I want to get on birth control, but I'm scared to go in for a gynecological exam. I am 18 and a first year. Could you describe what it's like please?


Dear First-Timer,

It's great that you're thinking ahead about birth control, and you're definitely not the only one who finds the prospect of a GYN exam a tad scary. But take heart — the exam should be painless, and your health care provider has seen the 'view from below' of lots of other women, so you don't have to be self-conscious about whatever you're going to show off.

An annual gynecological exam is a chance to assess your general health including your heart's health, blood pressure, and weight, as well as have a breast exam and a pelvic exam. It's also an opportunity for you to ask your provider any questions you may have, including those about the plethora of birth control options.

The provider may be a physician, a nurse practitioner, or a practical nurse. For the pelvic exam s/he will look at your vulva, examining the inner and outer lips, clitoris, and the vaginal opening. After that s/he will insert a speculum, an instrument that keeps the walls of the vagina open in order to examine your cervix. The provider will take a swab sample of your cervix to collect cells to examine in a laboratory for cancerous or pre-cancerous growths or other abnormalities. This simple test, called a Pap smear, is a critical part of every woman's yearly health exam because early detection and treatment of problems can reduce future complications. After the swab, the provider will insert a gloved finger into your vagina to feel the position of your uterus, fallopian tubes, and ovaries. The pelvic exam itself only takes a few minutes, so if you focus on relaxing and breathing deeply, it'll likely be over before you know it!

A Pap smear tests for cervical cell changes that are primarily due to human papillomavirus (HPV), a sexually transmitted infection (STI) that causes about 95 percent of all cervical cancers. In June 2006, the federal Advisory Committee on Immunization Practices recommended that all females aged 11 to 26 receive an HPV vaccine, ideally before becoming sexually active. You can ask your provider if the vaccine makes sense for you.

A Pap smear does not test for STIs, so if you have had sex, it's a good idea to get tested for STIs like gonorrhea, chlamydia, and HIV.

Because so many people feel nervous or uncomfortable about GYN care, most providers try hard to be sensitive and do whatever they can to help you feel at ease. They're there to help you, so being as open as possible about concerns you have about the exam itself or your sexual health will help you get the best care possible. Columbia students can call x4-2284 for more information about gynecological services available through Primary Care Medical Services.

Good luck!

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