“Open wide….And, no, you’re not at the dentist”
I consider myself really fortunate to have a job that I love.
A big part of my gratification is the fact that I get to see my patients year after year at all stages of their life. While I hope that my patients are just as happy to come and see me, I realize they don’t necessarily enjoy the experience of coming to the “gynecologist”. In fact, on the “hate-scale” some patients compare the visit to the gyne to going to the dentist!
I take those particular visits as a challenge and usually end by asking:
“So, did we use any drills today?, long sharp needles maybe?…See it wasn’t so bad after all!”
When you hate doing something you usually want it to go away really fast, especially when you are guided by fear. The point is, that many patients go into the gynecology visit with their eyes wide shut.
As doctors, we try to have women relax by explaining what to expect before and during the exam. We know it’s not an enjoyable experience so we try our best to make it quick.
However, I think it’s important to not exchange education for speed.
As a patient, you should know what is being sampled and why. You should know what your annual exam will entail before you even get there. You should know, for example, that a speculum exam doesn’t always include a Pap-test and a Pap-test doesn’t screen for sexually transmitted infections .
You see ladies, there’s a lot happening on my side of the drape!
Today’s blog will open your eyes to some of the mystery’s of your annual well-woman exam.
And hopefully, put you at ease so you can never confuse it with your dentist’s office again.
Because every decade of your life brings you a unique set of health concerns, I will follow up this blog with a detailed discussion and guide to getting the best out of your well-women exam at each decade of your life…so stay tuned for next week’s blog! You won’t want to miss it!
If you have been to your ob-gyn recently, you have probably been told that you don’t require an annual Pap exam for cervical cancer screening anymore as long as your last one was normal.
This is due to the fact that guidelines for cervical cancer screening have changed (more on this later).
You do, however, need to continue annual well-women visits to your gynecologist.
Well-women exams differ depending on your age and whether you have a specific complaint or medical issue. In addition to a physical exam and health screening, an annual well- woman exam differs from a usual doctors visit in that you will receive a pelvic exam and clinical breast exam.
Here is the breakdown of a pelvic exam so you can lay back and understand the process:
A pelvic exam has 3 parts:
1. The External Exam: Inspection of your genitalia.
This part entails a check of the outside of your vagina from your pubic bone all the way to your rectum. We specifically are looking to assure that your vaginal introitus (opening to the vagina), clitoris, vulva (vaginal “lips”), perineum (area between the vagina and the rectum), and the rectum look ok from the outside. We are looking for any abnormal looking lesions, skin tags, cuts, blisters, or changes in skin coloration. Some sexually transmitted diseases like genital warts and herpes can cause specific lesions on the labia. Vulvar cancer is very common in women between 60-70 years of age and may present with a painful, itching skin lesion.
Most of the time you won’t even realize this part of the exam is happening–it’s usually during the “So have you seen any good movies lately?—small talk.
2. The Internal Exam: Speculum exam:
The speculum is the instrument that is used to open up the vagina and allows us to take a better look inside. With the speculum in place we may then sample some of the vaginal discharge for common vaginal infections such as yeast and bacterial vaginosis. We can also sample cervical mucous for sexually transmitted infections (STI’s), or perform Pap-tests for cervical cancer screening.
During the exam we also assess the integrity of the vaginal walls for any prolapse or herniation that can occur from the other internal organs surrounding the vagina: bladder, uterus, and rectum. In patients who complain of urinary incontinence or leakage of urine we can do a split speculum test and check for bladder prolapse and leakage of urine by asking the patient to cough.
3. Bimanual exam:
This is also an internal exam where your gynecologist has one hand inside your vagina placed under your cervix and lifts your uterus as she feels on the outside of your lower abdomen with the other hand. This exam is done to assess the size and shape of your uterus and to assure that there are no masses or pain in the area around your ovaries.
The bimanual exam can sometimes be uncomfortable but usually not painful unless there is a problem.
There is no screening test for ovarian cancer, so an abnormal finding such as a mass on a bimanual exam can be the first sign to lead us to further testing.
A bimanual exam should start at age 21, however the exact regularity of this test has not been established for young patients who have no complaints. Any pelvic pain, irregular menses, or abnormal discharge are some complaints that would warrant a full pelvic exam including a bimanual exam regardless of your age.
Ok…You can open your eyes now!
So, that is what your missing while day dreaming about being at the dentist office! See, no drills, no sharp needles…not so bad!
Go ahead schedule that annual well-woman exam you’ve been putting off!
You are well educated now, so get engaged in your health and make a difference in your outcomes—that’s empowerment!