Your cousin just had a pelvic exam for the first time, and your mom thinks it would be a good idea for you to go, too. She makes an appointment and as she hangs up the phone, you feel:

Totally panicked.
You start praying for an avalanche, four flat tires on the car, that the gynecologist will get a broken arm, anything to avoid that appointment.
Pretty calm - you don't really mind going to the doctor that much, and if your cousin can handle it, so can you. But how will the doctor look at the inside of your vagina, exactly?

Confused.
You don't feel sick at all, and you just had some vaccinations for school and a physical for softball. Why waste time going to a doctor when you're OK?

These are just some of the feelings that girls may have before their first pelvic exam, and it's not surprising. You might be asking yourself "Why me? Why now?" The answer is now that you're older and going through puberty, you need special attention as a woman. That's where breast and pelvic exams come in.

Why You Need These Kinds of Exams

There are a number of reasons why a pelvic exam and a breast exam are important for teen girls, including:

*As a routine check: Many doctors recommend that a girl get her first gynecologic exam by the time she turns 18 or sooner if there is a concern.

*Some girls want to make sure that everything is developing normally and may want to be seen earlier.

*To prevent pregnancy or infection: If a girl has had sex or is sexually active, she needs to have a pelvic exam at least on a yearly basis. After becoming sexually active, she should have a pelvic exam as soon as possible to let the doctor screen for sexually transmitted diseases (STDs) and to discuss methods of preventing pregnancy and infections.

*To plan for health and safety: If a girl is considering having sex, seeing a doctor gives her the opportunity to discuss birth control and abstinence, how to prevent infections, relationships, and other important topics.

*To deal with a problem: There may be a number of concerns that lead to a visit to the doctor, including menstrual bleeding problems, missed periods, pain, signs of infection, and worries about development.

Different Exam Choices

You probably have a mother, aunt, grandmother, older sister, or friend who can recommend someone she likes when it's time for your gynecological exam. If you're going to be in charge of the decision or helping in the decision-making process, you have a few choices.

There are a number of different kinds of doctors and nurses who have special training in the health and diseases of women's reproductive organs, including the vagina, cervix, uterus, ovaries, and breasts. These health care professionals include pediatricians, gynecologists, family doctors, and nurse practitioners.

Pediatricians are doctors who have special training in the medical care of kids and teens. Some pediatricians perform gynecological exams and prescribe birth control.

Gynecologists are doctors who are specially trained in women's health issues. They also know how to promote good health for women and how to answer questions that women have about their bodies. Gynecologists are also the doctors who frequently prescribe birth control and teach patients how to use it.

A nurse practitioner is a nurse who has had advanced training. Many nurse practitioners give gynecological exams and also pay special attention to women's reproductive health.

Many family doctors perform gynecological exams and prescribe birth control, so this may be an option as well.

Whether you want to see a male or female health care professional for your care 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 say they feel comfortable being examined by a male doctor or nurse and that it's no problem at all. If the doctor or nurse practioner is male, they will usually have a female assistant in the room with them during all parts of the exam.

If you choose to go to a doctor's office to see a pediatrician, gynecologist, nurse practitioner, or family doctor, you may need to involve an adult for insurance purposes (it may be expensive otherwise).

It's best to involve your parents in your health care, but if for some reason you can't, you can take advantage of health clinics like Planned Parenthood that have fully trained staffs that can often care for you at a lower cost and that will respect your need for confidentiality.

The most important thing is that you feel comfortable with the person you choose to examine you. You want to be able to talk with him or her about important personal health and relationship issues.

What Happens When You Go for Your Pelvic Exam

You don't need to do anything special before going for a gyn (short for gynecological) exam, although when you make the appointment, you will want to be sure you won't have your period the day of the exam. Although you can have an exam during your period, this can make it difficult to get a proper Pap smear (more on this later).

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. If you think you might have your period on the day of your appointment, it's best to call the office or clinic and ask about it ahead of time.

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. It's important to answer everything truthfully - nothing you write will be something the doctor or nurse hasn't seen before. You might also be asked to write when you had your last period.

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: record your weight, take your pulse, and take your blood pressure. If you weren't asked about the date of your last period on the health form, the nurse or medical assistant will probably ask you.

He or she will then give you a paper gown and paper sheet and ask you to change out of your clothes before closing the door and leaving you by yourself to change. If you have brought a parent or another adult with you, and you want that person in the room during the exam, now is the time to say so.

You'll need to take off all your clothes (including your bra and underwear), although most nurses or medical assistants will say you can leave your socks on. This might feel a little weird at first, because you may not have had to take off all your clothes at the doctor's before. But just keep in mind that, again, it's nothing that doctors or nurse practitioners don't see hundreds of times a day!

After taking off your clothes, you'll put on the paper gown with the opening in the front (so it's like a giant vest), sit on the exam table, and cover your lower half with the paper sheet.

The Breast Exam

After a few minutes, the doctor or nurse practitioner will knock on the door to make sure you're in your gown. If you're ready, he or she will come in and go over anything you might have written down on your forms. Naturally, if you've left the space blank next to the question about your last gyn exam, he or she will know it's your first one. But if there's any doubt, be sure to bring it to the doctor's attention. That way, he or she will know to go slowly and explain everything that is going on.

If you feel nervous or have questions about what will happen, now is the time to speak up. The doctor or nurse practitioner won't mind - in fact, it will make the exam better and easier for everyone if he or she feels like you're relaxed and informed.

Now is also the time to ask when it's appropriate to discuss 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.

After talking for a few minutes, you'll be asked to lie on your back on the table with your gown open. You'll have the paper sheet covering your lower half. The doctor or nurse practitioner will give you a breast exam by pressing with his or her fingers on different parts of your breasts.

This is necessary to help look for "normal" lumps (which are quite common and are harmless), cysts, or, in very rare cases, breast cancer. After finishing, he or she may ask you to examine yourself or may move your fingers to show you how to do it.

Although breast cancer is very unusual in teen girls, it's important that you learn to examine your breasts yourself because knowing how your breasts feel early on can help you detect problems later.

The doctor or nurse practitioner will explain exactly how and when to do breast self-exams and answer any questions you have. He or she will then touch and press on your belly to feel for any problems with your spleen, liver, and kidneys. You'll sit up and the doctor or nurse practitioner will use a stethoscope to listen to your heart and lungs. He or she may also look into your ears, eyes, and nose.

?The Pelvic Exam

Next, the doctor or nurse practitioner will again ask you to lie down on your back and move down so your behind is at the end of the table. You'll bend your knees and pick up and rest your feet in two stirrups, which are metal triangular loops that stick out from the end of the table.

Stirrups might look a little scary, but they are really just there to rest your feet in and keep you more comfortable. The doctor or nurse practitioner will ask you to relax your knees out to the sides as far as they will go. It might feel a little funny at first to be lying there with your legs opened like this, but it's important to relax and remember that millions of women have these exams every year.

The doctor or nurse practitioner will put on gloves and examine the outside of your vagina. He or she will look to make sure that there are no sores or swelling and that everything looks OK on the outside.

Next, the doctor or nurse practitioner will want to look at the inside of your vagina and will do so with the help of a speculum (pronounced: speck-you-lumm). A speculum is a thin piece of plastic or metal with a hinged piece on one end that allows it to open and close (think of a hair clip). He or she will warm the speculum with water, and then slide the speculum into your vagina. Usually the doctor or nurse practitioner will tell you that he or she is about to place speculum inside you and will warn you that it might feel a little cold.

Once the speculum is in the vagina, it can be opened to allow the doctor to see inside. Putting in and opening the speculum isn't painful, although some women say that it can cause a bit of pressure. Naturally, if you've never had a doctor investigating that area before, you might get a little tense. But because the vagina is surrounded by muscles that can contract or relax, it's important to stay calm.

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 with the doctor or nurse practitioner can distract you from the pressure. Concentrate on keeping the muscles in the lower half of your body as relaxed as possible.

After the speculum is in place, the doctor or nurse practitioner will shine a light inside the vagina to look for anything unusual, like inflammation (redness or swelling), discharge, or sores. He or she will then do a Pap smear, which is the taking of some cells from the cervix. The cervix is the opening to the uterus, which is located at the very top of the vagina. To do a Pap smear, the doctor or nurse practitioner uses what looks like a very long mascara wand to gently scrape the inside of the cervix. This doesn't hurt at all; some women say they feel a little twinge, but it only lasts a second.

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.)

If you are sexually active, the doctor or nurse practitioner will then 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.

Next, the doctor or nurse practitioner will want to check out your uterus and ovaries. But because they are so far inside you they can't be seen at all, even with the speculum, he or she will need to feel them. While your feet are still in the stirrups, the doctor or nurse practitioner 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 or nurse practitioner 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 a twinge or two, but it isn't painful. Again, it's important to relax your muscles and take slow, deep breaths if you feel nervous.

After the Exam

Once the doctor or nurse practitioner is finished checking your uterus and ovaries, the exam is complete. Even though 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.

About 1 month from the day of your exam, you may receive a phone call, postcard, or letter with the results of your Pap smear from the doctor or nurse practitioner or the lab, or you may call the clinic if you prefer. The Pap smear is almost always normal in teen girls. Confidentiality is important; if you are concerned, most clinics will agree to send the results in a plain envelope that doesn't indicate the name of the clinic or the doctor.

If for any reason the doctor or nurse practitioner needs to see you again, the office or clinic will let you know. And if you ever have any other problems, such as an infection, irregular periods, an unusual discharge, or you suspect you have an STD, you'll need to go back to the doctor or nurse practitioner for another exam. Otherwise, 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 of a less-than-positive experience with a doctor or nurse practitioner, look into getting a new one. Almost all health care professionals are great and treat teens with care and respect, but if anything about your experience left you feeling weird, pay attention to your intuition.

Naturally, no one loves getting an exam, but having a good relationship with the doctor or nurse practitioner is very important. And if the physical discomfort of the exam left you not wanting another, remember that each time it gets easier and easier to relax. You can ask friends or siblings how they relax during an exam, or ask your doctor or nurse practitioner for tips.

Updated and reviewed by: Kim Rutherford, MD
Date reviewed: September 2001
Originally reviewed by: Ellen Feingold, MD, MPH, and Neil Izenberg, MD