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| |    What Teens Can Expect during a Pelvic Exam by Marjorie Greenfield, M.D. reviewed and revised by Marjorie Greenfield, M.D. The American College of Obstetrics and Gynecology recommends an annual pelvic examination and Pap test for all women by the age of 21 or within two years after they begin sexual intercourse, whichever comes first. Most practitioners also include a brief general exam (taking a blood pressure reading, possibly listening to heart and lungs) and a breast examination. It is important to note that although the standard recommendations now say to wait until age 21 to start Pap testing, many practitioners believe it is better to start sooner, so that early problems can be detected, and so that the young woman can be educated about preventing unwanted pregnancy and sexually transmitted infection. External genital examination At the start of a pelvic exam, the doctor looks at the external genitalia to be sure the anatomy is normal and that there is no inflammation or lesions. Sometimes a girl or her parents want the physician to assess whether the girl is a virgin. Although the hymen occasionally obstructs most of the vaginal opening, making it obvious that the girl has never had intercourse, a physical exam cannot always determine for sure if sex has taken place. Normal hymens come in many shapes and sizes and can be stretched by nonsexual or self-exploration activities. Speculum examination A speculum is an instrument, sometimes described as looking like the bills of a duck, with two blunt, slightly rounded pieces of plastic or metal that, when closed, can be inserted into the vagina. The two parts are then gently separated to open up the vaginal walls so that the practitioner can see into the vagina and the cervix. Once the speculum is in place, the practitioner will collect cells from the cervix for a Pap test, using what looks like a narrow tongue depressor and a tiny bottlebrush. A lab technician will view these cells under a microscope to screen for precancerous changes. If there are signs or symptoms of vaginitis, tests may be done on vaginal secretions. Cultures are obtained for sexually transmitted infection (STD) in girls who are sexually active or those with symptoms that might be indicative of infection. Since some girls may hide the truth when it comes to questions of sexual activity, cultures are sometimes taken even if a girl reports that she has not had sex. Most girls who are past puberty can tolerate a speculum exam without pain. There are extra-narrow speculums made for those who have never had intercourse. The bimanual examination Wearing gloves and using a water-based lubricant, the examiner carefully puts either one or two fingers into the vagina. The other hand presses on the abdomen so that the ovaries and uterus can be felt between the two hands. This allows the examiner to check for tenderness and growths. Even young teens usually can tolerate a one-finger examination. Emptying the bladder typically helps to make the exam more comfortable. However, it's important to remember that if the examination is painful, or if the patient's anxiety is too high, she has the right to discontinue the procedure. Sometimes a rectal exam is less uncomfortable and can give the doctor the same information about the internal structures. The rectal exam Similar to the bimanual exam, the doctor puts a gloved finger into the rectum to feel for tenderness and masses and sometimes to check for bleeding. This should not be painful, since a finger is smaller than a stool, but may feel very weird, like the bowels are moving. Some practitioners include a rectal as part of the routine exam, while others do this procedure only when there are specific reasons. STD screening One other purpose of routine gynecological examination is to test for sexually transmitted infection and to talk about birth control and the prevention of STDs. For this aspect of the appointment, it is clearly better not to wait until two years after initiating sexual activity! New studies have shown that the incidence of chlamydia infection is highest in girls between 15 and 24 years old. Sexually active girls and women in this age group should probably be tested twice a year--especially those who are high risk because they have had multiple sexual partners or a past history of sexually transmitted infection.
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