During your gynecologic or annual exam, the person seeing you in our clinic will hereafter be referred to as a provider. This visit may include any of the following depending on your age, if you are sexually active or if you have any problems.

• General physical exam
• Breast exam
• Pelvic exam
• Pap test
• Review of you vaccination status

You may have someone in the room while you are examined if desired. Many women use this appointment to discuss birth control options, exposure to and prevention of sexually transmitted infections (STIs), and to ask sexual and general health questions.

Why should I have a pelvic exam and Pap test?
This test is an important part of your overall health care.  From the time you begin menstruating (menarche) to the time your period ends with menopause, many different problems can occur.  It is important to take care of your sexual health so that you may enjoy sexual satisfaction, normal fertility, and uncomplicated pregnancy and childbirth.

By performing these exams when indicated, your provider can detect problems and treat them before they become worse.  A pap test is the way to detect any abnormal cells on the cervix.  

For the appointment:

• Don't use spermicides or vaginal lubricants in the two days before your exam. Avoid all vaginal treatments, including douches.
• Write down the first day of your last menstrual period, along with any questions you want to ask the provider.

Before the exam:
You will complete a health history form and your vital signs (blood pressure, temperature, weight and height) will be taken. You will be asked to empty your bladder if needed. Should you have any symptoms that you think may be related to a urinary tract problem, please tell the Medical Assistant before you urinate so a specimen can be obtained.

Once you are shown to your exam room, you will be asked to undress and put on a paper gown so that the gown opens in the front.  You will sit and wait for the provider.

The provider will enter, she will review your paperwork and ask questions.  You may ask any questions at this time as well.  

Pelvic Exam
The pelvic exam takes only a few minutes.  It includes an exam of your external sex organs for growths or rashes.  It also includes an exam to check your internal sex organs: vagina, uterus, ovaries, and fallopian tubes.

The pelvic exam can alert the provider to the presence of ovarian cysts (fluid-filled sacs), uterine fibroids (growths), tumors, and other abnormalities.

The provider will ask you to lie on the examining table, bend your knees, and scoot your bottom to the edge of the table. You will place your feet in supports on each side of the table in order to keep your legs open.

You may feel uncomfortable in this position, physically and emotionally.  Focus on relaxing; for some women, talking during the exam can make it easier.  Remember, the exam only lasts a few minutes.

The exam:
Your provider will put on a lubricated glove.  She will inspect the vulva (the external genitals) to look for any abnormalities.  The provider will then place 1 or 2 fingers in your vagina until touching the cervix.  The provider will perform an internal examination of your uterus and other reproductive organs, by pressing gently with the other hand on your abdomen.

The provider is examining the size, shape, and position of the uterus (an enlarged uterus could indicate pregnancy or fibroid), looking for tenderness or pain, which might indicate infection, and the presence of enlarged ovaries, cysts, or tumors.

Pap Smear
This test uses a speculum to check for cervical cancer.

The exam:
Following the pelvic exam the provider will gently insert a warmed, lubricated metal or plastic speculum, an instrument that holds the vagina open and makes the visual examination possible.

You will feel some pressure when the speculum is inserted.  You may also hear the clicking sound of the speculum opening.  If you feel pain, tell the provider so that the speculum can be adjusted.

The provider will examine your vaginal walls for inflammation, lesions, or unusual discharge.  She will check your cervix for signs of infection, damage, growths, discoloration, unusual discharge, and lesions.

The “smear” for Pap testing is now performed; this procedure is generally painless.  Cell tissue is gently taken from your cervix with a brush or cotton swab.

The Pap test we do at Campus Health Service is the ThinPrep®, which is the new technology in Pap tests.  We take the sample of cells that have been collected from the cervix and place it in a solution that goes to an outside lab specializing in reading Pap tests.

We get the results back in about two weeks.  If the results are not clearly normal or abnormal, the specimen is sent out for further testing and this may take another two weeks.  Most abnormal pap smear follow up and treatment is done routinely right in the Women's Health Clinic.

After the exam:
Someone from Campus Health will call you if your test was positive. You will also be sent an email linking you to a copy of your results. You may contact Women's Health to make sure that your test was negative if you do not receive a call, 621-6512.
 

Abnormal Pap Smears
Because it is a screening test, it cannot be used for definitive diagnosis.  It identifies those women who need further testing and allows them to be treated (IF treatment is needed) before the abnormal cells turn into anything serious. Abnormal cell growth is caused by HPV (Human Papiloma Virus).

We usually refer to the abnormal cell growth as dysplasia (from the Greek: "dys" means abnormal or impaired and "plasia" means cell growth).  It can also be called SIL (squamous intraepithelial lesion) or CIN (cervical intraepithelial neoplasm).  They are different terms that mean the same thing.  It is important to note that most of the time the abnormal cell growth or dysplasia will get better by itself without any treatment.
 

Clinical Breast Exam
During the visit, the provider will check your breasts for signs of cysts or lumps.  You should have your breasts checked by your provider each year.  This exam is done in addition to the monthly breast self- examination you should be doing on your own.
 

You should see a provider if you:

• Are experiencing abnormal bleeding
• Have severe pain in your lower abdomen
• Have vaginal discharge that has a foul odor or is causing irritation
• Are planning to become pregnant or are pregnant
• Have not had a menstrual period but have developed breasts and pubic hair
• Notice breast lumps, breast discharge, or changes in breast size
• Experience severe menstrual cramps or menstrual irregularity
• Have blood in your urine
• Have been exposed to an STD

If it is your first pelvic exam/Pap test:

• Know that you do not have to go alone (you have the right to bring a nurse, relative, or a friend into the exam room with you)
• Tell your provider that it is your first time having a pelvic exam/Pap test
• Ask your provider to tell you what she/he will do in the visit
• While the provider performs the different tests, ask her to explain what she is doing (you can ask for a hand mirror to see the provider perform the exam)
• Ask questions - a question about your body is never stupid

Tips:

• Relax (Breathe slowly and deeply, relax your shoulders, stomach and the muscles between you legs)
• Try to schedule your appointment when you are not having your period.  If you are having uterine bleeding and/or have irregular menstrual periods this may be more difficult.

Other Resources
http://www.womanhealth.net
This website provides useful information about women’s health, various gynecological conditions, and other resources.

http://www.alice.columbia.edu/goaskalice/
This website, from the University of Columbia Health Education Program answers nearly every question about sex, relationships, emotional health, alcohol and other drugs and much more!

http://www.womenshealthmatters.ca/centres/sex/
This website discusses various aspects of women’s sexual health and being a “sexual self”.

http://www.wdxcyber.com/mvulva.htm
This website is specific for women with vulvar disorders.

http://www.webmd.com
This website allows you to search for many different topics and conditions.
 

References:
1.  ETR Associates Pamphlet.  Women’s Health: What’s Normal, What’s Not, 1996.
2. American College of Obstetrics and Gynecology

Written by Heather Hiscox, MPH, CHES