Your Preparation

Medical and social history taken by the doctor

Physical examination

Laboratory tests

Discussion with your doctor after the examination is completed

What you need to do BEFORE your first visit
You need to prepare information for your doctor.  Obtain your childhood immunization and illness history from your parents or pediatrician.  Ask your parents about family medical history, especially breast and ovarian cancer. Write a list of your normal habits, such as sleep patterns, dietary, etc.  For your first exam and all yearly exams thereafter you should list: any vaginal infections you have treated yourself; note any dramatic weight fluctuations; your travel history; birth control; and sexual history.  If you are planning to travel, be sure you have the latest information about the shots you need for a trip to a another country.  You can call the Center for Disease Control in Atlanta or check their web site.  Do not douche or use vaginal medications 3-4 days before your visit if you are having a pap smear.

THOROUGH HISTORY
    The doctor should obtain a thorough medial history prior to your exam. She should ask about: childhood illnesses and immunizations; family history; occupation; travel history; stress levels; use of alcohol, tobacco and drugs; prescription drugs; sexual history; and birth control usage.

PHYSICAL EXAMINATION
    You may be a little nervous before your first physical and pelvic exam. That’s normal and expected. However, if there is pain caused by any part of the exam, you should let the doctor know. A pelvic exam may be a little uncomfortable, but should not be painful.
    Your examination should consist of: weight; blood pressure; looking at your eyes, ears, nose and throat; examining your neck for the size of the thyroid gland and any enlarged lymph nodes; listening to your chest and heart; breast examination sitting and lying down; abdominal exam; looking at your arms and legs; and the pelvic exam. A pelvic examination consists of three parts: looking at the outside; using a speculum - a small instrument which is inserted into the vagina - to check the vagina and cervix (A pap smear is taken at this time); and a manual pelvic exam in which the doctor inserts two fingers into the vagina and lifts the cervix. The abdominal hand can then feel the uterus and ovaries.

LAB TESTS
    Blood tests, urinalysis, and a pap smear, which was done during your pelvic examination, should be done routinely. A blood test checking on your cholesterol level should be done every 3-5 years, to the age of thirty-five and then yearly. Thyroid hormones should be checked every 3-5 years until the age of 40-45, then yearly. A complete blood count and chemistry panel needs done every 1-2 years. Your immunity to rubella should be obtained on your first visit. A urinalysis is done yearly. The pap smear, which scrapes off loose cells from the cervix and inside the cervix, using a small brush and scraper made of plastic or wood, is sent to the laboratory so the cells can be examined under the microscope. This should be done yearly, unless your doctor decides otherwise. But, a general and pelvic exam should always be done yearly whether or not you have a pap smear.
    If you have a family history of breast or ovarian cancer, the doctor may order other tests such as a mammogram. For those without a family history of breast cancer, a screening Mammogram should be done between 35-40; every two years from 40-50; and then yearly after the age of fifty. Mammograms save lives. Please be sure to get them as recommended.

DISCUSSION AFTER THE EXAMINATION
    After your examination, your doctor should tell you if there were any abnormalities. Please ask questions and ask the doctor to speak in language you understand. Your doctor may recommend immunizations such as a tetanus booster every ten years. Your doctor should tell you how long before lab tests are available. IT IS YOUR RESPONSIBILITY TO CALL TO OBTAIN TEST RESULTS. Sometimes things may be inadvertantly over-looked in a busy office or they may simply not call for normal results.
    Even though it sounds like a long ordeal, the physical exam takes a short time, but it is 'time well spent'. The majority of the time is spent talking to the doctor. Please be honest in your answers so you can get the best care possible and stay healthy.