Dr. MJ Bazos MD,
Patient Handout
The Pelvic
Exam
Guidelines for
Teens
As a young woman, your body has gone through a
number of changes over the past few years. An important part of growing up is
taking responsibility for keeping yourself healthy, This includes establishing a
partnership with your pediatrician regarding your health. Pelvic exams can be an
important way to take care of your health. Most women have questions and
concerns about their first pelvic exam, but knowing what to expect can help you
to feel more at ease.
Why do I need
a pelvic exam?
A pelvic exam is the
best way for your pediatrician to examine your reproductive system, which
includes the vagina, cervix, ovaries, fallopian tubes, and uterus (see
illustration). This visit is also a great time to talk to your pediatrician
about important health issues such as:
- your growth and development
- breast health
- menstruation (“periods”)
- sexuality
- pregnancy and birth control
- infection risk or to simply get advice about your
health.
The exam also includes
lab tests for common problems that can be easily treated if found early. Most
young women should have a pelvic exam by the end of high school. It should be
done earlier than this if the woman is sexually active or has a problem with her
reproductive system.
The
interview
Before the pelvic exam, your
pediatrician will ask you a number of questions to find out whether you are
having problems or are at risk for problems. For example, your pediatrician may
ask about your menstrual periods. Questions about your periods may
include:
- When did you have your first period? When did
your last period start?
- Do you have your periods regularly? How
often?
- How long do your periods last?
- Do you have any discomfort (pain, cramping,
headaches, mood swings) with your periods?
- Do you use tampons, pads, or both?
- Have you ever had vaginal itching, discharge, or
problems urinating?
Your
answers to these questions tell your pediatrician if your periods are normal. He
or she may give advice about menstrual discomfort, tampon use, and other
issues.
Your pediatrician may also ask you
about your sexual experiences. This is so your doctor can get to know you and
help you to protect your health, so giving honest answers is
important.
The information you give
to your pediatrician is confidential and will not be discussed with anyone else
without your permission (unless it is something life threatening).
The questions may
include:
- Have you ever had sexual intercourse?
- How old were you the first time you had
sex?
- How many sexual partners have you
had?
- What do you use to prevent pregnancy and
infection?
Your answers to these
questions help your pediatrician decide what services you need. He or she can
give you advice on decision making, abstinence, and prevention of pregnancy and
infection.
The
examination
Your pediatrician will tell
you what he or she is going to do at each step of the exam. If you have any
questions or feel uncomfortable, just let your pediatrician know. If you have a
male doctor, a female nurse or chaperone will normally be present during the
exam. You may request that your mother, older sister, or friend join you if it
makes you more at ease. You may also request that no one, other than the doctor,
be in the room during the exam.
Before the
exam, your height, weight, blood pressure, lungs, heart, and neck may be
checked. You may be asked to give a small sample of urine and to empty your
bladder to make the exam more comfortable. You will then be left alone to
completely undress and put on a gown. A sheet will be given for extra
coverage.
When your pediatrician comes into
the room, he or she will ask you to lie down on the examining table for the
breast examination. He or she will feel each breast for lumps, sores, or
swelling. Be sure to tell your pediatrician if your breasts are sore in any way
or if you have had any fluid leaking from your
breasts.
Your pediatrician will teach you
“breast self-exam,” an important part of keeping yourself healthy.
You should do a breast self-exam each month. This will alert you to any changes
or problems in your breasts and help you to be more familiar with your body.
Practicing breast self-exam as a young woman prepares you for later on, when
breast cancer is more common and regular breast self-exams are so
important.
Usually after the breast
examination, your pediatrician will check your abdomen and then do the pelvic
exam. The entire pelvic exam only takes about 5 minutes. It can be done even if
you have never had sexual intercourse, because the opening that allows your
period blood out is large enough to allow
examination.
Some young women who have not
had intercourse worry that having a pelvic exam will mean they are no longer
virgins. You should not worry about this; the pelvic exam does not change
whether or not you are a virgin. Also, the pelvic exam is not a
“test” to see if you are a virgin. The pelvic examination has three
parts. In the first part, the pediatrician will use a light to look at
the outside of your vagina and surrounding areas to make sure everything looks
normal.
During the second part,
the pediatrician will look inside your vagina. Your pediatrician will use an
instrument called a speculum to see inside. It will be made of disposable
plastic or sterilized metal. The speculum will be gently inserted into your
vagina. You will feel some pressure, but it should not hurt. Taking deep breaths
and trying not to tense up will help relax your vagina muscles and make this
part of the test easier. While the speculum is in place, your pediatrician will
take a sample of cells from the cervix. This is called a Pap smear. The Pap
smear is a test for infections or abnormalities of the cervix, and you should
not even feel it. The speculum will then be
removed.
In the third part of the
pelvic exam, the pediatrician feels your uterus and ovaries to check their size
and see if they are tender. This is done by the pediatrician gently inserting
one or two gloved fingers into your vagina and pressing on the outside of your
abdomen with the other hand. That’s it!
Most patients are surprised when their
first pelvic exam is over, it really is quick. If your pediatrician finds that
you have an infection or other problems with your reproductive system, he or she
may refer you to an OB/GYN (obstetrician/gynecologist). This type of doctor
specializes in women’s reproductive
health.
Take care of
yourself
Your first pelvic exam is one
of the many steps you will take as part of taking care of yourself as a young
adult. It is easiest to do this when you are well, before any problems occur. If
you are having sex, you should have a pelvic exam at least once a year. Even if
you are not having sex, you should begin having regular pelvic exams before you
finish high school or if you have any concerns about your vagina, uterus, and
periods. Along with eating right, getting enough exercise, not smoking, and
wearing seat belts, regular visits to your pediatrician for checkups are
important. Your pediatrician cares about your health. Even as you get older,
seeing your pediatrician regularly will help you learn the best ways to take
care of yourself.
How to do a breast
self-exam
Once a month, right after
your period, you should examine your breasts. Although breast cancer is rare in
young people, it usually can be cured if found early, and a breast self-exam is
the best way to find it.
1. Stand in front
of your mirror with your arms at your sides and see if there are any changes in
the size or shape of your breasts. Look for any puckers or dimples, and press
each nipple to see if any fluid comes out. Raise your arm above your head and
look for changes in your breasts from this position as
well.
2. Lie down and place your left hand
under your head. Hold your right hand flat and feel your left breast with
little, pressing circles. Think of each breast as a pie divided into four
pieces. Feel each piece and then feel the center of the “pie” (the
nipple area).
3. Now put your left arm down
at your side, and do the same thing on the outside of the breast, starting under
the armpit.
4. Repeat steps 2 and 3 for the
other side. Most women have some lumpiness or texture to their breasts; breasts
are not just soft tissue. Get to know your breasts — then be alert for any
lumps or other changes if they should ever
appear.
Remember, most lumps and changes
are not cancer. However, if you think you have found a lump or notice any other
changes, don’t press or squeeze it; see your
pediatrician.