What's Up Down There

September 9, 2012

There’s nothing more daunting than the prospect of going to the gynecologist for the first time. A doctor down there? No, thank you! But one of the worst things you can do for your oh-so-important dancer body is put off your visit—especially if you’re having a problem.

Dr. Lauren Streicher, MD, a gynecologist and assistant professor at Northwestern University’s Feinberg School of Medicine in Chicago, IL, says girls come to her at any age if they’re experiencing issues, like pelvic or abdominal pain or infrequent periods. If you don’t have concerns about your health, schedule an appointment as soon as you’re thinking about becoming sexually active. And if neither of those factors apply, you won’t need to have your first visit until you’re 21, the age recent studies recommend starting to screen for cervical cancer and pre-cancer.

No matter when you go or for what reason, the first time you see an OB/GYN you may be intimidated. Fear not: DS talked to Streicher and two other board-certified gynecologists about exactly what to expect, so you can be prepared for—not scared of— your first appointment.

Before Your Visit

When selecting a doctor, you’ll be able to choose a man or a woman—just go with whichever you’ll be more comfortable with. Physically, you won’t need to do anything special to prepare for an appointment—just take a shower like you normally would. But you can do a little research to make your doctor’s job easier. Learn the basics of your family and personal history: Have any relatives had cancer, heart disease or other serious illnesses? Write down the names of any medications you’re taking and anything you’re allergic to. Also, know the date of the first day of your most recent period.

When you arrive, you’ll fill out some paperwork, and the front desk will check your insurance to make sure everything’s covered. If you don’t have insurance—or don’t want to use your parents’ insurance—clinics like Planned Parenthood often have alternative financial plans available.

In the Exam Room

Once you’re in the room, a medical assistant will record your basic vital stats—including blood pressure, height and weight—just like at the pediatrician. When your doctor comes in, the first thing you’ll do is just talk. If you’ve come with your mother, sister or other trusted friend, she’ll often be allowed to stay in the room for a couple questions, but then be asked to step outside for the rest of the appointment. And what you tell your doctor in that room stays in that room. “It’s important to understand that your visit is completely confidential,” says Dr. Gillian Dean, MD, MPH, an OB/GYN who is interim medical director at Planned Parenthood of NYC. “It’s against the law for the doctor to discuss anything that happens without the patient’s permission.”

Your doctor will ask questions about your periods, whether or not you’re sexually active, your general health and your diet and exercise. Then, it’s your turn to ask her questions—and nothing is off-limits. “Being a gynecologist is almost like being a psychologist,” says Dr. Diana Wang, MD, FACOG, of the Seton/University of Texas Southwestern OB/GYN residency program in Austin. “Anything you’re concerned about is fair game.”

If you’re sexually active, you might be asked to pee in a cup or give a blood sample to test for sexually transmitted infections, and you can discuss birth control options. But there may be no need for an actual vaginal exam on the first visit. If you’re 21 years old, or your doctor determines you need an exam, she’ll give you a gown to change into and ask you to get undressed. (That means completely undressed—underwear and bra, too—but you can leave your socks on if you’d like.) She’ll leave the room while you change.

The Exam

When the doctor returns, you’ll be asked to sit on an examination table and put your feet in a pair of elevated stirrups. There are three main parts to what comes next.

• First, your doctor will place a speculum into your vagina to inspect the vagina and cervix and conduct a Pap test that checks for cancerous or precancerous cells on the cervix. “The speculum is usually made of metal, and people say it looks like a duckbill,” Dean says. “Once it’s inserted and gently opened, the practitioner shines a light inside to see the back of the vagina, where the cervix, which looks like a small donut, is located.”

“The speculum should never be painful, but you’ll feel some pressure,” Streicher says. To make the speculum experience more comfortable, she suggests scooting your butt as close to the edge of the table as possible and letting your knees fall to the sides as if you’re doing a butterfly stretch. “Dancers are strong and they tend to tighten their butt muscles and lift their hips off the table—but that’s the exact opposite of what you want to do,” Streicher says. “Imagine the muscles you tighten to stay in relevé—those are the muscles you need to loosen as much as possible.”

The doctor will swab a soft brush (it looks like a long Q-tip) inside your cervix, which may be a little uncomfortable (although some women don’t feel a thing). Then, the speculum comes out—generally after no more than 30 seconds.

• Next comes the pelvic exam. The doctor will place one or two gloved fingers in your vagina, then gently press down on your belly to feel your uterus and ovaries. Again, focus on relaxing your body, especially your stomach muscles, to avoid any discomfort. And don’t forget to breathe.

• Your doctor will then do a breast exam, moving your arms to different positions and lightly pressing on parts of your breasts. “It shouldn’t hurt,” Streicher says. “But if you know you have tender breasts, try not to drink any caffeine that day, which will help. And if you can, schedule your appointment after your period, not before.”

Throughout the entire exam, it’s important to speak up if you’re feeling uncomfortable, nervous or embarrassed. Remember, there’s almost nothing your doctor hasn’t seen or heard, and for her, looking at you “down there” is just as un-scandalous as when your pediatrician looks at your throat or your ears.

Wang adds that it’s essential to trust your doctor enough to ask questions about what she’s doing. “It’s very empowering for a girl to be educated about her own body,” she says. “Your body is your life, especially as a dancer. You need to know more about yourself than anything else.”