Preparing for Your First Gynecology Exam
- Dr. Heather Swain PT, DPT, CIDN, CPT
- 6 days ago
- 10 min read
Whether you are going to the gynecologist for the first time yourself, or perhaps looking to make your daughter's first trip less awkward, this post is for you. You're not alone if the idea of going to the gynecologist yourself, or the idea of your child going, makes you a bit uneasy.
Although women are typically more comfortable, and more frequent consumers of healthcare services than men, there are some appointments that women prefer to avoid. Reproductive and sexual health care visits usually rank high on the list of 'least favorite doctors' appointments'. Our relationships with our bodies around the topics of sex and reproductive health are complicated.
Though there are many cultural and social factors that influence our views of ourselves, it's clear that this broken relationship with our self-image is a long-standing trend. It was perhaps captured best by the early Renaissance artist Masaccio in Expulsion from the Garden of Eden. The artist makes quite the insightful social commentary on the differences in how males and females view the less desirable parts of their humanity. The scene displays Adam and Eve leaving the Garden of Eden after they have sinned and eaten the fruit from the forbidden tree. The artist's portrayal depicts Adam covering his face (and emotional distress), while making no effort to conceal his genitals. Eve, in contrast, covers her body and leaves her grief-stricken face in full view. Many would agree in modern society, that not much has changed.
Although Renaissance artists were comfortable painting nude subjects on church walls and ceilings, many people throughout history haven't been. Ironically, fig leaves were added to this painting later by a generation that viewed the nudity of the subjects as inappropriate for display in public artwork (pictured, left). The leaves were removed in a restoration of the artwork to its original form in the 1980's (pictured, right). (1) If you are hoping to restore comfortability with your body before your first gynecology visit, check out our post: Reclaiming the Vulva (Coming Soon).
In the meantime, let's cover some questions to ask yourself in advance to help you be as comfortable as possible with your gynecology exam. These can help you feel more in control for your upcoming visit. We'll also cover some comforting perspectives to put your mind at ease.
Preference Questions to Ask Yourself
Comforting Perspectives
Do I prefer someone that I already know and trust, or someone I've never met?
Assuming that you have grown up with the societal norm that taking your clothes off in front of other people is not socially acceptable, having a gynecology exam can feel awkward. For a woman's entire life, she has most likely been taught not to show her vulva to other people. That line of thinking often doesn't magically disappear when it's time to go to the gynecologist.
It may help to consider your upbringing and how you have learned to view your body. For people who have learned that they should only be naked in front of another person in a serious committed relationship, such as a marriage, the idea of seeing a total stranger for a gynecology exam may feel incongruent.
Some people feel that due to the more personal nature of the exam, they prefer someone that they know well and trust. Disrobing in front of a complete stranger may feel more inappropriate than disrobing in front of a primary care doctor who knows you well.
On the other hand, the closeness of a relationship may make some people feel more uncomfortable. Some people prefer to see a gynecologist because they have a close relationship with their primary care doctor, and it may feel awkward to them to see their primary care doctor on a regular basis knowing that they have seen their vulva.
This is ultimately a question of personal preference. There isn't a wrong answer; it's about choosing what makes you more comfortable.
Do I prefer to see a specialist, or ask my primary care doctor?
Many primary care doctors feel comfortable performing what's called a well woman exam. Primary care doctors often treat patients with routine gynecological issues such as yeast infections. There are some pros and cons to consider about having your first exam done by your primary care doctor, as opposed to a gynecologist.
Experience level: This is a double-edged sword. There are advantages to seeing a specialist who performs vaginal exams every day. They are very comfortable performing the exam. They have more specialized knowledge, which can be helpful especially, if you have concerns about your pelvic health.
You should consider, though, that sometimes when a provider does something every day, routine can be blinding. Despite their best efforts, providers sometimes forget that just because they do this exam every day, doesn't mean that you do.
A gynecologist may be more likely to rush, or may explain less about what they are doing because they don't realize that it isn't routine for you. Regardless of whether you decide to have your first gynecology exam performed by a primary care doctor or a gynecologist, you should always remind them when they walk in the room that this is your FIRST exam.
The gynecologist may see you on their schedule as a new patient, but that doesn't mean they know that this is your first exam; especially if you are older. They may assume someone else has examined you before and you are just establishing with their practice as a new patient. To be clear, when we say "older", we mean older than 18. While in other contexts 18 wouldn't be considered "older", many women have their first gynecology exam younger than 18 either due to menstrual problems, or being sexually active.
Reminding your provider that this is your first exam, encourages them to slow down and explain to you everything that they are doing. To a gynecologist, your visit is just another routine exam. As a person who is nervous about their first exam, it might be hard for you to imagine, but your exam is the easy part of your gynecologist's workday. It's similar to seeing your primary care doctor for an annual physical, rather than because you are sick and need advice on a symptom/problem. To the gynecologist, your exam is routine.
In contrast, because a primary care doctor most likely does fewer well woman exams, they are generally less likely to rush. For them, this is a higher liability service. They are more likely to be careful to explain the exam well and be mindful of everything they are doing.
Most healthcare providers live with varying degrees of underlying fear of lawsuits. When it comes to evaluating pelvic health, there is more opportunity for a patient to allege inappropriate behavior. Primary care doctors know this and most likely will be more conscientious accordingly. OB-GYNs, on the other hand, may be a bit thicker skinned to the idea of lawsuits. The American Medical Association reports that 63% of OB-GYNs have been sued at least once. (2). In their line of work, lawsuits are normative. It's more a matter of when they are sued, not if they are sued.
This doesn't mean that most OB-GYNs are not good doctors. While some lawsuits are based on legitimate claims of neglect and malpractice, many healthcare lawsuits ultimately end with the provider being cleared of wrongdoing. If it gives you peace of mind to check out your doctor's record, medical licensing boards make any disciplinary action on a provider's license public records. A search engine query for the electronic licensing board in your state will typically yield an e-licensing website that gives you the opportunity to input your provider's name and check their record.
Do I prefer a male or a female provider?
There are some generational and cultural perceptive differences here. For those who grew up in the baby boomer and Gen-X generations, the majority of doctors were male. The idea of seeing a male gynecologist was so commonplace that women didn't think of it as odd.
As Millennials and Gen-Z started to come of age for gynecology exams, female doctors were increasingly common. When given the option, some patients have strong opinions on preferring a male or female provider.
Reasons people give for preferring a female provider include:
She has a vulva too, so she would know what it feels like to have an exam and would understand better.
Some people question why a male doctor would choose this specialty; they wonder if he is "a creep".
Patients with a history of sexual abuse perpetrated by a male may feel more comfortable with a female provider.
Religious reasons: some religions prohibit women from being touched by male doctors who are not their husbands or an immediate family member.
Sexual orientation: some patients are more comfortable with a female provider if they identify as heterosexual. They may feel inappropriate having their bodies examined by a male provider.
Reasons people give for preferring a male provider
The belief that, because the male provider does not have a vulva, he will do a better job of listening and trying to understand. His lack of personal experience can be seen as a positive. The patient is concerned a female provider may be biased. The female provider may assume that because the female provider's body functions a certain way, that the patient's should too.
Patients with a history of sexual abuse perpetrated by a woman may feel more comfortable with a male provider.
Sexual orientation: some patients who identify as lesbian/homosexual may feel inappropriate having their body examined by a female provider.
Who do I want in the room?
For some, the idea of going into this kind of appointment alone is frightening. They may feel safer having someone they know and trust present during the exam to make sure that nothing inappropriate is happening. This is especially true for individuals who have experienced trauma and struggle with freezing responses in stressful situations.
This may take the form of having a parent present, or it could be an older sibling, a friend, or a partner.
If you are a parent trying to help your daughter prepare, this is an important conversation to have. A teenager may not want their parent to be present for this kind of examination. They may also be more comfortable with it and prefer it depending on the scenario.
It's important to take time and explain the options to your daughter. For example, it is possible for you to be in the room with her for the exam, but not see her body. She may not understand this until you explain it. Remember, she has no frame of reference for what will happen at this appointment.
Frequently, if parents are present in the room, they will be sitting next to their daughter. Their daughter will have a sheet across her lap that keeps her body covered so that the only person who can see it is the doctor and perhaps the medical assistant chaperone who is present. The medical assistant chaperone may be present both for legal reasons to protect the doctor, and to assist in documentation while the doctor is working.
While talking with your daughter about the process is generally a good thing and creates a culture of openness, some teens may not want to have this conversation with their parent. If so, providing your daughter with a written explanation of what to expect during a gynecology exam, and giving her the opportunity to ask you questions afterwards, may make her more comfortable. (Coming soon, see: Understanding the Process-Your First Gynecology Exam)
Comforting Perspectives
Patients have privacy rights
We often share details about our health with our doctor that we don't share with everyone. Doctors are held to legal standards when it comes to protecting your personal health information. If you share information about your gynecological health with a doctor, they cannot share it without your consent. There are a few exceptions to these rules in the fine print of your HIPPA privacy notice, but they are extreme cases. If you are not a missing person in a police investigation and a judge is not signing a court order to have your records released for example, your information should remain private.
Providers' point of view
While it may sound a bit cold, doctors are often expected to see a lot of patients in order to meet their productivity requirements and justify their salaries. The average doctor's appointment is scheduled for 10-15 minutes. You may get slightly more time as a new patient, but on the whole, many gynecologists won't remember you very well. If your gynecologist is seeing 30 patients in an 8 hour day, that makes 150 patients in a week, and 7,500 visits in a year. When a provider sees so many different people, things start to blend together.
Keep in mind that if you are healthy, you will probably only see your gynecologist once a year. To put it plainly, even if you saw them in the grocery store, they most likely won't remember you. It may also be a comforting thought for you to recognize that, if you don't live in a small town, chances are, you have never seen your doctor outside of their office anyways, and most likely never will.
If your gynecologist is an OB-GYN, they may also deliver babies. Babies come on their own time, and delivering babies means that you will work inevitably work some night shifts. If one of the other doctors in their practice calls out sick with the stomach flu, OB-GYNs don't have the luxury of cancelling deliveries and telling pregnant women to wait to deliver until the next day. If this happened to your OB-GYN the day before your exam, they may be coming to work pretty tired. If you add in the sleep deprivation factor, it's even less likely that your OB-GYN will remember your routine gynecology exam.
Closing Thoughts:
While these questions and topics help many people gain a sense of control over their healthcare experience at the gynecologist, and put their minds at ease, it isn't an exhaustive list. It's always good to ask yourself, or your daughter, "What do I need to feel comfortable?" and "What variables am I able to control to give myself more decisions?" Does keeping your socks on make you more comfortable? Going first thing in the morning after you've been able to shower? Knowing you have something to do beforehand to keep your mind distracted? There are many individual preferences that you can control to consider.
This post is intended for educational purposes and is not a replacement for individual medical advice. You are encouraged to work with your team of healthcare providers, such as your primary care doctor, gynecologist, counsellor, or pelvic floor physical therapist, to find the best solution for your unique situation.
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