First gynecological examination

The first gynecological examination can be, but shouldn't, a very traumatic experience for a (young) women, which can lead to irregular going to the gynecological examination and that can be life-threatening.

Women regularly tell us that the gynecological examination is something very uncomfortable and mostly compare it to a dental examination. It shares the first spot as the most uncomfortable examination, but we rarely hear from someone that it is comfortable to go to the gynecological examination.

It shouldn't be that way! We, as gynecologists, need to pay quality attention to this first examination and gradually, just like a child adapts to something, feels as comfortable as possible. That first contact should not be a lifelong trauma, but unfortunately it happens to be that way very often.

Fear is somewhat understandable and normal because it is something new and unknown and especially because it is an examination of an intimate part of the body. Because of everything that has been said, we need to carefully approach the topic of the first gynecological examination.

The first gynecological examination includes the following:

It begins with the conversation which is the first and the inevitable part of the first examination, not only because of medical reasons, but because of the fact that the woman because more relaxed and adapted to that new and potentially uncomfortable situation.

A gynecologist is a person to which you can say all your most intimate problems knowing all will remain between you two.

Maybe that is the chance to talk about something which you cannot talk with somebody else and you will get a thorough examination and advice.

After that comfortable conversation, vaginal examination will be done to those who had sexual relationships (on the gynecological table with legs spread and raised) which has two parts:

Firstly, examination of the external genital organs (labium majus and minus, clitoris, vaginal orifice) and examination with the help of an instrument called the speculum. The speculum is usually made of metal or plastic, has the shape of a duck beak and is used to move the vaginal walls to see the inside of the vagina and the cervix of the uterus. At this point, a Pap smear is taken, which owes its name to Georg Papanicolaou who introduced it to clinical practice. It is done by using a wooden spatula and brush to take smears of the vagina, cervix and cervical canal. Then, a cytologist does the analysis of the cytological smear under the microscope and the result tells us about potential inflammation, abnormalities and pre-cancerous and malignant states of the cervix. It is a relatively simple method with the accuracy of 70-80%, and in combination with other methods (colposcopy and histology) up to 90-95%. The speculum examination takes 1-2 minutes and is mostly painless, but can be uncomfortable if the vagina is sensitive because of infection or some other reason. The Pap smear is taken between the 10th and 20th day of the menstrual cycle (the menstrual cycle begins the first day of menstruation).

The second part of the vagina examination is a so-called bimanual examination (with two hands) which is done in a way that the gynecologist careful he enters the vagina with one forefinger and middle finger, and with the other hand presses the lower part of abdomen from the outside. With this examination the position, size, movement and eventual pain of the pelvic organs (vagina, uterus, ovaries) is determined. This examination should not be painful but in case it is, the woman should show the gynecologist where the pain is located. We have to note that it is very important for the woman during the gynecological examination to relax as much as possible, so the muscles of the genital region are less tense, and the pain also reduces. If the woman did not have sexual relationship, then the rectal examination (not the vaginal examination) through the large intestine is done to examine the genital organs. Furthermore, the Pap test should not be done because it could damage the hymen. Also, the Pap test is not necessary because the changes to the cervix are most commonly caused by the human papilloma virus (HPV) which is transmitted sexually.

Today, and inevitable part of the first gynecological examination is the ultrasound examination.

We perform the ultrasound examination with the so-called vaginal probe (it is better if the bladder is empty) which is inserted through the vagina and if the woman did not have sexual relationship, then it is inserted through the large intestine, i.e. rectally. Also, it can be done with the abdominal probe externally on the abdomen where the woman is suggested to fill the bladder so the visualization can be better.

The ultrasound examination is best done in the first part of the menstrual cycle, after menstruation, although there are disorders where it should be done in the middle of the cycle (your gynecologist will inform you about this). For the first time, it is recommended to do the latter and come around the 10th-12th day of the menstrual cycle because the ultrasound and the Pap test are done together for the results to be more accurate.

Furthermore, the degree of clarity of the vaginal discharge can be evaluated and therefore many causers of the inflammation and sexually transmitted diseases can be detected.