Generality
The first gynecological examination is a very important appointment to assess the health status of every woman's genital apparatus .
This exam allows to inspect and verify the correct functioning of the reproductive organs, allowing an approach to the various aspects of intimacy (periodicity of the menstrual cycle, contraceptive methods, sexual life, fertility and pregnancy). From an early age, the first gynecological examination is also useful to learn about the pathologies that can involve the genital system (vaginal infections, ovarian cysts and various other problems) and to know how to identify suspicious signals related to them early.
The first gynecological examination includes three main moments:
- Informative interview : it precedes the actual gynecological examination and serves the doctor to collect the patient's clinical data. During this initial interaction, the stages in which the first gynecological examination takes place are explained, step by step.
- Inspection : consists of simple observation of the external genitalia. Through inspection, the doctor can highlight any inflammatory states, malformations or other injuries.
- Internal examination : this control involves the evaluation of the internal organs (uterus, ovaries and vagina) through bimanual palpation, vaginal exploration and visit with the speculum. If you have not yet had sexual intercourse, this part of the first gynecological examination can be modified: if necessary, for example, the rectal examination could be performed.
In addition to having diagnostic purposes, the first gynecological examination allows screening tests to be carried out, useful for the prevention of female tumors, such as the Pap test.
What's this
First gynecological examination: what does it consist of?
The first gynecological examination is a specialist examination that is performed by the gynecologist, to ascertain the health status of the female, external and internal genital organs (vagina, uterus, ovaries and fallopian tubes). The purpose of this assessment is, first of all, to assess the correct functioning of the reproductive system, in addition to identifying the pathologies and dysfunctions that can affect it, improving the possibility of treatment.
Why do you run
First gynecological examination: what is it for?
The first gynecological examination is an exam that allows:
- Evaluate the normal state of the female genital system;
- Diagnose or rule out the presence of diseases, including endometriosis, fibroids or uterine cancer.
During the first gynecological examination, the interaction with the doctor is useful for the patient to ask questions and ask for explanations, of which one feels the need, concerning intimacy . Furthermore, during this exchange, the gynecologist provides information on correct lifestyles and risk behaviors (eg contraception, hygiene habits, diet, etc.). In other words, the first gynecological examination is a moment that can be exploited to deepen the knowledge of one's body, remove some curiosity and feel relieved if some concern arises about one's health, contraception or sexuality.
In addition to having diagnostic indications, the first gynecological examination can be associated with:
- Therapeutic acts : if any pathologies are found during the examination, the first gynecological examination is useful to address a treatment plan;
- Screening investigations : during the first gynecological examination, the gynecologist can take samples useful for reference investigations for the prevention of cervical cancer, such as the Pap test and the HPV test, where early diagnosis is essential.
When it is indicated
First Gynecological examination: when to do it?
The first gynecological examination is very useful when a woman becomes familiar with her body and begins to be aware of her femininity. Therefore, the exam should be scheduled when you want to have the first report : the interaction with the gynecologist allows you to acquire a good sex education and monitor your health status .
The first gynecological examination is strongly recommended even if particular problems such as:
- Vaginal pain;
- Intimate burning or itching;
- Vaginal discharge different from the usual in color, consistency, quantity and / or smell;
- Disorders of the menstrual cycle (irregularity, painful and / or hemorrhagic menstruation, amenorrhea, etc.);
- Pelvic pain of any kind (during menstruation or other days);
- Breast or nipple changes (tenderness, palpable nodules, cysts or nipple discharge);
- Blood leaks between cycles;
- Pain during sexual intercourse (dyspareunia).
The first gynecological examination can also be carried out for the prescription of contraceptive therapy or in the case of occasional unprotected sexual intercourse, especially if it is suspected of having contracted a venereal disease.
First gynecological examination: can it be done if you are still a virgin?
The first gynecological examination can be performed even if there have not yet been cohort relationships; in this case, the doctor will be as gentle as possible and will use appropriate tools, which can also be introduced through an intact hymen.
For virgin women, if necessary, the gynecological examination could be performed rectally.
At what age do the first gynecological examination take place?
The age at which to undergo a gynecological examination for the first time is variable. In general, it is good to undergo a check between 16 and 21 years, to check that there are no problems, or within a year of the first sexual intercourse . Of course, it is possible to go to the gynecologist even earlier, to clarify all the doubts concerning the menstrual cycle (eg periodicity, abnormal losses, how to treat hygiene during menstruation etc.).
As anticipated, regardless of young age, the first gynecological examination should be scheduled even if particular disorders arise (eg inflammation of the external genitalia, alterations in the development of the genital apparatus and hormonal dysfunctions), of which symptoms can be spies such as:
- Abundant or smelly vaginal discharge;
- Intimate itching or burning;
- Lower abdominal pains;
- Abdominal swellings;
- Irregular cycle or absent at 15-16 years.
For girls, the first gynecological examination is useful for an approach to aspects of sexuality that are unclear (note: with the menarche and the first ovulation, the beginning of a pregnancy is possible) and to receive advice on the available contraceptive methods and best suited to your needs.
Preparation
First gynecological examination: how to prepare for the appointment?
- To undergo the first gynecological examination there is no need for a particular preparation, but, if it serves to feel at ease, it is possible to wash and shave as usual (in general, the presence of superfluous hair is not a detail that to the doctor it matters).
- To carry out the first gynecological examination, it is advisable that the rectum and bladder are empty, unless otherwise indicated by the doctor (for example, due to the need to perform a pelvic ultrasound).
- During the first gynecological examination, it is very likely that the doctor will ask you to remove your briefs and unfasten the bra. For this reason, it is better to opt for comfortable and practical clothes to put on and take off.
- As for menstruation, if the first gynecological examination is scheduled for a check, it is preferable to fix it in the absence of the flow. The best time to perform the exam is from the 10th to the 18th day from the beginning of the menstrual cycle.
How it happens
In general, the first gynecological examination involves three main phases:
- Informative interview (anamnesis).
- External exam :
- Inspection and palpation of external genitalia;
- Internal examination :
- Examination with the speculum;
- Vaginal exploration and bimanual palpation;
- Rectovaginal palpation or rectal exploration (sometimes).
Faced with specific needs or problems, this basic scheme can be modified by the gynecologist, adding a breast examination or supporting instrumental investigations . For example, the first gynecological examination can be completed by a transvaginal ultrasound, to assess the presence or suspicion of diseases such as fibroids, endometrial polyps or ovarian cysts.
Initial interview: what is asked?
Like any other medical check-up, the first gynecological examination includes an initial interview. This interaction allows the collection of the patient's medical history, taking into consideration the main reason for the visit (check or suspected pathology).
The questions asked by the gynecologist include:
- Date of the last menstruation;
- Age of onset of the first menstruation (menarche);
- Characteristics of the menstrual cycle: rhythm (ie every how many days there are menstruation), loss of blood between one cycle and another, presence or absence of premenstrual syndrome, etc .;
- Characteristics of menstruation: quantity and duration of losses, presence or absence of dysmenorrhea;
- Daily use of drugs (which and why);
- Most important diseases of family members (family history), such as tumors, diabetes, menstrual irregularities, early menopause, thyroid dysfunction and coagulation disorders.
This part of the appointment is also important to overcome the embarrassment or anxiety associated with this "delicate" moment.
Regarding the disorders (if any) that induce the girl or woman to contact the gynecologist for the first time, it is necessary to report:
- Signs and symptoms (vaginal discharge, itching, intimate burning, pain, etc.);
- Moment and circumstances in which they occurred;
- Factors that make them worse or contribute to alleviating them;
- Diagnosis or examinations already carried out by other specialists (in this case, it is useful to bring the documentation with you).
During this first phase of the gynecological examination, the doctor can collect information about any illnesses he had in the past, allergies, surgical interventions and lifestyle (smoking habits, alcohol or drug intake, sports practiced, sleep quality, appetite disorders and body weight, possible constipation and disorders of urinary function). The interview can end with the detection of blood pressure, weight and height.
External examination
To perform the first real gynecological examination, the patient is seated on the gynecological table, which includes two supports to support the legs and keep them raised and spread. The position may seem uncomfortable or embarrassing, but it is the best way to perform the exam.
The first gynecological examination involves the inspection of the pelvic region, of the hairs, of the adipose panniculus and of the pubic skin, followed by the examination of the inguinal lymph nodes and external genitalia (hymen, clitoris, large and small lips, urinary meatus, outlet of the vaginal glands, perineum and anus). These anatomical regions are examined to verify that there are no signs of infection, malformations, inflammations or other abnormalities, such as swelling, erythema, pigmentation changes, hematomas, ulcerations and nodules. The observation of large and small lips allows to highlight sore spots, redness, swelling or abnormal secretions.
Internal examination
During the first gynecological examination, the internal examination involves two moments:
- Examination with the speculum . It consists in introducing into the vagina an instrument consisting of two valves that can spread apart (speculum), which allows the visualization of the inside of the vagina, the neck of the uterus (or cervix) and to perform a Pap test (or Papanikolaou test ). The speculum is not used if you do not yet have sexual intercourse. This phase of the first gynecological examination allows us to highlight any abnormalities present, such as, for example, inflammation, polyps or suspected lacerations.
- Vaginal exploration and bimanual palpation . Once the speculum has been removed, the first gynecological examination involves the evaluation of the uterus and annexes . The gynecologist introduces the index finger (or index plus the middle finger) of the right hand into the vagina and, with the left hand presses the surface of the abdomen, to analyze the position and volume of the pelvic organs (uterus and ovaries).
- Rectal examination. In some cases, rectal exploration replaces vaginal examination in virgin women or in those situations where it is difficult ( vaginismus ) or impossible. These controls allow to appreciate the posterior wall of the uterus and highlight new growths or collections that can be easily examined from the finger introduced into the rectum.
Breast examination
The doctor can complete the gynecological examination by performing the examination of the breast, by inspection and palpation, to check that there are no nodules or other abnormalities.
After the evaluation, the doctor teaches the patient how to perform breast self-examination ; this should be done by every woman once a month, preferably a week after the end of menstruation, when the breast is not swollen or sensitive.
First Gynecological Visit: how does it end?
At the end of the first gynecological examination, the doctor will give the patient a description of what he has been able to verify. If, during the examination, pathologies have been found, the gynecologist can investigate the clinical picture by performing other investigations (eg pelvic or transvaginal ultrasound, colposcopy, cervical swab, endometrial biopsy, etc.) and establish the most appropriate therapeutic program for the case.
Some advice
First gynecological examination: is it painful?
If the vaginal musculature is relaxed, the first gynecological examination is not painful and is certainly of better quality. During the exam, it is useful to remember to breathe slowly and deeply, trying not to stiffen the abdominals.
After the first gynecological examination: how often do you check?
Regardless of age, it is advisable to undergo an annual or biennial gynecological check-up, even if it looks good. In the presence of particular problems that require more frequent monitoring, the gynecologist may indicate a different periodicity.
