If you've never paid a visit to a gynecologist, then there's no time like the present! Gynecologists specialize in female healthcare and treating diseases of the female reproductive organs, so virgin or not, get ready for some straightforward questions. Nothing is off-limits to your gynecologist.
As a follow-up to our guide to birth control methods in the Philippines, we spoke to Dr. Rebecca Singson, M.D. about what to expect when consulting a gynecologist for the first time.
1. What is the ideal age for your first visit to a gynecologist?
Dr. Singson: As soon as you start having sex. But if you’re not sexually active, 18 is the recommended age. Having said that, women normally develop menarche (the first menstruation) between the ages of nine and 13. They’re still children, but once they get their menstrual period they need to understand the implications of that. It means they can start releasing an egg, they can get pregnant if it’s fertilized by sperm, so they need to get access to information! Especially if their menstrual periods are not regulated, if they’re skipping for months without menses, if they have pimples—if there’s an obvious hormonal imbalance, that has got to be addressed. Because there are implications on your future ability to develop cancer, if your hormones are not regulated while you are young. I think if you have regular periods from the time you have onset of menses, then you can see a gynecologist from after the first sexual contact or when you turn 18.
But if you have irregular periods from the time you begin your menstruation then you should be brought to a gynecologist for investigation. It has to be ascertained whether you have an ovarian cyst, or you have polycystic ovary syndrome (PCOS), or you simply don’t have a developed hypothalamic-pituitary axis. There is a very intricate interrelationship between the hormones secreted by your pituitary gland and your ovaries. When you’re young that’s not yet so developed, and you can have irregularity based on that, but that’s got to be addressed."
2. What happens during a woman's first visit to a gynecologist? Do you actually undergo physical tests (pap smear, breast exam, etc.) then and there? Is there any pain involved, and can you ask for anesthesia?
Dr. Singson: A breast exam is done as well as a thorough physical exam, but if the patient is a virgin just coming in for a routine check-up, then gynecologists can dispense with a pelvic exam. A pelvic ultrasound may or may not be requested for a baseline test. Anesthesia is never necessary for any of the exams. There are no tests that would cause an allergic reaction.
Aside from the breast and pelvic exam, a general physical exam is done.
During the general exam, your height, weight, and blood pressure will be checked. The thyroid will be observed for any enlargements of the neck. Any abnormal hair patterns will be monitored—male pattern hair above the lips, under the chin, on the sides of the face, around the nipples, excessive hair below the navel, arms and legs, etc. Alopecia (a type of hair loss) as well as excessive hair may both be signs of excessive testosterone hormone release due to either polycystic ovary syndrome or a testosterone releasing adrenal or ovarian tumor.
3. Is there a difference in tests, or how tests are performed, if you’re a virgin versus if you’re sexually active?
Dr. Singson: With a virgin, an internal vaginal exam would never be done. If the virgin came for a gynecological problem, a trans-rectal (through the anus) pelvic exam would be performed. A trans-rectal ultrasound is possible even on a nine year-old because their poo will be bigger in diameter than a trans-rectal probe. An external genital exam of the vulva may be done to inspect if there are any abnormalities with the anatomy—like adhesions of the vulvar lips (when the labia stick together) or an imperforate hymen (a hymen without an opening)—or dangerous moles that may convert to a malignant melanoma.
A non-virgin would get a pelvic exam and a vaginal ultrasound would be requested.
4. What questions do gynecologists usually ask a first-time patient?
Dr. Singson: First of all, a patient is asked if there is any chief complaint that prompted the consult in the first place. So a history of the illness is thoroughly investigated. Next, a patient's past medical history is delved into to uncover if there were illnesses that may complicate or be related to the current complaint. A family history of illnesses is also examined. Questions about menstrual regularity and last menstrual period are also asked, since the presence of dysmenorrhea, abnormal bleeding, or discharge are relevant.
It is important to ask whether the patient is sexually active, the age of her first sexual activity, as well as how many sexual partners she has had. Sexual activity before age 18 and having more than five sexual partners increase the risk of cervical cancer. Vaccinations, particularly that of the Human Papillomavirus (HPV) vaccine, act to prevent cervical cancer, and are routinely given to 9-year-olds and above. In addition to routine vaccines, special vaccines may be given to young women such as the Hepatitis A virus vaccine and/or the Pneumococcal vaccine.
5. What questions should a first-time patient ask their gynecologist?
Dr. Singson: First-time patients should discuss sexual health (unprotected sex, sexually transmitted diseases, and contraceptive possibilities when the time arises). Don't be afraid to ask questions like "What is a morning after pill?" or questions about menstrual irregularities. The gynecologist can offer advice on how to improve your lifestyle and eating habits, or supplements that can promote health and preserve fertility.
6. How often would you suggest a patient see their gynecologist after their first consultation?
Dr. Singson: After your first consultation, a yearly visit is fine unless you need to return for your lab test results.
7. How often do you have to return for a breast exam, pap smear, pelvic exam, etc.? Are there any tests that require the patient to be of a certain age or body development?
Dr. Singson: Patients should return annually for most routine tests and every three years for pap smears. Pap smears are started at 21 years old regardless of sexual experience.
8. How can you prepare for your first physical exam? Do you need to be completely naked? Do you need to shave down there?
Dr. Singson: Patients may be required to remove their bra and panty and change into an examining gown. It is easiest, however, to come in a skirt and shirt, in which case you will be only required to remove/unhook your bra and remove your underwear. There is no need to shave. You would be asked to lie down on an examining table with your buttocks at the end of a table and your feet hanging on stirrups to promote exposure of the perineal area.
For non-virgins, a lubricated plastic or stainless speculum is usually inserted intra-vaginally to inspect the cervix after which a digital pelvic examination is done to evaluate the uterus, fallopian tubes, and ovaries. A rectal examination simultaneously with a vaginal examination may also be done especially in the presence of dysmenorrhea or suspicion of any pelvic masses.
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