When is the best time to schedule an exam?
Generally it's the week after your period. This is when breasts tend to be least lumpy, so the breast exam will be as painless as possible and any serious lumps will be easiest to feel. The worst time is the week before your period, when your breasts may be swollen and sore. You can have a pelvic exam during your period, but the presence of blood may make Pap smears hard to read.
Don't use yeast medications, spermicides or douches 24 hours before your exam. If you're sexually active, it's also best not to have sex the day before. If you have questions to ask the doctor, you may find it helpful to write them down first. Sometimes we forget when we're in the stressful office environment. When you arrive, ask if they will want a urine specimen. If not, urinate before you see the doctor. It'll make the exam more comfortable.
Yours should know about your family's medical history and your sexual and gynecological history. He or she should ask if you're using birth control or are at risk for a sexually transmitted disease. And sensitive doctors always ask whether you have any questions or concerns. If you've had unprotected or forced intercourse, you should volunteer this information. Unusual bleeding, discomfort or itchiness should also be reported. And any old question you've got, go ahead and ask! Don't be embarrassed! How else will you get answers? Remember, write down questions before you go to the office, so you don't forget 'em in the stress of the moment.
She or he really should spend at least 30 seconds on each breast, and probably longer. You should definitely be doing self-exams at home to familiarize yourself with your own anatomy and to notice any changes or lumps. (Often lumps are simply fibroids or cysts, but the more comfortable you are with examining your breasts, the more likely you are to find any problematic growths or tumors.) Your doctor will want to take special care if you have a family history of breast cancer. Also, ask your doctor if she or he thinks you should have more frequent mammograms if you do have such a family history. Generally, the American Cancer Society recommends one mammogram by age 40 and a mammogram every year or two thereafter. Teenage girls generally don't have to worry about mammograms yet, but now is the perfect time to start doing breast self-exams. Ask your doc for a card or pamphlet with how-to information. Most have them available right in the office.
It ain't fun, no matter what. But if you relax your muscles, it'll be easier. A good doc should tell you what he or she is seeing; if the doctor doesn't, ask him or her. "Everything look normal?" is a perfectly fine question. The doctor should first examine the external surface of your vagina, feeling for bumps or sores. These might be an indication of an ingrown hair, a blocked gland, a herpes blister, or a genital wart. Next he or she will insert a speculum (a device that holds the walls of the vagina open) and examine your vaginal walls for sores and inflammation and your cervix for discharge, signs of infection and damage. He or she will probably take a Pap smear, a little scraping of cervical cells that doesn't hurt but might feel weird. (Afterward, a little spotting is normal, but tell your doctor if it's more than a few droplets of blood.) In the (recent) past, there've been some problems with reading Pap smears. Today there are laws about how many slides a cytologist (a cell-sample slide-reader) can read per day. If you would like to know the specifics, just ask your doctor.
Next comes the manual portion of the exam. The doctor inserts two gloved, lubricated fingers into your vagina while pressing gently on your abdomen. This is how she or he checks out the surface of your uterus, ovaries and fallopian tubes. This usually doesn't hurt, but it'll help the doctor if you relax, breathe slowly and deeply.
Finally, you should have a rectal exam. If your doctor doesn't make this exam a regular practice, go ahead and ask about it. It may sound bizarre to actually request this, but it's important. This step, in which one finger is in the vagina and the other is in the rectum, can help detect rectal lesions and growths (an early sign of colon cancer) and also helps point out endometriosis, ovarian cysts, and the alignment of the uterus and other pelvic organs.
The doctor should summarize for you what he or she has learned from your exam, and give you the chance to ask more questions. Ask when you can expect the results of your Pap test, and have them mailed to you (call if you don't get them). Now is a good time to talk about anything that might be bothering you, like having to wait more than 15 minutes when you have an appointment, or the manners of the office staff, or the attitude of the doctor herself.
If the doctor seems uninterested in letting you in on what he or she is doing, or if she speaks in clipped medical jargon, ask follow-up questions until you understand. If problems persist after a few visits, it might be time to consider switching doctors.
It's always nice to know what you're taking. Some questions: What is this? What does it do? Any foods I should avoid while taking it? Any other drugs interact badly with this? How long do I have to take this? Will I need to refill the prescription or make another appointment to see you? Is there a generic version that's cheaper?
There you go! Just be aware and assertive. Believe it or not, most doctors are grateful that you're interested in taking care of yourself.