remember... when you are up in the stirrups (such a dignified position), relax and keep your knees apart. The tendency is to clench. So focus on breathing sloooowly.

Plastic speculums? Oh, I am envious.
posted by TWinbrook8 at 4:11 PM on September 29, 2009

If you aren't sexually active, do you need to go to a gynecologist?

Yes, absolutely, the same way you see a dentist even if you don't have cavities. Women should start their annual visits soon after establishing a regular menstrual cycle. GYNs deal with the health of your whole reproductive system, and even nuns get cervical cancer.

Plus it's interesting. You can, if you like, see your own cervix, which you should as it's nifty. You can also sometimes find out things you might want to know, like if you have a tipped uterus, or whatever.
posted by DarlingBri at 4:25 PM on September 29, 2009

A tip: If you're very modest or get cold easily, or are a larger woman, consider bringing your own sheet to the appointment. Yes, it sounds silly, but you will be warmer and more comfortable and I've yet to meet a doctor who wouldn't work with it.

Also, the doctor should talk with you before you undress so you can get more comfortable. If the doctor doesn't do this automatically, you can ask for this. doctor told me that cutting back on caffeine the week before the exam helps with the breast exam, FWIW (something about caffeine intake making breasts lumpier?).
posted by eleanna at 4:38 PM on September 29, 2009

(in my office, the robe is slit up the front, which is a little disconcerting at first - I thought I had it on backwards).

Yeah... when they do that, I wait until they've left the room and they get another cloth robe from the closet and put it on facing the other way so I'm covered. I consider it my exam room cardigan and at that point I feel a lot more comfortable. Look, if there's a fire, I want to be prepared. I'm not running outside with flappy gown areas of nudeness.
posted by jerseygirl at 4:49 PM on September 29, 2009

Remember this:

The doctor cannot make you do anything you don't want to do. If you don't want to get a breast exam, you don't have to. If you don't want to strip totally naked for the paper gown, you don't have to. If you don't want to step on the scale, you don't have to. If the doctor doesn't like it, that's his or her problem. Just know that you have the power to ask for what makes you comfortable and they are responsible for accommodating your wishes.

Anecdote: my new gyno at the local Family Planning was an asshole. At this point, it was my fourth or fifth exam, so the pap and pelvic were old hat. But this time, I encountered something I hadn't before experienced at any of my exams. Right after the pap smear portion of the exam, the doctor warned me before inserting a finger into my rectum (presumably to check for any irregularities in the vaginal-rectal wall). I didn't know what to do, so I acquiesced to the exam. I know now, though, that I wanted to say "no". And I could have. I think I just needed someone to assure me that the doctor had no power over me and that I was, in fact, paying her to do the exam, not vice-versa.

This doesn't mean that you should be scared, though. I've had, I think, nearly ten exams from almost as many random nurse practitioners. Most of them were lovely, professional people and incredibly helpful in answering any of my million-odd questions about sex, birth control or women's health issues in general. I credit one of them for getting me started using the Divacup!
posted by theraflu at 5:07 PM on September 29, 2009 [1 favorite]

There will be two people in the room with you - the doc and an assistant who's there to be sure there's no hanky-panky.

That has never, ever been the case for me, over 10+ years of GYN visits in different states.

I find that well-trained GYNs tend to be overdescriptive to a fault ("Okay, I'm going to put my hand on your thigh. That cold thing is the speculum," etc.), so you'll probably know exactly what they're up to at all times.
posted by mynameisluka at 5:30 PM on September 29, 2009 [1 favorite]

The feel of the metal speculum will definitely be cold and a bit uncomfortable, but it only lasts a few minutes.

My Dr runs warm water on the speculum before he inserts it.
posted by JujuB at 5:40 PM on September 29, 2009

I guess one thing you can take away from this thread is that every gynecologist has a different routine :)
posted by muddgirl at 5:44 PM on September 29, 2009

Response by poster: I'm so grateful for each of your replies and anecdotes, which I have read and will continue to read with interest, and I feel inestimably better for knowing that lots of ladies go through this and come out relatively unscathed (which I already knew, but it's reassuring to hear all the same).

This helps me picture what will go down, I think being mentally prepared for what'll happen (or what may happen) will make a world of difference for me. Thank you so much, everybody.
posted by gavagai at 5:59 PM on September 29, 2009

The thing I remembe most from my first exan was the big smile of the assistant who was standing in the viewing area. Mad me wonder "Does it look funny?" they've probably fixed that by now, but, unless she laughs, I wouldn' worry.
posted by path at 6:21 PM on September 29, 2009

Expect to hear the phrase, "Can you scoot down a little more?"
posted by timeo danaos at 6:58 PM on September 29, 2009 [2 favorites]

Just chiming in to agree with a lot of this. I honestly enjoy pelvic exams! I do! Sexual health is great, I know that I am taking care of myself and doing something that is really good for me.

One thing: I always find the breast exam slightly weirder than the pelvic exam. When she is doing the breast exam, my doc is sort up "up here" with me, near my head. During the pelvic exam, she is "down there," and the robe is sort of hiked up but draped over my knees, so there is a wall between me and her. I can hear her, but it feels more private, almost. Does that make sense? I am not nervous, and I assume that I come across that way, but still my doc tells me what she is doing every step of the way "ok, now I am going to insert two fingers [they are gloved and lubricated with KY, never fear!]"..."ok, now you are going to feel the speculum" etc. I find the pap smear slightly uncomfortable, but barely so. (Again, the pap smear is swabbing the cervix with a little swab thing, to scrape off some cells to look at.) Not something I'd ask to be done just for fun, but nothing that hurts enough that I really think twice about it.

And then I have her test for chlamydia and gonorhea, and sometimes HIV. We talk about regular physical stuff (exercise, various uninteresting chronic diseases, lab tests, since this is my regular internist PCP), and she always asks "how things are going with my partner, are things ok at home" (and it always takes me a second to realize that she is asking about domestic violence, not making small talk). And then I get a refill on my birth control, and all done!

And yeah, I have never had two people in the room with you - the doc and an assistant who's there to be sure there's no hanky-panky, not ever.

Do let us know if you have any specific questions. It's easy to gloss over some of the details if you are familiar with them.
posted by teragram at 7:04 PM on September 29, 2009

(Very interesting about the no-assistant thing! I've had this in several states, US northeast. I guess there is a lot of variation. Anyway, if you find yourself solo with the examiner and you want a second person to be there, you can probably ask. And if you find yourself with examiner plus an extra person, the reason they're there is anti-hanky-panky.)
posted by LobsterMitten at 7:18 PM on September 29, 2009

From a mental perspective: If you don't know your way around your own vagina/vulva, spend time doing that. Masturbate. Do whatever you need to feel real ownership of/connection to your genitalia before laying there spreadeagled for someone else to poke and prod them.
posted by needs more cowbell at 7:29 PM on September 29, 2009

I've only had one gyno put their finger in the rectum out of 6 - but they didn't warn me about it, so if you're concerned, ask them not to.

Also, trust your instincts about whether or not you like this gyno and want to go back to them - it took me 4 bad doctors to find one I actually liked. Of course you'll be uncomfortable because it's your first exam, but if it's anything beyond the usual "eek I'm naked and they're looking right into my private parts and touching my breasts more thoroughly than anyone ever has" then listen to your gut and try another doctor. Ideally you should be able to carry on a regular small talk conversation with the doctor, and also be able to discuss birth control methods and STDs and strange pain after sex and all that with them without being embarrassed - so find a doctor that you could do that with, especially now when you're just going for regular check ups.

And just relax - to you it's a big first time event, but to the doctor you're just the 43980895th vagina they're seeing this month.
posted by KateHasQuestions at 8:05 PM on September 29, 2009

the only time i've had the extra person in there was when i had a male doctor. this was in berkeley, CA, at a university health center.
posted by apostrophe at 8:13 PM on September 29, 2009

It feels really weird, but scoot down as FAR as you can without falling off the end of the table. You'll be in a squatting position, and the deeper the squat, the easier it is for the doc to reach your cervix. I didn't figure this out until I was pregnant (and getting endlessly poked and prodded). It can make the difference between a painful exam and one that you barely feel.
posted by peep at 9:05 PM on September 29, 2009

I also got my first exam in my early 20s, before I was sexually active. I had female roommates, so I was well prepared and my first gyno was great. I still think about her and how she made that first experience so comfortable for me. What did catch me off guard were the questions about if I had ever been sexually abused or wanted to discuss anything confidentially. Don't be freaked out by this- it's the doctor's job, and if you do have something of that nature you want to talk about, you should feel free to do so. Also, ask lots of questions. This is a great opportunity to get answers about things you might feel embarrassed about asking other people about (what birth control method should I use, why is one boob lower than the other, how come my periods are so heavy....)
Also, you might want to consider whether you would feel more comfortable with a male or female doctor. I only see female gynos. No offense to all of the wonderful and talented male gynos out there, but personally I just feel more comfortable with a lady. This might be something to consider if it's your first time.
It's really not that bad. Really. And it lasts less than a half hour usually.
posted by firemonkey at 10:56 PM on September 29, 2009

Make sure they are well-aware that you have never been sexually active, as this affects what you may be tested for. For example, many doctors automatically test for (and bill you for!) pregnancy and STIs.

Frankly, if you've never, ever been sexually active, you may want to reconsider getting a pap test. It's unlikely to hurt you, but there's no point. Pap tests are a screening tool for cervical cancer, which is caused by HPV, which is an STI. Here are the American Cancer Society's full guidelines for pap tests. They state that cervical cancer screening should begin "three years after first vaginal intercourse or age 21," but that An upper age limit for when to initiate screening is needed for providers who don’t ask patients about their sexual history and for adolescents who are unable or unwilling to disclose prior consensual and/or nonconsensual intercourse. Such an upper age limit ensures that young women, including victims of sexual abuse, are protected. [...]
Provider discretion and patient choice following counseling should be used to guide the initiation of cervical cytology screening in young women aged 21 and older who have never had vaginal sexual intercourse and for whom the absence of a history of sexual abuse is certain.

In other words, the American Cancer Society set the 'age 21" protocol to protect patients and doctors who are uncomfortable asking about sex as well as victims of sexual abuse, and patients who have never been sexually active may safely choose not to be screened.
posted by Violet Hour at 11:16 PM on September 29, 2009

Most cases are cervical cancer are caused by HPV, not all. I think its a good idea to go if you can afford it.
posted by Bunglegirl at 9:23 AM on September 30, 2009
posted by IndigoRain at 4:08 PM on September 30, 2009

I had my first visit almost 2 months ago. Virgin here as well.
I can't say it was pleasant. Not to freak you out but I was a little more freaked out cause I wasn't prepared for it. I went in for period pain and ended up with a pelvic.

Know your period history. Last period, flow, pain, start and end date. The basics. Family history is helpful too. I needed it to rule out some things or narrow it down. You may not but a basic knowledge of it is good.

You will put on the backwards paper gown, more like a paper robe. I thought I had it on wrong too. Nope. The assistant led me to the room and gave me a gown but didn't stay in the room.

Breast exam is awkward but the doctor talked me through it. It wasn't so much the touchy as it was the closeness of the doctor's face.

Small speculum didn't seem so small to me. I'm not one to stick stuff up there but it didn't look small to me. She talked about different sizes but I don't think she used it. Make sure you ask for it. Also mine were warmed metal and I didn't think to ask for a plastic one but if that's possible and you want it then theres no harm in asking.

I wasn't at all able to say no about the two fingers deal. She said this is what I'm going to do and did it without me being able to really understand or have the time to speak. Not only that but she didn't talk much other than to say could you scoot down and relax. Make sure if talking is what you want, then thats what you get. That's what I'm going to do with this new Dr.

The pap is not required, I don't think. You can get it if you want it but it is not required, I'm told, if you have not had sex. I say get it anyway.

Most of all try to relax. It didn't last long though it felt like it. I would even go as far as saying if this is a new doctor and you have the chance to speak a bit with them, check your comfort level. if you are not comfortable with the Dr. just talking then don't go through with it. I wish I would have done that with this past Dr. She wasn't horrible but at the back of my mind she didn't rub me right. You don't want to end up with a bad story cause you didn't listen to yourself.
posted by grablife365 at 2:17 PM on October 1, 2009

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