What is a gynecological exam like? I am going to have one in about a week, and I am nervous. What can I expect the doctor to do?

--J.

Being nervous in the gynecologist's office seems to be universal -- I'm surprised I don't have a complex about people not liking to come see me! Every doctor has a different style of practice, so what I can do is tell you how I approach a new patient and suggest you call your doctor's office and speak to a nurse about how that office does things.

The first time a patient comes to see me, I meet her in my consultation room. There we talk about what has brought her to the office and any problems or concerns. I then ask questions about her medical history, including when periods began and about their flow, pain and regularity; past and current sexual activity; previous pregnancies, if any, and what happened with each; and past infections or gynecologic problems. I also ask about her general health and family history and inquire about habits such as exercise, diet, and use of tobacco, alcohol and drugs. For a young women with no problems or questions, this part may take only a few minutes; with another woman, it might take an hour.

Next, I describe the exam (especially if she has never had one) or talk about issues she has brought up, like contraception options or menopause. Then the nurse escorts her into the exam room, taking her weight and blood pressure and perhaps obtaining a urine sample. She will be asked to get undressed and put on a gown and sit on the exam table. Then I'll come in and do the exam that we've already talked about.
I begin the exam by listening to the heart and lungs and feeling the thyroid gland in the neck. I'll look at the skin for obvious signs of skin cancer. (I'm a gynecologist, not a dermatologist, and therefore may not notice subtle changes.) Then I do a breast exam, explaining how to do it at the same time. I feel the belly for masses or tender spots.

Then it is time for the pelvic exam. I ask the patient to scoot to the end of the table and rest her feet in "stirrups" (mine are padded). I examine the genitals, looking for any lesions or signs of infection. Next I place a speculum into the vagina. This device holds the vagina open so I can look at the cervix. I warm up my speculum, and I tell you what I am going to do right before I do it. Placing the speculum may be uncomfortable, and it is important that you relax at this point, as tensing your muscles makes it worse. I swab the cervix to get a sample of cells, and I smear the swab on a slide for a Pap test or send it to the lab for cultures, if needed. I remove the speculum and then insert one or two gloved fingers with a cold (usually), slimy (always) lubricant on them, while placing my other hand just above your pubic bone; this way, I can feel the size of your uterus and ovaries. Sometimes a rectal exam is done, too; this involves placing one finger into your bottom. I mention anything I find as I go along.

I'll be the first to admit GYN exams are not fun, although I'll take a Pap smear over a visit to the dentist any day! Good communication between you and your doctor is important. I also firmly believe that talking to you first while you are fully dressed helps put you more at ease. Be sure to tell your doctor you are nervous and have never had an exam; if you don't, he or she may assume you have had an exam before and may not explain what he or she is doing.