The Gynecological Exam

By Kerri S. Smith

Annual gynecological exams are crucial in detecting problems early and beginning treatment before they become life threatening. To help overcome the trepidation many women feel about a visit to the gynecologist, here's an outline of how you should prepare for your exam and what you can expect.

Before You Go:

• Schedule your appointment for a time between you know you won't be having your period.
• Avoid douching or using vaginal creams for three days prior to your appointment.
• If you don't already know, find out if your mom, sisters, aunts or grandmothers have had gynecological cancers, endometriosis, PolyCystic Ovarian Syndrome, or other conditions.
• Jot down any specific questions or concerns you may have about your gynecological health, including any symptoms such as vaginal discharge, itching or odor.
• Make a note of the date of the first day of your last period, as well as the typical number of days between the first day of one period to the first day of the next. Also note how many days your period usually lasts, as well as whether the flow is typically light, medium or heavy.
• If you're nervous or need support, ask a friend to go with you to the appointment.

The Office Visit:

• The medical assistant or nurse will usually ask to weigh you, take your blood pressure and possibly ask you for a urine specimen. Note that you can decline being weighed if you're uncomfortable with doing so.
• The doctor will go over your medical history with you and ask you many of the questions that you've already jotted down in your notes. This is the time to bring up any concerns or symptoms you've been having, as well as to ask any questions you may have about the exam.
• This is a good time to ask when you'll receive exam results, and how the information will be communicated to you. Do you need to call? Will they call you? Will they mail you results?
• You'll be asked to undress, and will be given an exam gown and drape. If you're concerned that the gown won't fit, you can bring your own large-size gown (contact NAAFA at 800/442-1214) or a shirt that opens down the front. The drape lies across your legs.

The External Exam:

• While the tests the doctor performs will vary according to your history, generally s/he will do a clinical breast exam, which involves manipulating each breast and nipple and under each arm to check for lumps and discharge. Usually, you will by lying down on the exam table, and you may be asked to put your hand under your head during this exam.
• For the pelvic exam, you will be asked to scoot down to the end of the exam table and place your heels in the stirrups. The drape will be covering your legs; if you haven't been given a drape, ask for one. You'll then be asked to spread your legs apart so the doctor can begin the exam.
• During the external exam, the doctor will visually exam your genitals to look for redness, discharge, cysts or other conditions. This usually only takes a few seconds.

The Internal Exam:

• Before the internal exam, many doctors will warm and/or apply a lubricant to the speculum - the tool that they use to open your vagina in order to examine your cervix.
• The doctor will insert the speculum into your vagina, and when the speculum opens, you will probably feel pressure against your vaginal walls. The sound you may hear is the doctor securing the speculum in place.
• Both your vaginal walls and cervix will be examined for inflammation, discharge and other abnormal conditions.
• The doctor will take a Pap smear, which involves collecting a few cells from your cervix to check for cancerous or pre-cancerous cells. Many women feel this is the most uncomfortable part of the exam, and it's not unusual to experience slight cramping during this procedure.
• The doctor may also conduct a test for sexually transmitted diseases, which involves collect a sample of cervical mucus with something that looks like a long Q-Tip.
• At some point during the internal exam, the doctor will perform what's called a "bimanual exam," during which s/he will insert two gloved, lubricated fingers into your vagina. With the other hand, s/he will press down on your lower belly to feel for your internal reproductive organs.

After the Exam:

Congratulate yourself on taking care of your gynecological health!

Finding a Doctor

Many plus-size women delay getting gynecological care because of prior mistreatment by health care professionals. Take the time now to do research and find a doctor who will treat you with the respect you deserve. Here are a few tips to aid your search:

• Talk to friends - Ask your plus-size friends for referrals to size-friendly gynecologists.
• Send a mailing - Get a list of gynecologists from your health plan - or even look in the phone book - write letters of inquiry. State that you're a plus-size woman, give a brief synopsis of your health history and outline your concerns about unbiased care. Ask if the clinician has experience with plus-size patients, and if s/he is willing to treat you, rather than your weight.
• Interview doctors - Set up short appointments with the doctors you're considering, in order to determine if you and the doctor would make a good team. When making the appointment, be clear that it isn't for an exam, but rather just to talk.