Guide to Gynecological Exams
a good guide to a very important exam
Date: 3/2/2006 8:54:19 PM ( 17 y ) ... viewed 3335 times
When Gene Autry sang "Back in the Saddle Again," he seemed like a real happy guy. So happy that you''''re sure he never rested his bum on a gynecological exam table. If he''''d put his feet in those stirrups, you know he''''d be singing a different tune.
Yeah, the annual trip to the gynecologist isn''''t one we tend to praise in song. Instead, mere mention of the words "pelvic exam" is enough to elicit moans of dread from most women. Some of us put off scheduling the event indefinitely. Others manage to actually get it into the appointment book, but when the day is upon them, every other activity under the sun suddenly starts looking more attractive. Even those three-o''''clock meetings suddenly seem like can''''t-miss events.
If you think it''''s no big deal to skip your annual exam, think again. This is the time when your doctor can perform several important exams that are crucial in monitoring your health. It''''s also the time when you can talk to your doctor and ask questions about birth control, sexually transmitted diseases (STDs), prepregnancy planning, prenatal care or any other issues on your mind.
Your annual exam with your gynecologist should begin with an interview with your doctor, says Eddie Sollie, M.D., associate clinical professor of obstetrics and gynecology at the University of Texas Southwestern Medical Center at Dallas and author of Straight Talk with Your Gynecologist. This should take place while you are fully clothed and before any exams are done. It''''s a chance to discuss what''''s happened since your last exam, he explains. If you aren''''t offered an interview but want one, don''''t be afraid to ask, says Dr. Sollie.
Following the interview a nurse might weigh you, ask for a urine sample and do a blood test. As usual, you''''ll be shown to the exam room and asked to get undressed and put on a cloth or paper exam robe.
Your doctor should start the examination at the top of your body and move downward from there, says Dr. Sollie. Your doctor may examine your eyes and ears, feel your throat to see if your thyroid is enlarged and listen to your heart and lungs with a stethoscope. Then she''''ll move on to the four central components of the annual gynecological exam--a breast exam, a pelvic exam, a Pap test and a digital rectal exam.
The breast examination is the time when your doctor can visually inspect and manually examine your breasts to search for any lumps or discharge. This should also be a time when your doctor instructs you on how to do a proper breast self-exam. (To make sure you''''re getting the whole story on this, see "Get in Touch with Your Breasts" on page 58.
Your doctor will also examine your abdomen and groin area, gently pressing the area to check for any masses that might mean tumors.
Here''''s Looking at You
When your doctor starts the pelvic exam, she''''ll generally begin by examining your vulva (or external genitalia), the area that begins at your pubic hair and extends to your anus. She''''s looking for any discharge, sores or bumps that may indicate an STD, a cancer or other skin changes.
During this part of the gynecological exam, ask for a mirror that you can hold while your doctor''''s having a look, suggests says Anita L. Nelson, M.D., associate professor of obstetrics and gynecology at the University of California, Los Angeles, UCLA School of Medicine and director of the women''''s medical clinic at the Harbor UCLA Medical Center in Torrance.
Be sure to tell the doctor about any changes that you''''ve noticed in your genital area. Holding the mirror, you can follow the doctor''''s exam. This also helps the doctor point out any condition that you should monitor at home.
Then the doctor will do the speculum exam. First, she''''ll gently insert a warm, lubricated speculum--which is simply a sterile examination tool--into the opening of your vagina. While the speculum is in place, your doctor will look at the vaginal walls, looking for any abnormal discharge or lesions.
The Pap test--which most doctors recommend having annually--begins with a gentle cleansing of the cervix. The doctor then takes a sample of cells from your cervix and places them on a slide.
The cells are sent to a laboratory for analysis, primarily to detect precancerous changes and cervical cancer.
If early changes are detected, they can usually be treated to prevent a progression to cancer. Occasionally, the Pap test can also indicate the presence of other infections, some of which are STDs.
Following the Pap test your doctor should do a bimanual pelvic exam, which just means the doctor uses two hands to check your uterus and ovaries. After removing the speculum, your doctor will insert several fingers into your vagina and feel the top of your abdomen with the other hand. By doing this she can detect whether your ovaries are enlarged or have cysts and can feel any fibroids or other tumors growing in the uterus.
Can You Trust Your Pap Test?
There''''s a certain percentage of error in every medical test, and to some degree, that''''s unavoidable. Here are some things that you can do to reduce the margin of error.
Check the lab. The lab doing the work should be certified by the College of American Pathologists or the American Society of Cytologists, says Eddie Sollie, M.D., associate clinical professor of obstetrics and gynecology at the University of Texas Southwestern Medical Center at Dallas and author of Straight Talk with Your Gynecologist. Be sure to ask, even though you might feel uncomfortable. No question is a bad question.
During your period, skip it. The test won''''t be trustworthy if it''''s done during your period, according to Dr. Sollie. So if you''''re having your period when you''''re supposed to go in for the test, call and postpone it.
Clear the area. If you''''ve been having a discharge from an infection, you should first treat the infection. Later, after it''''s cleared up, return to the doctor for your Pap test, says Dr. Sollie.
Don''''t douche. If you douche before the exam, the Pap test won''''t be accurate, says Dr. Sollie.
Go for doctor detection. If some abnormality has been reported from a previous Pap test, you may want to ask that your test be read by a pathologist, says Dr. Sollie. An abnormal Pap test is usually the result of some cellular changes in the cervix, and a pathologist may be more skilled at interpreting and monitoring those changes.
Check it yourself. While not all doctors advocate this, Dr. Sollie strongly urges you to request a copy of their Pap test lab reports. This allows you to check the name and social security number on the report and make sure that it''''s yours. You can also check to see if the Pap test was of adequate quality. Look specifically for one or two statements that will give you a clue. The report should say "endocervical cells are present" (unless you have had a hysterectomy) or "smear quality: satisfactory or optimal specimen."
If you don''''t see these terms, your physician should repeat the test at no cost to you, Dr. Sollie says. Or if the test says "inadequate specimen" or "endocervical cells not present," you should get a second test done.
Don''''t accept classes. The up-to-date system for analyzing Pap tests is the Bethesda system. Your lab report should list a descriptive term--"normal," "atypia" or "dysplasia"--in the section reporting cell examination, called cytological diagnosis. If your results come back to you listing a class--Class I, Class II and so on--don''''t accept that, says Dr. Sollie. That indicates that an outmoded method was used to analyze your Pap test.
Finally comes the digital rectal examination. Placing a finger in your rectum, the doctor feels for tumors in that area. Your pelvic exam is not really complete unless your doctor does a rectal exam, says Dr. Sollie.
How You Can Ace the Exam
Here''''s what doctors recommend that you do to get the most out of your annual exam.
Time it right. Schedule your annual exam at the right time in your menstrual cycle, says Dr. Nelson. The best time is 10 to 14 days after the first day of your period. At this time in your cycle, your breasts won''''t be as lumpy and tender as they can be in the latter half of your cycle. This is also the time to get the best Pap test results; your cervix is more open at this time of the month, allowing your doctor to get a better sample.
If planning your exam that precisely is difficult for you, just be sure you do not have your period at the time of your exam and have been finished with it for at least a few days, so your vagina is free from any discharge.
Fend off interference. A number of things--including douching, medications and spermicides--can interfere with your Pap test results, says Dr. Nelson. Many doctors warn against douching at any time, since it can contribute to the spread of some infections in the reproductive tract.
Bring your script. If you have questions for your doctor, write them down and bring them with you to the office. That way you''''ll be less likely to forget something.
Bring a friend. One of the most important things is to have a chaperon present, says Dr. Sollie. This could be your doctor''''s nurse, a friend, or husband, he says.
Speak up. Just because your doctor has done a bimanual pelvic exam doesn''''t mean that a Pap test has been done. So be sure to ask whether it has. Also, if you have a new sexua| partner or are concerned about STDs, you should specifically ask to be tested for STDs, says Dr. Sollie.
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