A doctor holds a tablet and writes while a patient talks and gestures with her hands

Gynecological Information

Gynecological Exams

Regardless of your sexual orientation or whether you are sexually active, GYN exams are an integral part of a woman's comprehensive health care. Women should begin having an annual gynecological exam as early as 13-15 year of age, and begin cervical cancer screening (Pap test) every 2 years beginning at age 21.  Regular GYN exams allow you to maintain an up-to-date knowledge of your reproductive health, to become familiar with what is normal for your body and to be better able to identify future health problems

Having regular GYN exams can:

  • Prevent Illness
  • Detect cancers such as cervical, uterine, and breast cancer at an early and potentially more treatable stage
  • Detect sexually transmitted infections (STIs) before they cause infertility or other damage
  • Provide healthcare before, during, and after pregnancy

If you are concerned or nervous about having a GYN exam, learning what the exam involves can help ease any reservations you might have about scheduling your exam. Typically, a GYN exam involves a discussion of your medical and sexual history, a brief physical exam, a breast exam, a pelvic exam, STI tests, and other lab tests and counseling as needed.

Procedure

Your provider will use a speculum -- a plastic instrument that s/he will gently insert into your vagina. The speculum spreads the vaginal walls slightly apart so that the cervix can be seen. At this point there is usually some pressure, but if you feel pain, let your provider know so s/he can adjust the speculum for greater comfort. Your provider will look at your cervix to make sure it looks healthy. (If you would like to see your cervix you can ask your provider for a mirror at this point.) Once the speculum is in place, your provider will look for any irritation, growths or abnormal discharge from the cervix.

If you are due for a Pap Smear, your provider will use a small plastic spatula and a small, soft brush device to take a Pap Smear, a quick sample of your cervical cells. This test will be sent to a lab to determine if there are any abnormal cervical cells. The frequency of Pap Smears is determined by your age and whether you have any history of past abnormal Pap results.

Next, your provider will gently remove the speculum and perform a bimanual exam. With a gloved hand s/he will insert 2 fingers into the vagina and with the other hand on top of your abdomen will feel your uterus, fallopian tubes and ovaries. S/he is feeling the size, shape and position of the uterus and whether there is any tenderness or swelling. Again, some pressure is felt here and you may experience the sensation of having to urinate, but it is quick.

How to prepare for GYN exams

It's a good idea to refrain from having intercourse or douching for the 24 hours before your exam. These activities can irritate the genital area and vaginal lining and obscure test results.

If you are having your period at the time you are scheduled to have a GYN exam, call your provider to see if you will need to reschedule. When you're having your period it can be difficult for the provider to clearly see your anatomy and it can obscure test results.

Do GYN exams hurt?

For most women, GYN exams are at worst mildly uncomfortable and a bit awkward. You can tell your provider what you're feeling during the exam so s/he can slow down or make adjustments so that you'll be as comfortable as possible. Your medical provider will take the time to describe what s/he is doing. If at any point you decide that you don't want to go further with the exam; that is ok. You are in complete control of the exam and can ask your provider to stop at any time you are uncomfortable.

Yeast Infections

A vaginal yeast infection is irritation of the vagina and the area around it called the vulva. Yeast is a type of fungus. Yeast infections are caused by overgrowth of the fungus Candida albicans. Small amounts of yeast are always in the vagina. But when too much yeast grows, you can get an infection. Yeast infections are very common. About 75 percent of women have one during their lives. And almost half of women have two or more vaginal yeast infections.

Signs and Symptoms

The most common symptom of a yeast infection is extreme itchiness in and around the vagina.
Other symptoms include:

  • Burning, redness, and swelling of the vagina and the vulva
  • Pain when passing urine
  • Pain during sex
  • Soreness
  • A thick, white vaginal discharge that looks like cottage cheese and does not have a bad smell
  • A rash on the vagina

You may only have a few of these symptoms. They can be mild or severe.

Do I need to see a doctor?

Yes, you need to see your doctor to find out for sure if you have a yeast infection. The signs of a yeast infection are much like those of sexually transmitted infections (STIs) like chlamydia (KLUH-mid-ee-uh) and gonorrhea (gahn-uh-REE-uh). So, it's hard to be sure you have a yeast infection and not something more serious. If you've had vaginal yeast infections before, talk to your doctor about using over-the-counter medicines.

How are they treated?

Yeast infections can be cured with antifungal medicines that come as creams, tablets, ointments and other suppositories that are inserted into the vagina. These products can be bought over the counter at the drug or grocery store.

Infections that don’t respond to these medicines are starting to be more common. Using antifungal medicines when you don't really have a yeast infection can raise your risk of getting a hard-to-treat infection in the future.

Other Issues

Bacterial Vaginosis

The vagina normally has a balance of mostly "good" bacteria and fewer "harmful" bacteria. Bacterial vaginosis, known as BV, develops when the balance changes. With BV, there is an increase in harmful bacteria and a decrease in good bacteria. BV is the most common vaginal infection in women of childbearing age.

Pelvic Inflammatory Disease

PID is inflammation caused by infections ascending from the vagina or cervix to the upper genital tract. This includes the lining of the uterus, the ovaries, the fallopian tubes, the uterine wall and the uterine ligaments that hold these structures in place. It is estimated that there are approximately 1 million cases of PID in the U.S. each year. Approximately 85% of all cases of PID are caused by sexually transmitted infections (STIs). The disease can be caused by many different organisms or combinations of organisms, but is frequently caused by gonorrhea and chlamydia.

Amenorrhea

Amenorrhea is the abnormal absence of menstrual periods. Generally speaking, there are three categories of women who have experienced amenorrhea:

  • Women who have never had a menstrual period by age sixteen.
  • Women who have not had a period for two to three months or more.
  • Women who have irregular periods that may vary from 35 to 90 days.

If you menstruate fewer than four times per year or if you miss three consecutive periods, you need to see a health care provider. If you are sexually active, you should see a provider for a pregnancy test after one missed or late period. You should also see a provider if you notice breast/nipple discharge, or if you notice unusual facial hair or other body hair growth.