Breast and Pelvic Exams
Why You Need These Exams



The American College of Obstetricians and Gynecologists recommends
that a girl make her first visit to a gynecologist when she is between
the ages of 13 and 15. Not all girls will need a pelvic exam during this
initial visit, though. Many gynecologists will just do a regular health
exam and talk to the girl about her development.

Yearly gyn visits are important for a number of reasons, including:

• as a routine check. You'll want to be sure you're developing normally.
  
• to deal with a problem. There may be a number of
  concerns that lead to a pelvic exam. For example, if you have problems
  with your periods, missed periods, pain, signs of infection, and worries
  about development, it's a good idea to see a doctor.
  

Also, if you have ever had sex, you are probably going to need a pelvic exam.

Choosing the Right Doctor



If you're going to be involved in deciding who you'll see for your
pelvic exam, you have a few choices. These experts can prescribe birth
control and provide education about reproductive health, STD prevention,
and birth control:

Family doctors and pediatricians. If your family
doctor or and pediatrician does pelvic and breast exams and advises
teens on sexual health, it means you can see a doctor you already know
and feel comfortable with for your first pelvic exam.

Specialists. a number of different kinds of doctors and nurses have special training in women's reproductive health:

• Gynecologists are doctors who have been specially trained in women's health issues.
  
• Adolescent medicine doctors have been trained in
  the health and management of teen issues. They are familiar with the
  concerns most young women have about their reproductive systems and can
  advise them on birth control and STD prevention.
  
• Nurse practitioners who specialize in gynecology
  have advanced training that allows them to pay special attention to
  women's reproductive health, including giving breast and pelvic exams.
  

Whether you want to see a male or female health care professional is
up to you. Some women say that they prefer being examined by a female
doctor or nurse because it puts them more at ease and they feel like
they can talk more openly about women's health problems and sexuality
issues. Other women feel comfortable being examined by a male doctor or
nurse. If the doctor or nurse is male, he will usually have a female
assistant in the room with him during all parts of the exam.
Making the Appointment



It's best to involve your parents in your health care. If you want to
go to a doctor's office for your exam, you may need to involve an adult
for insurance purposes (it may be expensive otherwise).

If for some reason you can't involve your parents, you can take
advantage of health clinics like Planned Parenthood or your local teen
clinic. These clinics have fully trained staff who often can care for
you at a lower cost and respect your need for confidentiality. Each
state has different guidelines on which medical issues teens can get
confidential care for. Your doctor should be able to explain these
issues to you.

The most important thing is that you feel comfortable with the person
who is examining you. You want to be able to talk with him or her about
important personal health and relationship issues, including birth
control.

What Happens When You Go for Your Gyn Exam



You don't need to do anything special before going for your exam.
When you make the appointment, try to schedule the exam for a time when
you won't have your period. For many young women, that can be hard to
predict, though — lots of girls have irregular periods at first. Ask the
doctor's office or clinic when you make the appointment what you should
do if you get your period. Some doctors say it's OK to come for an exam
if your period is just beginning or just ending and it's very light,
but everyone has a different policy.

When you arrive for your appointment, you may be asked to fill out
some forms while you wait. These forms ask questions about any illnesses
or conditions you have, your health habits (like whether you drink or
smoke), any family illnesses that you know of, and your history
regarding sexual activity, pregnancy, and birth control. You might also
be asked for the date of your last period (or a doctor or nurse will ask
during your exam).

When you first go into the exam room, a nurse or medical assistant
will do a few things that your doctor has probably done a million times
before, such as recording your weight and taking your blood pressure.
You'll then be left alone to change out of your clothes. It may feel
weird taking off even your underwear because you may not have had to
undress completely for a medical exam before. The nurse or medical
assistant will leave you a paper sheet or gown — or maybe both — to
cover you. If you're cold, most doctors and nurses won't mind if you
keep your socks on.

After a few minutes, the doctor (or nurse practitioner, if that is
who you choose to see) will knock on the door to make sure you're in
your gown. If you're ready, he or she will come in and start the exam.
The doctor may start by going over anything you wrote down on your
forms, or you may talk about these things later.

If this is your first gynecologic exam, let the doctor know. That
way, he or she will know to go slowly and explain everything that's
going on. Now is also the time to ask about birth control or sexuality
if you need to. Some doctors like to discuss these things before the
exam, and some like to do it after. Your aim is to make sure you get
your questions answered.The Breast Exam



During the physical part of the gynecologic exam, you'll be asked to
lie on your back on the table. You'll have the paper sheet or gown
covering you, and the doctor will only uncover the parts of your body
being examined.

The doctor will give you a breast exam by lightly pressing on
different parts of your breasts. After finishing, he or she may show you
how to examine your own breasts. This helps you become familiar with
how your breasts feel so you know which lumps are normal and which may
be the result of a change.



The Pelvic Exam



During the pelvic part of the exam, the doctor or nurse practitioner
will ask you to move down so your behind is at the end of the table.
You'll bend your knees and rest your feet in two stirrups, which are
metal triangular loops that stick out from the end of the table. These
might look a little scary, but they're just there to rest your feet in
and keep you more comfortable. The doctor will ask you to relax your
knees out to the sides as far as they will go. It might feel a little
funny to be lying with your legs opened like this, but everyone feels
that way at first.

The doctor will put on gloves and examine the outside of your vagina
to make sure that there are no sores or swelling and that everything
looks OK on the outside.The Internal Exam



Next, the doctor will want to look at the inside of your vagina and will do so with the help of a speculum (pronounced: speh-kyuh-lum).
A speculum is a thin piece of plastic or metal with a hinged piece on
one end that allows it to open and close. The doctor or nurse will warm
the speculum with water (some offices keep the speculum warmed in a
drawer with a heating pad). The doctor or nurse will then slide the
speculum into your vagina. Usually the doctor will tell you when he or
she is about to place the speculum inside you so it doesn't come as a
surprise.

Once the speculum is in the vagina, it can be opened to allow the
doctor to see inside. Putting in and opening the speculum should not be
painful, although some women say that it can cause a bit of pressure and
discomfort. Naturally, if this is your first exam, you might feel a
little tense. Because the vagina is surrounded by muscles that can
contract or relax, the exam can be more comfortable if you try to stay
calm and relax the muscles in that area.

If you feel like you're tensing up the muscles in your vagina, try
breathing deeply or doing some breathing exercises to help you stay
relaxed. Sometimes humming your favorite song or making small talk can
distract you and allow you to feel more relaxed.

After the speculum is in place, the doctor will shine a light inside
the vagina to look for anything unusual, like redness, swelling,
discharge, or sores.



Because the ovaries and uterus are so far inside a girl's body that
they can't be seen at all, even with the speculum, the doctor will need
to feel them to be sure they're healthy. While your feet are still in
the stirrups, and after the speculum is removed from the vagina, the
doctor will put lubricant on two fingers (while still wearing the
gloves) and slide them inside your vagina. Using the other hand, he or
she will press on the outside of your lower abdomen (the area between
your vagina and your stomach). With two hands, one on the outside and
one on the inside, the doctor can make sure that the ovaries and uterus
are the right size and free of cysts or other growths.

During this part of the exam, you may feel a little pressure or
discomfort. Again, it's important to relax your muscles and take slow,
deep breaths if you feel nervous.Pap Smears



A Pap smear may be part of the pelvic exam, although not all teens
need to get a pap smear. Pap smears are used to check for abnormal
cells. The American College of Obstetricians and Gynecologists
recommends that girls should get a Pap smear about 3 years after first
having sex and then every year after that. All women should have a Pap
smear by age 21.

To do a Pap smear, the doctor will gently touch the cervixcervix to pick up cells from that area.

The Pap smear shouldn't hurt, but it might be uncomfortable,
especially if this is your first pelvic exam. The good news is this part
of the exam is over quickly.

The cells that have been collected are sent to a laboratory where
they are studied for any abnormal cells, which might indicate infection
or warning signs of cervical cancer. (Like breast cancer, cervical
cancer is very unusual in teen girls.)

STD Tests



If you have had sex, the doctor or nurse practitioner may test for
STDs. He or she will swab the inside of the cervix with what looks like a
cotton swab. The speculum is then slid out of the vagina. As with the
Pap smear, the sample is sent out to a laboratory where it is tested for
various STDs.

Talk to your doctor or a nurse about how you want to be contacted
with results, and what they should do if they are unable to reach you.
Again, doctors and nurses will do their best to maintain
confidentiality, but they need to be able to reach you
After the Exam



Although reading this article may make it seem long, the entire
pelvic exam (the parts involving your vagina, cervix, uterus, and
ovaries) really only takes about 3 to 5 minutes.

Afterward, you'll be left alone to get dressed. Some women say that
they bleed a tiny bit from the Pap smear after the exam, so they like to
put a pantiliner in their underwear as they get dressed. If you bleed a
tiny bit, it's no big deal — it's nothing like a period and it won't
last.

If you haven't discussed your questions before the exam, now's the
time. Don't be afraid of questions that sound stupid or silly — no
question about your body is stupid, and this is the best time to get
answers.

The Pap smear is almost always normal in teen girls. But if for any
reason the doctor or nurse practitioner needs to see you again, the
office or clinic will let you know. Unless you notice any health
problems, you won't need to go for an exam for another 6 months to a
year.

It's very important to go for pelvic exams on a yearly basis — even
when you're feeling good — because they help detect any problems early
on. If you don't want to return for another exam because you didn't like
the doctor or nurse practitioner, look into finding a new doctor or
clinic.

And if the physical discomfort of the exam left you not wanting
another, remember that each time it gets easier and easier to relax.
Naturally, no one loves getting an exam, but having a doctor or nurse
practitioner you trust can really help.