Your First OB-GYN Visit

Part of growing up is learning to take care of your body.

This means making good choices for your health, avoiding things that can hurt you, and seeing a doctor - including an obstetrician gynecologist - at least once a year for care. This doctor also is called an OB-GYN. You and your doctor will talk about your general health and any problems you may be having. You also will discuss when you should have a pelvic exam and Pap test. This article will help answer some of the questions you may have about your visit.

Doing Your Part for Your Health

Seeing your doctor every year is part of taking care of yourself. Routine care will help:

• Prevent health problems from happening
• Find problems early and control them or keep them from getting worse
• Teach you good choices to make for your health

You can play an active role in your health care by getting care and being open and honest with your doctor.

What To Expect at Your Visit

You should have your first OB-GYN visit when you are between the ages of 13 and 15 years. You will feel more at ease at this visit if you know what to expect.

Questions Your Doctor May Ask You: What is the reason for your visit? Do you have any health problems? Have you started having periods? If so: How old were you when you started your period? What was the date of your last period? How often do you get your period? How long does your period last? What is the amount of flow (light, medium, heavy)? Do you have cramps? What is your family's medical history (for instance, has anyone in your family had cancer)? What did you eat yesterday? Do you exercise or play sports? Do you take any medicines? Do you take any vitamins, herbs or supplements? Do you use tobacco, alcohol or other drugs? Have you ever had sex? If so: When was the last time you had sex? What do you do when you have sex? Do you use birth control? Within the last year, have you been hit, slapped, kicked, or been physically hurt by someone? Are you in a relationship with a person who threatens or physically hurts you? Has anyone forced you to have sexual activities that made you feel uncomfortable? Do you ever feel sad or as though you have nothing to look forward to?

Getting to know and trust your OB-GYN is a good idea. In fact, the first visit may just be a talk between you and your doctor to get to know each other and to find out what to expect at future visits.

You can play an active role in your health care by getting care and being open and honest with your doctor.

Confidentiality Many young women want to talk to their doctors, but they are afraid that what they tell their doctor will not be confidential Ñ that is, that the doctor will tell someone else, like their parents. If you are concerned about confidentiality, you and your doctor should talk about it before you answer any questions. Your doctor needs to talk about confidentiality with your parents, too. It may be good for all of you to sit down together to discuss this. Or, your doctor may choose to talk alone with each of you.

You may have certain exams at the first visit. It depends on your age, if you have had sex, or if you have any problems. Tests may include:

• General physical exam
• Pelvic exam
• Breast exam
• Pap test
• Further tests

It is normal to feel nervous about your first visit. There is no need to feel scared or embarrassed. If you are nervous, talk to your doctor, your parents or someone else you trust about it.

Symptoms That Need Care If you are having any of the following symptoms, see a doctor:  Severe pain in the lower abdomen Bad cramps during your period Periods that are not regular Pain around the vagina or swelling, itching or discharge Blood in your urine You think you may be pregnant (for instance, you have missed your period) Signs you may have an STD (for instance, you feel burning or itching or have discharge)

Your doctor may ask a lot of questions about you and your family. Some of these questions may seem personal (see box). Your doctor needs to ask them to best know how to care for you and keep you healthy. Giving open and honest answers to these questions is key to your care.

This is a good time to ask your doctor any questions you might have. Don't be embarrassed. This is a chance to get answers.

Exams

During your exam visit, your height, weight and blood pressure will be checked. Your OB-GYN may do a breast exam, pelvic exam and Pap test. All women who are 18 years of age or older or who have had sex should have a pelvic exam and Pap test. You also may need an exam if you are having health problems (see box). You or your doctor may request to have a nurse, family member or friend in the room with you.

The Breast Exam

At one of your visits, your doctor may check your breasts for signs of any problems. He or she also may teach you how to examine your breasts.

How To Do a Breast Self-Exam Looking The self-exam should always be done in good light. Stand or sit in front of a mirror. Place arms at your sides. Look for dimpling, puckering or redness of the breast skin; discharge from the nipples; or changes in breast size or shape. Look for the same signs with your hands pressed tightly on your hips and then with your arms raised high. Feeling Lie flat on your back. Place a folded towel or a pillow under your left shoulder. Place your left hand under or over your head. You also can feel for changes when you are standing. With your right hand, keeping the fingers flat and together, gently feel your left breast without pressing too hard. Use one of the three methods shown here. Then lower your right arm and do the exam on the other breast.     Choose one of these methods  Circle: Begin at the top of your breast and move your fingers slowly around the outside in a large circle. When you return to the top, move your hand a little closer to the nipple and make a smaller circle. Do this in smaller and smaller circles until you have examined all of the breast tissue. Lines: Begin in the underarm area. Slowly move your fingers down until they are below your breast. Move your fingers closer toward your nipple and go slowly back up, using the same motion. Use this up-and-down pattern all the way across your breast. Wedge: Begin at the outside edge of your breast. Slowly work your way in toward the nipple, doing one wedge-shaped section at a time. Do this until the entire breast area has been examined.

Don't Forget With any pattern, be sure to examine the nipples also. Gently squeeze the nipple and check for any discharge. Examine the upper chest area and below the armpits Ñ these places also have breast tissue. Call your doctor if you notice any lumps or changes in your breasts.

You will be asked to lie on the exam table and open your gown. The doctor will examine your breasts by moving his or her fingers around your breasts in a pattern. He or she will check for problems, such as a lump. If the exam is done just before your period, your breasts may be sore.

The Pelvic Exam

For the pelvic exam, a device called a speculum may be used to help look at the cervix and vagina. It is placed into the vagina to hold open the vaginal walls. You will feel some pressure when the speculum opens. A Papa test and tests for STDs may be done at this time.

The doctor also may do an exam of the internal organs, including the rectum and vagina. The doctor places one or two gloved, lubricated fingers into the vagina and reaches up to the cervix. The other hand presses on the abdomen form the outside. This helps the doctor check the size, position and shape of these organs.

For the pelvic exam, the doctor will look at your reproductive organs for signs of problems. The pelvic exam has three parts:

1. Looking at the outside of your private parts (the vulva)
2. Exam with speculum (device used to spread the walls of the vagina so your cervix can be seen)
3. Exam with gloved hands to feel internal organs

For the pelvic exam, you will be asked to undress and put on a paper or cloth gown. Then you will lie on an exam table. You will be asked to put your feet against footrests and slide to the end of the table.

Your doctor may check your abdomen, pelvis and vagina. Try to relax. If you are tense, you may feel some pressure or discomfort.

The Pap test can be done during a pelvic exam when the speculum is in the vagina. The doctor inserts a small brush or scraper through the vagina into the cervix. The brush or scraper is used to remove cells from the cervix. Cells will be taken from inside the opening of the cervix and from the outer part of the cervix. The cells are sent to a lab to be tested. A specially trained technician or doctor looks for cells that do not look normal. Your doctor will talk to you about the results if any problems are found. Changes in the cervix do not always mean cancer. If there are changes, you doctor will arrange a follow-up visit.

The Pap Test

If you are 18 years of age or older, or have had sex, you should have a Pap test. It is done to check for abnormal cells in the cervix. It is done in the same position as a pelvic exam. In fact, it may be done during a pelvic exam, when the speculum is in the vagina.

For the Pap test, the doctor inserts a small brush or scraper through the vagina into the cervix. Cells are removed from the cervix. The cells then are sent to a lab to be studied.

It is best to have a Pap test when you don't have your period. It is a good idea not to put anything in the vagina for two to three days before the test. You may have some slight spotting after the Pap test.

Immunizations

Your doctor may discuss your immunization history with you at this visit. You may need to get certain immunizations. Immunizations are shots that help prevent some infections. They are a part of routine care.

Table 1 lists immunizations for your age group. Find out which ones you need and how often. Then, fill in the blanks on the table to help you keep track of when you last had them.

Table 1. Immunizations for Adolescents and Women Ages 13 to 18 Years
Immunization	What and Why	When	Last Done	Next Needed
Tetanus­diphtheria booster	A shot to immunize against the diseases tetanus and diphtheria	Once between ages 11 and 16 years
Hepatitis B vaccine	A shot to immunize against the disease hepatitis B	One series for those not immunized previously

Special Concerns

Many young women have the same health concerns. These include:

• Cramps and problems with periods
• Acne
• Weight issues
• Concerns about sexuality
• Questions about birth control
• Concerns about sexually transmitted diseases (STDs)
• Emotional ups and downs or depression

Talking with your doctor about these issues is a key step to staying healthy. Your doctor is there to listen and help.

Most young women enjoy good health. Many health problems for women this age are a result of high-risk behaviors. Many problems arise from:

• Unsafe sex (sex without a condom or with more than one partner)
• Drug use
• Violence
• Motor vehicle accidents

During your visit, your doctor may offer some tips on how you can help prevent these problems and stay healthy (see box).

Being Healthy To be strong and healthy for years to come, I need to:  Eat a well-balanced diet Maintain a healthy weight. Exercise for at least 30 minutes three times a week Avoid smoking, drinking alcohol and using illegal drugs. Tell my doctor if I use any type of vitamins, herbs or supplements. Wear a safety belt every time I ride in a car or truck. Wear a helmet and use other safety gear when I ride a bike or motorcycle, or when I rollerblade, skateboard or use a scooter. Do a breast self-exam once a month. Seek help if I have emotional ups and downs or feel depressed. Use birth control if I'm having sex. Protect myself from STDs by using a latex condom. Keep up with the exams, tests and immunizations I need.

Finally ...

Your first OB-GYN visit is a great chance to take charge of a healthy lifestyle. You may be nervous at first. Knowing what to expect will help ease your fears.

Be involved in your health care. Follow up on tests. Ask your doctor questions. Work with your doctor on a routine basis to ensure you have all the tests and immunizations you need to stay healthy.

Glossary

Birth Control: Prevention of pregnancy.

Cervix: The lower, narrow end of the uterus, which protrudes into the vagina.

Condom: A thin rubber sheath covering the penis.

Obstetrician­Gynecologist: A physician with special skills, training and education in women's health.

Pap Test: A test in which cells are taken from the cervix and vagina and examined under a microscope.

Pelvic Exam: A manual examination of a woman's reproductive organs.

Period: The discharge of blood and tissue from the uterus that occurs when an egg is not fertilized (also called menstruation).

Sexually Transmitted Disease (STD): A disease that is spread by sexual contact.

Speculum: An instrument used to spread the walls of the vagina so that the cervix can be seen.

Vagina: A passageway surrounded by muscles leading from the uterus to the outside of the body.

Vulva: The lips of external female genital area.

Copyright ©June 2001 American College of Obstetricians and Gynecologists