Your First Time

This story originally appeared in Teen Vogue

What’s Up, Doc?

Here’s what you need to know for your first to a gynecologist.

Jasmine, seventeen, is sitting in the waiting room of a doctor’s office. She’s nervous—this isn’t a routine checkup. It’s her first gynecological exam. “No one has ever looked at me down there before,” she says. Her friends who’ve been examined haven’t done much to relieve her anxiety. “I know they stick something cold in there,” she reports. It didn’t help when she went to the movies the night before. “There was a gynecology scene—they didn’t exactly show what was happening but you could tell what the doctor was going to do. I was like “Oh nooooooo!”

Jasmine isn’t the only one who’s uncomfortable with someone she’s never met before looking at her “down there.” In one infamous episode of Sex and the City, Samantha tries to calm down shy Charlotte, who has just had an unfortunate trip to the gynecologist, by telling her, “It’s just a vagina.” But even if you’re not as blase as Samantha about matters pertaining your private parts, seeing this vitally important doctor is a necessary step in taking control of your health and your reproductive destiny, says Dr. Carrie Cwiak, assistant professor of gynecology and obstetrics at the Emory University School of Medicine. “It’s something every woman goes through,” she points out, “It’s a rite of passage.” Here are the most important things you need to know for your first time.

How do I know if I need to see a gynecologist?

“The most common reason is because girls are, or are thinking about becoming, sexually active,” says Paul Blumenthal, a Baltimore gynecologist. A gynecologist (or a nurse practitioner with a focus on gynecology) can help you determine which birth control method is going to work best for you, and talk to you about STI prevention. “Sexually active” in this context means any kind of sex: oral, vaginal, or anal, giving or receiving. Be completely honest with your doctor about what you are up to: he or she is there to treat you, not to judge you. You should also go if you have a specific concern (ie. you haven’t gotten your period by age sixteen, you got your period once and haven’t gotten it again for over a year, your periods are incredibly heavy or painful, you think you might have an infection).

How can I find a good gynecologist?

“I think you have to find someone who really specializes in adolescent gynecology,” says Dr. Laura Schiller, a Manhattan gynecologist. So try asking a friend for a referral rather than just going to see your mom’s doctor. If no one you know has a name for you, you might want to ask your school nurse or call a local clinic such as Planned Parenthood.

When should I make an appointment?

Schedule for a day when you’re in-between periods, because blood in your cervix or vagina can interfere with test results. (And you shouldn’t be douching anyway, but definitely not before your visit, says Dr. Schiller.Douches will wash away your secretions, making it harder for the doctor to tell if everything is functioning properly. )

What if I want to talk to the doctor about sex or other things I don’t want my parents to know about?

“Your mom can call and hound us, and I’m not going to talk to her unless you’ve given me permission,” says Dr. Schiller. But not every doctor is as conscientious about patient confidentiality. Under HIPAA, the Health Insurance Portability and Accountability Act, doctors are required to have you sign a privacy policy, but it does have exceptions (and some deferrals to state law) that allow doctors to disclose information about minors to their parents. If you have any concerns, check to see if your provider’s policy says anything about maintaining privacy for minors. If it doesn’t, ask. “Have a conversation with the provider and confirm confidentiality if it concerns you,” says Dara Klassen, Director of Legal Affairs for Planned Parenthood Federation of America. If the provider won’t guarantee your privacy, go elsewhere. (Planned Parenthood does guarantee privacy to minors in all of its clinics.)

What will the doctor want to talk about?

Before your exam, your doctor will probably want to have a talk about your general health. Be prepared to discuss your sexual history (if you have any), what you eat, whether you exercise, if you take any drugs or drink, just to name a few possible topics. Be open and honest. “We are not the police,” says Dr. Blumenthal, “If we ask a question it’s because the answer will reflect on the patient’s health status and maybe help us find the best treatment or solution to a health problem or need.” For example, a teen who is not getting her period but has healthy eating patterns will be treated differently from a girl who isn’t getting her period and is skipping meals (in the latter, it could be a sign of an eating disorder). And if you ever use drugs or drink, you may be more likely to end up in a sexual situation—in which case the doctor will want to discuss contraception. You should also bring up any concerns you might have, like cramping or mood swings, or feel free to ask questions about birth control or Sexually Transmitted Infections.

What is a breast exam like?

“The younger you are, the less likely you are to have breast cancer,” says Dr. Cwiak. But since early detection of any tumors is critical, a gynecologist may still want to perform a breast exam. After you finish talking, you’ll be asked to lie with your back on the table with your gown open and put your feet in footrests (sometimes called stirrups). The doctor or nurse will give you a breast exam by pressing with his or her fingers on different parts of your breasts, and show you how to do a self-exam.

Do I have to have the pelvic exam?

According to Blumenthal,  there is little reason to do a pelvic exam if a teenager is not sexually active. If your doctor does perform a pelvic exam, he will probably explain what’s going to happen to you before the exam begins, and keep you informed about what’s happening throughout the procedure.

What is the pelvic exam like?

Your doctor will sit between your legs on a stool and insert a speculum into your vagina. The speculum is a small (about the size of a tampon) device that allows the doctor to look at the walls of the vagina and the cervix. “You are going to feel pressure, but it shouldn’t feel painful,” says Schiller. If anything hurts, you can ask your doctor to stop. The doctor might take a qtip and swab the vagina, then send that specimen off to the lab. If you’ve already been sexually active, the doctor might perform a Pap smear, which tests for HPV, the human papilloma virus, a Sexually Transmitted Infection that can be a precursor to cervical cancer. A Pap smear means that the doctor will take a wooden stick like a popsicle stick and rub it against your cervix. That specimen would also be sent off to a lab for examination. After the speculum is removed, the doctor might insert a finger into your vagina or your rectum, or palpitate your stomach to check for any irregularities. The entire exam shouldn’t take more than seven to twelve minutes. Testing for other STIs like gonnorhea, chlamydia, and even trichomonias might not be a matter of course, even if you are sexually active, depending on your doctor and/or your insurance coverage. If you want to make sure you get tested for these or other STIs, make sure to ask.

What if I forget to ask my doctor an important question?

Before the visit is over, ask your doctor how you can get in touch if you have any further questions. Most gynecologists encourage regular contact, and will return calls from patients by the next day if not the same day.

Will I need to come back?

Typically, about a year later, according to Dr. Cwiak. You might need to go back sooner if you’ve had a Pap and the results are abnormal, or if you have any other problems, such as side effects from birth control. Dr. Cwiak also suggests that you ask your doctor for a prescription for emergency contraception. “Even if you don’t need it that day,” she says, “you can keep it on hand in case you ever need it.”

—Mikki Halpin

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