The first gynecological examination includes three main moments:
- Informative interview: it precedes the actual gynecological examination and is used by the doctor to collect the patient's clinical data. During this initial interaction, the stages of the first gynecological examination are explained step by step.
- Inspection: consists in the simple observation of the external genitalia. Through inspection, the doctor is able to highlight any inflammatory states, malformations or other injuries.
- Internal examination: this check involves the evaluation of the internal organs (uterus, ovaries and vagina) by means of bimanual palpation, vaginal exploration and examination with the speculum. If you have not yet had sexual intercourse, this part of the first gynecological examination it can be modified: if necessary, for example, the examination could be performed rectally.
In addition to having diagnostic purposes, the first gynecological visit allows to carry out screening investigations, useful for the prevention of female tumors, such as the Pap test.
, to ascertain the health of the female genital organs, external and internal (vagina, uterus, ovaries and fallopian tubes). The purpose of this assessment is, first of all, to evaluate the correct functioning of the reproductive system, as well as to identify the pathologies and dysfunctions that can affect it, improving the possibility of treatment.;
During the first gynecological examination, the interaction with the doctor is useful for the patient to ask questions and ask for explanations, which are felt the need, relating to intimacy. Furthermore, during this exchange, the gynecologist provides information on correct lifestyles and risk behaviors (eg contraception, hygiene habits, diet, etc.). In other words, the first gynecological examination is a moment that can be used to deepen the knowledge of one's body, remove some curiosity and feel relieved if there is some concern about one's health, contraception or sexuality.
In addition to having diagnostic indications, the first gynecological examination can be associated with:
- Therapeutic actions: if any pathologies are found during the examination, the first gynecological visit is useful for directing a treatment plan;
- Screening investigations: during the first gynecological visit, the gynecologist can perform the samples useful for the reference investigations for the prevention of cervical cancer, such as the Pap test and the HPV test, where early diagnosis is essential.
The first gynecological examination can also be carried out for the prescription of contraceptive therapy or in the case of occasional unprotected sexual intercourse, especially if it is suspected of having contracted a venereal disease.
First Gynecological Examination: Can it be done if you are still a virgin?
The first gynecological examination can be performed even if you have not yet had coital intercourse; in this case, the doctor will be as delicate as possible and will use special instruments, which can also be introduced through an intact hymen.
Virgin women could be given rectal gynecological examinations if necessary.
At what age should the First Gynecological Examination be?
The age at which to undergo a gynecological examination for the first time is variable.In general, it is advisable to undergo a check-up between the ages of 16 and 21, to verify that there are no problems, or within the year of the first sexual intercourse. Of course, it is possible to go to the gynecologist even earlier, to clarify all doubts. concerning the menstrual cycle (eg periodicity, abnormal losses, how to take care of hygiene during menstruation, etc.).
As anticipated, regardless of the young age, the first gynecological examination must be scheduled even if particular disorders arise (eg inflammation of the external genitals, alterations in the development of the genital system and hormonal dysfunctions), of which symptoms such as:
- Abundant or foul-smelling vaginal discharge
- Intimate itching or burning
- Pain in the lower abdomen;
- Abdominal swelling;
- Irregular or still absent cycle at 15-16 years.
For girls, the first gynecological examination is useful for an approach to the aspects of sexuality that are unclear (note: with menarche and the first ovulation it is possible to start a pregnancy) and to receive advice on the contraceptive methods available and best suited to your needs.
it is not a detail that the doctor cares).Faced with specific needs or problems, this basic scheme can be modified by the gynecologist, adding a breast exam or supporting instrumental investigations. For example, the first gynecological visit can be completed by a "transvaginal ultrasound, to assess the presence or suspicion of diseases such as fibroids, endometrial polyps or ovarian cysts.
Initial interview: what is asked?
Like any other medical check-up, the first gynecological visit involves an initial interview. This interaction allows the collection of the patient's clinical history, taking into consideration the main reason for the visit (control or suspected pathology).
Questions asked by the gynecologist include:
- Date of last menstruation;
- Age of onset of the first menstruation (menarche);
- Characteristics of the menstrual cycle: rhythm (ie how many days you have menstruation), blood loss between one cycle and the other, presence or absence of premenstrual syndrome, etc .;
- Characteristics of menstruation: quantity and duration of losses, presence or absence of dysmenorrhea;
- Daily use of drugs (which and why);
- Major illnesses of family members (family history), such as cancer, diabetes, menstrual irregularities, premature menopause, thyroid dysfunction and bleeding disorders.
This part of the appointment is also important for overcoming the embarrassment or anxiety associated with this "delicate" moment.
Regarding the disorders (if any) that cause the girl or woman to go to the gynecologist for the first time, it is necessary to report:
- Signs and symptoms (vaginal discharge, itching, burning, pain, etc.);
- Time and circumstances in which they occurred;
- Factors that make them worse or help relieve them;
- Diagnosis or examinations already carried out by other specialists (in this case, it is useful to bring the documentation with you).
During this first phase of the gynecological examination, the doctor can collect information about any previous illnesses, allergies, surgery and lifestyle (smoking, alcohol or drug intake, sports practiced, sleep quality, appetite disturbances and body weight, possible constipation and urinary function disorders). The interview can end with the measurement of blood pressure, weight and height.
External examination
For the execution of the first actual gynecological examination, the patient is made to sit on the gynecological table, which provides two supports to rest the legs and keep them raised and spread apart. The position may seem uncomfortable or embarrassing, but it is the best way to perform the exam.
The first gynecological examination involves the inspection of the pelvic region, the hair, the adipose tissue and the skin of the pubis, followed by an examination of the inguinal lymph nodes and external genitalia (hymen, clitoris, large and small labia, urinary meatus, outlet of the vaginal glands, perineum and anus). These anatomical regions are examined to verify that there are no signs of infection, malformations, inflammations or other anomalies, such as swelling, erythema, pigmentation changes, hematomas, ulcerations and nodules. Observation of the labia majora and labia allows to highlight points. painful, red, swollen or abnormal secretions.
Internal examination
During the first gynecological examination, the internal examination includes two moments:
- Examination with the speculum. It consists in introducing an instrument into the vagina consisting of two valves that can spread apart (speculum), which allows you to view the inside of the vagina, the cervix (or cervix) and to perform the Pap test (or Papanikolaou test The speculum is not used if you have not yet had sexual intercourse. This phase of the first gynecological examination allows you to highlight any anomalies present, such as, for example, inflammation, polyps or suspicious lacerations.
- Vaginal exploration and bimanual palpation. Once the speculum has been removed, the first gynecological examination involves the evaluation of the uterus and appendages. The gynecologist introduces the index finger (or the index finger plus the middle finger) of the right hand into the vagina and, with the left hand, presses the surface of the abdomen to analyze the position and volume of the pelvic organs (uterus and ovaries).
- Rectal examination. In some cases, the rectal examination replaces the vaginal examination in virgin women or in those situations where the latter is difficult (vaginismus) or impossible. These checks allow to appreciate the posterior wall of the uterus and highlight growths or collections that may easily be examined by the finger introduced into the rectum.
Breast examination
The doctor can conclude the gynecological examination by carrying out the examination of the breast, by inspection and palpation, to verify that there are no lumps or other abnormalities.
After the evaluation, the doctor teaches the patient how to perform a breast self-exam, which should be done by each woman once a month, preferably one week after the end of menstruation, when the breasts are not swollen or tender.
First Gynecological Examination: How Does It End?
At the end of the first gynecological examination, the doctor will give the patient a description of what he has been able to verify. If pathologies were found during the examination, the gynecologist can investigate the clinical picture by performing other investigations (eg pelvic or transvaginal ultrasound, colposcopy, cervical swab, endometrial biopsy, etc.) and establish the most suitable therapeutic program for the case.
