What to expect at your Gynecologic visit

What Happens During a Gynecologic Visit?!

One of the most frequently asked questions by women worldwide is "what should I expect from my annual Gynecologic visit?". 

Well the answer is simple; your gynecologist is your primary health care provider. 

It is crucial for everyone to have his/her own health care provider, and the best one for women is their Gynecologist. 

During your yearly visit, your Gynecologist will ask you basic general health questions (past medical history, past surgical history, social history (smoking, alcohol, drug use...), medications use, vaccination records and family history of diseases and cancers). Indeed, you may find these questions sometimes irrelevant to your chief complaint or reason for visit, however every question has its own worth and will guide your doctor for a better, more tailored plan of management. 

Also your physician is expected to dwell more into any gynecologic concerns (abnormal uterine bleeding (ie. abnormal patters in your menstrual cycle), abnormal vaginal discharge, abnormal itching "down there", any urinary symptoms (burning sensation, blood in urine, frequent urination, incontinence...), abdominal/pelvic pain..) 

Also expect your gynecologist to go deep into your sexual history, so don't be shy! The doctor-patient relationship is sacred and private, so don't hesitate to be talkative and expressive of all your concerns. If you feel uncomfortable with or judged by your physician, switch to another. You should know that it is never your fault for being uncomfortable, instead it's the duty of your physician to make you feel at ease especially when tackling such private matters. 

Later your gynecologist will register the date of your last pap smear (the smear for cervical cancer screening), last mammography (screening modality for breast cancer), last colonoscopy (screening modality for colon cancer) and last DEXA scan (bone scan as a screening modality for osteoporosis or brittle bones). 
To note that a pap smear is recommended to be done every three years as of the age of 21 for all sexually active women, until the age of 65 (if adequate screening history is available). Mammography is recommended to be performed on a yearly basis after the age of 40 as per the American College guidelines. And colonoscopy is recommended to be done every 10 years as of the age of 50 (or earlier in the setting of a personal or family history of colonic polyp/cancer). Finally the DEXA scan should be performed every 5 years after the age of 65 (or earlier in high risk women for brittle bones).

After this thorough history is over, your physician will examine you. Expect a chaperone to be present in the examination room during your physical exam.
The examination in the gynecologist clinic is not limited to the pelvic exam!
It is crucial for your physician to check your thyroid gland (the gland your doctor feels over the anterior aspect of your neck), and to check your heart, lungs and lymph nodes (lymph nodes are small structures that can be felt by your physician in the neck, upper chest, underarm and inguinal regions, they can be significant in the setting of malignancies or infections)
Also expect your physician to do a breast examination to assess for any breast skin changes, dimples or masses that warrant further investigations.
Then comes the value of the abdomino-pelvic examination which always starts with the general abdominal palpation for any painful areas or masses. 

Finally the physician will end the examination by doing the pelvic exam by assessing any skin changes, redness, scales or evidence of infections "down there". Also your physician will perform a speculum examination (if you have ever been sexually active) in order to assess the vaginal tissues and the cervix. A pap smear would be performed during this step (if due). 

Moreover, some schools recommend an annual vaginal ultrasound to be performed during the same visit in order for the physician to check on the ovaries and uterus (you should know that this step is debatable in the States for financial reasons and lack of cost-effectiveness. Yet in Lebanon and other countries where Ultrasound machines are readily available free of charge in the clinics, performing an annual ultrasound becomes of paramount value)

So in conclusion, your annual gynecologist visit is more than a pap smear or pelvic exam.
Your gynecologist is your PRIMARY HEALTH CARE PROVIDER, and visiting him\her on a yearly basis is of cardinal importance.

Know what to expect and trust in your physician

Be safe! 

Karam 


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