Not your mom’s gyno visit—a Top 10 guide:

Bonus: 11 items in the top 10 guide. 

My title isn’t meant to be a trigger, and I’m sorry if it is for you.  I know that not everyone has a mom in their lives, some for not-so-great reasons, some because they have two dads.  But we haven’t figured out how to hatch people in a lab and incubate them, so some woman carried you and birthed you, and hopefully had a great obstetrician/gynecologist (OB/GYN) along the way. 

That’s what I did when I could practice: I was an OB/GYN.   One of the things that I miss is seeing a young woman who is terrified for her first visit to the gyno, talking her through it, and hearing at the end, “That wasn’t as bad as I thought it would be.”  Pretty amazing Minnesota compliment. 

I can’t do your visit or exam, but I can talk you through it.  Here are some of the things you should know: 

1. Not every visit to the gyno means that you need a pelvic exam with a speculum (aka duckbill, although this drawing looks like a T Rex to me): 

• Many young women worry about this part for the entire visit, when they may not need it.  If your visit is for cramps, or heavy periods, or you want to start the pill, you don’t always need a pelvic exam. 
  

2. But sometimes you do need a pelvic exam: 

• A pelvic exam means that the provider will take a look at the outside to see if things are okay, and may take samples from the inside if needed for infection testing.  We have swabs that pick up DNA from some of the most common STD’s (sexually transmitted diseases or infections), so we only need to use a skinny swab, like a long q-tip.  If the pelvic muscles are relaxed, we can feel with just one or two fingers if the insides are normal for bleeding/cramping issues.  3. “But I forgot to shave my legs!” 

• Your provider does not care.  Also, we do not care about chipped toenail polish.  A shower in the past 24 hours is nice, but not mandatory.   4. Speaking of shaving... 

• It is the cheapest way to remove unwanted pubic hair.  It is also the most likely to cause problems, like a skin infection.  Skin infections can be irritation of the hair follicles (cleverly named folliculitis), which sometimes need antibiotics.  Infections can also be more serious or annoying, like molluscum, especially if you use someone else’s razor.   Molluscum can spread to your partner.   If you can afford it, a clipper or waxing is much safer.  Laser is the Mercedes of hair removal—a great choice if you can afford it, but not the only way to get there.  

• Shaving also causes micro cuts in your skin, which increases the risk of some viral infections, like herpes, HIV, HPV.  We don’t have a cure for any of these viruses.  Condoms help, but aren’t perfect.  They particularly don’t protect areas that you would shave.   5. “You said partner.  Define partner?” 

• Anyone that you have had sex with is a partner for infection definitions.  6. “But I’m a virgin.” 

•  you’ll still be a virgin after a pelvic exam  7. “Define sex”:  

• any contact between your mouth, vulva, vagina, anus (any and all of the “down there”) with anyone else’s down there, including penis, vulva, vagina, anus.  Or their mouths with your down there.   I stopped using the question “Are you sexually active?” when I realized that lots of women interpreted that as “am I having sex with a penis in the vagina right now?”  or today, or this week.  Really, what we want to know is your risk for infections and/or pregnancy.  Infections are much less likely, but not impossible, with one partner. You can get chlamydia (one of the most common STDs in the US, often asymptomatic) in your throat. So, if you have sex of any kind with more than one partner, or they have had another partner, you should be tested.  Another way to look at it is when you have sex, you’re also being exposed to every other partner that they have ever had.  And vice versa.   
  

  • Lastly: don’t play STD or pregnancy roulette unless you are really okay with the outcome.  

  • >80% of couples who have sex without consistently using reliable contraception will be pregnant within a year.  This is particularly true for younger bodies who are most fertile.   

  • If you are a female with a partner with a penis, you should be on birth control or consider a prenatal vitamin.

  • More than half of all STD’s are in young people, between 15 and 24.  For super fun diagrams and scary statistics, try https://www.cdc.gov/nchhstp/newsroom/fact-sheets/std/std-us-2021.html 
    

• 8. “I heard an exam hurts.” 

• It shouldn’t.  If you have used a tampon, you can relax your pelvic muscles.  Relaxing your pelvic muscles is the best way to make the exam easier, and shorter.   

• What a stupid thing to tell you to do, relax when you’re nervous.  Here’s what I would tell you in my office: 

  • Take a big breath in, count to 3, and let it out for a count of 4.  Do that as many times as you need to during the exam.   

  • Music can help.  There’s science behind this.  Ask your provider if you can listen to music, and keep it at a level where you can still hear her voice.  

  • The pelvic exam feels super weird.  Nobody looks forward to it, not the first time or the fiftieth time.  Your buns will be all the way at the end of the exam bed.  When they feel like you might fall off, you’re in the right place.  You won’t fall off. There are holders for your feet, called stirrups.  These should be at a place where your knees are bent without feeling cramped.  These can be adjusted if needed.   

  • Think about pushing your bum down towards the floor.  I know, sounds weird.  But it relaxes the right muscles, and you want this to be efficient, right? 

  • Speaking of weird, relaxing the muscles on the inside of your thigh (upper leg) and letting them fall open, like a frog or a butterfly, is just the trick.   

  • Having a speculum or a 2 finger exam will probably make you feel like you have to pee.  You won’t pee on anyone.  You will feel a little pressure.   

  • Make sure you tell your doctor if this is your first exam, if something pinches, or something is painful. 

  • Your doctor should wear gloves.  This is a medical exam.  It shouldn’t give you the heebie-jeebies.  You can always have someone else in the room for an exam.  It can be a nurse, an assistant, or a family member.   

• If you have had a female circumcision or sexual assault, tell your doctor.  This exam can trigger a powerful emotional response or PTSD, and your doctor will try to help.     9. “I heard I need a Pap Smear” 

• This has changed since Gen X, when women were told to get Pap smears when they started having sex.  Now Pap smears start at age 21 at the earliest.  Different national groups are studying when the best time is to start HPV (human papillomavirus) testing, and they don’t always use the same guidelines. Based upon your clinic and provider, recommendations may vary slightly.  It’s okay.  The women who get cervical cancer in the 2020's are almost always women who have a faulty immune system, didn’t have access to health care or didn’t follow up.   There has been A TON of research on this.    Also a ton of research on the HPV vaccine, which helps prevent cervical cancer (see more below).  You should get the HPV vaccine if you haven’t already—a true allergic reaction is incredibly rare.   10. “Didn’t I just have a pap smear in the ER?” 

• Likely nope.  Especially if you were in the emergency room or urgent care.   A pelvic exam does not mean you had a pap smear.   

• Pap smears look for changes that can become cancer of the cervix.  The cervix is the doorway between the vagina (where you put a tampon) and the uterus (where a baby grows).  Paps are designed to pick up these changes before we can see them, and now to pick up the virus (HPV) that causes cervical cancer.   

• Any woman who has had sex with a male partner has probably been exposed to HPV.  It is the common cold of having sex.  Like most people with a cold, these changes usually go away on their own and don’t cause long term problems.   Most young women will have the virus but not get cancer, which is why we no longer look for it under the age of 21.   Stay tuned for what happens as more young people who have had the vaccine approach the age when we worry about cervical cancer.    11. A gyno is a safe adult that you can have a private discussion with and know that the information is in the vault. 

• Your parent may REALLY want to be in the room with you the whole time, or you may want that. At some point, every good gyno will ask the adult, if you have one with, or friend/peer/partner to leave the room and talk to you alone. This information is protected, private, and can’t be shared with anyone UNLESS we are sincerely worried about your safety or someone else’s. This includes abusive situations, known STD’s where the law requires partner notification, thoughts of hurting yourself or others. It does not include asking your parents about your SO or preferences when we see them at school functions, or church, or whatever. We just don’t do that. We can’t do that. So, if you have questions that you think are weird, and want to ask a gyno first, go for it. We won’t share it.  

• You should know that number 11 on the top ten list was brought to you by the Queer and Curious version of this list.  It occurred to me that confidentiality worries apply to the heteronormative as well.  

• If you have labs or tests done and use your family insurance for the visit, they may see that you had this testing done. Some of it is routinely recommended for all teens. It’s okay to throw your provider under the bus and use that line.   "Dr. X said that the health department recommends that everyone is tested for infections."

• Whatever your stance on reproductive rights, Planned Parenthood provides more preventive care in testing, paps, and birth control than any other service. No questions asked, no need to use your family insurance if it isn’t safe. There are other clinics that do this as well, likely in your area. You have a friend that knows, or you can ask your family doctor or school nurse. When you hit your teens, during a well exam your doctor should give you the chance to ask questions and be asked questions without an adult in the room. 

A reliable online resource for more questions is the American College of Obstetrics and Gynecology (ACOG): https://www.acog.org/womens-health/faqs/your-first-gynecologic-visit 

It’s going to be okay.  And feel free to treat yourself afterwards...you deserve it.