Your Daughter's First Gynecological Exam

Explaining the Importance of the Exam

Chances are, your daughter has associated visits to the doctor with health problems. She may not understand why she would go to the doctor when she feels perfectly fine.

Explain that the visit serves at least three main purposes:

1. Information. She can get accurate information and confidential answers to any questions she may have concerning sex, sexuality, her changing body, and menstruation.
2. Prevention. She can learn about pregnancy prevention, sexually transmitted diseases, and healthy lifestyles.
3. Treatment. For girls who experience missed periods, pain, or other reproductive problems, the doctor can look into why the problems are occurring and offer treatment.

Also, you may want to reassure your daughter that even though there are a lot of different parts of the gynecological exam, the entire exam — and the part she might feel most uncomfortable about — doesn't take long.

Selecting a Health Practitioner

The doctor or nurse practitioner that your daughter sees should be someone who takes the time to make her feel as comfortable as possible. Though you have probably been the dominant force in making your daughter's health decisions up until now, it's wise to involve her in this one.

Here are some ways to consider your daughter's preferences:

• Ask your daughter what type of health professional she would prefer. A male or female? Someone who is younger or older? In some cases, she might be able to stick with the pediatrician or family physician she has seen before. If either of you would like to move on, though, you have a variety of health professionals to choose from: adolescent medicine specialists, gynecologists, or nurse practitioners trained in gynecology.
• Before sending your daughter to the health professional that you use, check to see if she is comfortable with that. Some girls might be hesitant to confide in someone who has a connection to their mother.
• Ask her if she would like you to be in the exam room with her. Whatever your daughter decides, allow her some time alone with the doctor or nurse practitioner. You want your daughter to be completely honest with the doctor, not withhold information that she is too embarrassed to share in your presence. In addition, alone time will allow her to recognize the doctor as an objective and knowledgeable person to talk to about any concerns she may have in the future.

Your needs are important, too — you should trust this person with giving your daughter appropriate information about important decisions in her life.

Matching a Health Practitioner to Your Family's Needs

Once you have your daughter's input, use these suggestions to find a doctor who best fits your family's needs:

• Get a referral. Ask your pediatrician or family doctor for recommendations. If you have close friends who have recently taken a daughter to her first exam, ask them if they liked their health professional. If there is a particular hospital or practice you prefer, see a physician or nurse practitioner associated with that facility.
• Ask questions. Ask about the health professional's confidentiality policy. This may affect how open your daughter is during the visit. Most offices will not share the details of the exam with the parent unless the patient says it's OK or if the physician feels that the child may be engaged in an activity that could be harmful. Also, different states have different rules with regard to confidentiality.

Other questions you may want to ask:

• Are you board certified?
• What is your approach toward discussing sexual activity?
• Do you have experience with first-time patients and teens?
• Will you be the health professional to see my daughter every time she goes or will she see different providers?
• Who else will be in the examining room?

Share the answers to these questions with your daughter. And don't hesitate to interview several health practitioners before deciding on the best fit.

About the Exam

Before the appointment, try to give your daughter a sense of what will happen in the exam room. Most gynecological exams include certain procedures, though they may not occur in the same order in every office.

It's important for your daughter not only to know what to expect, but why the doctor is doing it and how any discomfort she is feeling can be minimized. If applicable — and both of you are comfortable with the idea — consider letting your daughter see these steps firsthand by sitting in on one of your exams.

The Medical History Talk

Your daughter should be prepared to answer questions the doctor asks relating to her medical and reproductive history, including:

• When was your last period?
• Are you, or have you ever been, sexually active (meaning vaginal, oral, or anal sex)? If so, are you using birth control and STD protection?
• Are you having any problems with your period, such as discharge or pain?
• Do you think you could be pregnant?

Through this discussion, the doctor will decide which tests to run and what issues to discuss. Stress to your daughter the importance of answering these questions truthfully, even though she might feel uncomfortable about it. For example, the health professional can help determine, based on your daughter's sexual history, whether she is at risk for sexually transmitted diseases (STDs). If she is, the doctor will know to test for them.

Encourage your daughter to ask any and all questions she has — no matter how stupid or embarrassing she fears they may be. Let her know that nothing she says will be something that the doctor or nurse hasn't heard before or will share with anyone else. Remind her that this information is confidential.

The Physical

Your daughter has probably experienced a physical before, so most of this will be familiar territory for her.

One of the health care workers, probably an assistant or nurse rather than the doctor, will measure your daughter's vital signs, including weight and blood pressure. The doctor may examine her neck, breasts, heart, lungs, and abdomen. Your daughter may also provide a urine sample.

This examination gives the doctor background on your daughter's general health and a baseline to use for comparisons in future exams.

The Breast Exam

Though breast cancer is very rare in teens, the breast exam is still an important part of a GYN visit. During this part of the exam, the doctor or practitioner will do a breast exam to make sure that your daughter is developing normally and to detect lumps, cysts, or breast problems.

The doctor also may show your daughter how to do a breast self-exam to help her become familiar with how her breasts feel so that she knows which lumps are normal and which may indicate a potential problem.

The External Examination

If she hasn't already, your daughter will undress and put on an examination gown. Her pelvis and thighs will be draped with a sheet. She may be asked to lie on the table with her knees bent and spread apart. The doctor may have her place her feet in stirrups. In this position, the doctor will check the vulva (the external genitalia).

The purpose of this part of the exam is to make sure there are no sores, swelling, or any other problems with the external genitalia.

The Internal Examination

If an internal pelvic exam is needed, the doctor will place one hand on the outside of your daughter's abdomen and one or two fingers inside the vagina.

The clinician's hands are used to feel the size and position of the ovaries and uterus. A speculum allows the doctor to visually examine the walls of the vagina and the cervix and to perform screening tests, such as a Pap smear and tests for some STDs.

Let your daughter know that she may feel some pressure, but this shouldn't hurt. She may be able to decrease any discomfort by taking slow, deep breaths and relaxing her stomach and vaginal muscles. In addition, the clinician will likely make efforts to make her feel more comfortable by starting up a conversation or having interesting posters in the room to look at.

The Pap Smear

During the internal exam, the doctor or nurse may take a Pap smear. Gynecologists recommend a Pap smear beginning at age 21.

In a Pap smear, cells are gently scraped from the cervix using a small brush and a small spatula. The specimen is sent to a lab to check for abnormal cell changes and cervical cancer.

The practitioner may recommend the human papillomavirus (HPV) vaccine. This vaccine protects against the main types of HPV that cause genital warts and certain types of cancer, especially cervical cancer. Even if your daughter receives the HPV vaccine, she should still get regular Pap smears to screen for forms of cervical cancer not covered by the vaccine.

Sexually Transmitted Diseases Testing (Optional)

Testing for STDs is not automatically included in a gynecological exam. However, girls who have been sexually active should be tested for STDs. Some STDs can be tested for with blood or urine tests. Sometimes, the clinician obtains a sample with a cotton swab (just like during the Pap smear) during a pelvic exam.

The samples are sent to a lab, where they are tested for STDs like gonorrhea and chlamydia. When talking to your daughter about whether she should get tested, it's important that she know that vaginal intercourse isn't the only way to contract these infections — they can be passed through oral and anal sex as well.

The office staff can let you know different options for your daughter to get the results confidentially. For instance, instead of calling the patient or sending a letter with the results, some offices require the patient to call in.

Once you and your daughter have gone to the first exam, encourage her to talk about the experience (as much as she is comfortable). If she indicates that the doctor or nurse practitioner made her feel uncomfortable, discuss finding a new one. Once she starts, your daughter should continue to go for gynecologic exams every year to keep her informed and healthy.

Reviewed by: Larissa Hirsch, MD
Date reviewed: September 2011