If you’re nervous about getting your first gynecological exam, you’re definitely not alone. “Speculum,” “stirrup” and “Pap smear” can seem like pretty scary words when you’re not 100% sure what they mean, and having someone (even a medical professional) looking at your genitals is bound to feel uncomfortable.
I’m an adolescent health specialist, and frequently give pelvic exams to young women and men (many trans men need pelvic exams, too) who have never had one before. In celebration of Cervical Health Month, I want to break down what happens during a gynecological exam, so you know exactly what to expect.
But first, you may be wondering: Do I actually need a pelvic exam? Your doctor will give you a pelvic exam if you have pelvic pain, irregular bleeding, or if there are signs of an infection. Otherwise, you don’t need routine exams until you’re 21, when you should start getting regular Pap smears. You do NOT need a pelvic exam if you’ve never had sex (including oral and anal sex!), even if you are over 21. You also do NOT need a pelvic exam just because you want to start using birth control.
You don’t necessarily need to see a gynecologist for a gynecological exam. Many primary doctors also perform them—just ask!
1. Let’s Talk
To start out, a visit for a gynecology exam is like any other doctor’s visit. Your doctor will talk to you about your general medical history. They’ll also ask about your sexual health history. This includes how many sexual partners you’ve had and if you use protection and contraception. It may feel weird to talk about sex, but it’s important to be completely honest with your doctor so they can give you the care you need.
Ask about getting the HPV vaccination, if you haven’t already. If you’re under 15 years old, the vaccination requires only two shots. If you get it later, you’ll have to get three.
If it’s your first gynecological exam, or you’re nervous, tell them! To relax, you can listen to music while they perform the exam, or ask if it’s all right if a parent or sibling stays with you.
Now is also the time to bring up any other questions or concerns, like your irregular periods, the annoying ingrown hairs on your bikini line, pain during sex, or anything else on your mind. Believe me, I’ve heard it all and I know your doctor has too.
2. Getting Medical
After you’ve finished talking, your doctor will leave the room for you to change. They’ll usually ask you to take off all your clothes, including your underwear and bra, and put on a paper gown. They’ll perform basic medical checks like listening to your heart and lungs.
3. Breast Exam?
Sometimes (but not always) your doctor will also perform a breast exam to check for unusual lumps, which can be a sign of breast cancer. Breast exams are recommended every year once you turn 21.
4. Pelvic Exam Part 1: The External Exam
Next, your doctor will ask you to slide to the very edge of the exam table, so you feel like you’re almost falling off, and lie down. You’ll place your feet into stirrups, which keep your knees apart during the exam. Because a lot of people feel a bit awkward in this position, I like to make small talk and ask my patients questions about their life—your doctor may do the same. Throughout the whole pelvic exam, your doctor will be very clear about what they’re doing, so you know where they’ll be touching you before you feel it.
The doctor will visually examine your external (outside) genitalia, using gloved fingers to part the lips of your labia. They’re checking for any abnormalities, such as warts, cuts, irregular hair distribution, and any other signs of STIs or hormonal issues.
5. Pelvic Exam Part 2: The Speculum Exam
Next, your doctor will put some wet jelly on to a speculum and insert it about 2/3 of the way into your vaginal canal. The speculum is then opened slightly, so the doctor can see your vagina and cervix, which connects your vagina to your uterus. This may be slightly uncomfortable, but it should NOT be painful. If it is, tell your doctor.
If your doctor thinks it’s a good idea to test for an infection, they’ll take a sample of fluid from your vagina. You will probably not be able to feel this. If you’re getting a Pap smear, your doctor will take a sample of cells from your cervix. Some people have a few cramps when they get a Pap smear. This is a completely normal reaction to having anything go through the neck of your cervix, and they shouldn’t be severe. When your doctor is done, they will remove the speculum.
6. Pelvic Exam Part 3: The Bimanual Exam
Then, your doctor (wearing gloves, and after putting some lubricant on their fingers) will insert two fingers inside your vagina, and use their other hand to gently press down on your belly. This way, they can feel the size of your uterus, and sense any tenderness on your ovaries and fallopian tubes (which may be a sign of cysts or other medical issues). Again, if you experience any pain, immediately tell your doctor.
7. That’s It!
After your doctor is done with the pelvic exam, you can take your feet out of the stirrups and sit up, fully covered. Your doctor will talk to you about any concerns they have or tests they’re doing. If they noticed any abnormalities, they may refer you to a gynecologist (if that’s not already who you’re seeing). Being referred to a gynecologist doesn’t necessarily mean that anything is seriously wrong with you—it just means that your doctor wants a specialist’s opinion. If you got a Pap smear, you may experience some light spotting, so your doctor will usually give you a panty liner.
It may sound like a long process, but the whole pelvic exam only takes a few minutes. It can seem scary the first few times you get it done, but before long you’ll be a pelvic exam pro. If you’re 10-22 years old and live near NYC, you can stop by Mount Sinai Adolescent Health Center for completely free, confidential and non-judgmental medical care, including gynecological exams.
Lonna Gordon, MD, PharmD is a pediatrician at Mount Sinai Adolescent Health Center who is fellowship trained in adolescent medicine. In addition to general adolescent care, Dr. Gordon sees obese adolescents who are interested in comprehensive medical and reproductive health care through a structured, multidisciplinary approach to weight loss.
The Mount Sinai Adolescent Health Center is located in New York City. It provides comprehensive, confidential, judgment free health care at no charge to over 10,000 young people every year. This column is not intended to provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual, only general information for education purposes only.