Dr. MJ Bazos MD, Patient Handout
The Pelvic Exam
Guidelines for Teens
As a young woman, your body has gone through a number of changes over the past few years. An important part of growing up is taking responsibility for keeping yourself healthy, This includes establishing a partnership with your pediatrician regarding your health. Pelvic exams can be an important way to take care of your health. Most women have questions and concerns about their first pelvic exam, but knowing what to expect can help you to feel more at ease.

Why do I need a pelvic exam?
A pelvic exam is the best way for your pediatrician to examine your reproductive system, which includes the vagina, cervix, ovaries, fallopian tubes, and uterus (see illustration). This visit is also a great time to talk to your pediatrician about important health issues such as:
The exam also includes lab tests for common problems that can be easily treated if found early. Most young women should have a pelvic exam by the end of high school. It should be done earlier than this if the woman is sexually active or has a problem with her reproductive system.

The interview
Before the pelvic exam, your pediatrician will ask you a number of questions to find out whether you are having problems or are at risk for problems. For example, your pediatrician may ask about your menstrual periods. Questions about your periods may include:

Your answers to these questions tell your pediatrician if your periods are normal. He or she may give advice about menstrual discomfort, tampon use, and other issues.
Your pediatrician may also ask you about your sexual experiences. This is so your doctor can get to know you and help you to protect your health, so giving honest answers is important.

The information you give to your pediatrician is confidential and will not be discussed with anyone else without your permission (unless it is something life threatening).
The questions may include:
Your answers to these questions help your pediatrician decide what services you need. He or she can give you advice on decision making, abstinence, and prevention of pregnancy and infection.

The examination
Your pediatrician will tell you what he or she is going to do at each step of the exam. If you have any questions or feel uncomfortable, just let your pediatrician know. If you have a male doctor, a female nurse or chaperone will normally be present during the exam. You may request that your mother, older sister, or friend join you if it makes you more at ease. You may also request that no one, other than the doctor, be in the room during the exam.
Before the exam, your height, weight, blood pressure, lungs, heart, and neck may be checked. You may be asked to give a small sample of urine and to empty your bladder to make the exam more comfortable. You will then be left alone to completely undress and put on a gown. A sheet will be given for extra coverage.
When your pediatrician comes into the room, he or she will ask you to lie down on the examining table for the breast examination. He or she will feel each breast for lumps, sores, or swelling. Be sure to tell your pediatrician if your breasts are sore in any way or if you have had any fluid leaking from your breasts.
Your pediatrician will teach you “breast self-exam,” an important part of keeping yourself healthy. You should do a breast self-exam each month. This will alert you to any changes or problems in your breasts and help you to be more familiar with your body. Practicing breast self-exam as a young woman prepares you for later on, when breast cancer is more common and regular breast self-exams are so important.
Usually after the breast examination, your pediatrician will check your abdomen and then do the pelvic exam. The entire pelvic exam only takes about 5 minutes. It can be done even if you have never had sexual intercourse, because the opening that allows your period blood out is large enough to allow examination.
Some young women who have not had intercourse worry that having a pelvic exam will mean they are no longer virgins. You should not worry about this; the pelvic exam does not change whether or not you are a virgin. Also, the pelvic exam is not a “test” to see if you are a virgin. The pelvic examination has three parts. In the first part, the pediatrician will use a light to look at the outside of your vagina and surrounding areas to make sure everything looks normal.

During the second part, the pediatrician will look inside your vagina. Your pediatrician will use an instrument called a speculum to see inside. It will be made of disposable plastic or sterilized metal. The speculum will be gently inserted into your vagina. You will feel some pressure, but it should not hurt. Taking deep breaths and trying not to tense up will help relax your vagina muscles and make this part of the test easier. While the speculum is in place, your pediatrician will take a sample of cells from the cervix. This is called a Pap smear. The Pap smear is a test for infections or abnormalities of the cervix, and you should not even feel it. The speculum will then be removed.
In the third part of the pelvic exam, the pediatrician feels your uterus and ovaries to check their size and see if they are tender. This is done by the pediatrician gently inserting one or two gloved fingers into your vagina and pressing on the outside of your abdomen with the other hand. That’s it!

Most patients are surprised when their first pelvic exam is over, it really is quick. If your pediatrician finds that you have an infection or other problems with your reproductive system, he or she may refer you to an OB/GYN (obstetrician/gynecologist). This type of doctor specializes in women’s reproductive health.
Take care of yourself
Your first pelvic exam is one of the many steps you will take as part of taking care of yourself as a young adult. It is easiest to do this when you are well, before any problems occur. If you are having sex, you should have a pelvic exam at least once a year. Even if you are not having sex, you should begin having regular pelvic exams before you finish high school or if you have any concerns about your vagina, uterus, and periods. Along with eating right, getting enough exercise, not smoking, and wearing seat belts, regular visits to your pediatrician for checkups are important. Your pediatrician cares about your health. Even as you get older, seeing your pediatrician regularly will help you learn the best ways to take care of yourself.
How to do a breast self-exam
Once a month, right after your period, you should examine your breasts. Although breast cancer is rare in young people, it usually can be cured if found early, and a breast self-exam is the best way to find it.
1. Stand in front of your mirror with your arms at your sides and see if there are any changes in the size or shape of your breasts. Look for any puckers or dimples, and press each nipple to see if any fluid comes out. Raise your arm above your head and look for changes in your breasts from this position as well.
2. Lie down and place your left hand under your head. Hold your right hand flat and feel your left breast with little, pressing circles. Think of each breast as a pie divided into four pieces. Feel each piece and then feel the center of the “pie” (the nipple area).
3. Now put your left arm down at your side, and do the same thing on the outside of the breast, starting under the armpit.
4. Repeat steps 2 and 3 for the other side. Most women have some lumpiness or texture to their breasts; breasts are not just soft tissue. Get to know your breasts — then be alert for any lumps or other changes if they should ever appear.
Remember, most lumps and changes are not cancer. However, if you think you have found a lump or notice any other changes, don’t press or squeeze it; see your pediatrician.