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Family Health Magazine
ADOLESCENT HEALTH

A Woman's Physical Exam
An essential part of caring for your health

The words “complete physical exam” have long stirred up feelings of concern in many young women. Many wonder why on earth they need a complete physical exam, especially when they’re feeling well. Often, women put off having a physical exam primarily because of fear of the unknown. However, it is important for women, particularly, to have regular physical exams as part of maintaining their health. Knowing what to expect at a physical exam can make the entire experience easier.

Why have a physical examination at all?

There are a number of reasons why all women should have a regular physical exam. First, regular consultations allow your doctor to get to know you a little bit better. In this way, he or she will be better able to deal with your problems if and when they arise in the future. Second, a routine physical exam is important to make sure that everything is developing normally. If problems are found, it is always important to pick them up as early as possible. Third, it is important for women to have annual screening for problems such as cervical and breast cancer, and possibly sexually transmitted diseases. Finally, the routine physical allows you to discuss plans for good health and safe living. You can discuss healthy eating, relationship issues, birth control, prevention of infection, and other important topics.

Who should I see for a physical exam?

Family doctors are skilled in doing routine physical exams. If you already have a family doctor, you’re all set. If you don’t have a family doctor, ask your friends and family members for recommendations as to who to see. You can also call your local chapter of the College of Physicians and Surgeons for a list of doctors in your area who are willing to take on new patients. Whether you see a male or a female doctor is entirely up to you. Some women feel more comfortable with a female doctor, while to others it makes no difference. If you see a male doctor, there will likely be a female assistant in the room to help him with the exam.

What’s involved with the exam?

Every doctor has a slightly different order and style when they do a physical exam; however, most examinations involve the same basic elements.

What comes first?

When you arrive at the office for your scheduled appointment, be sure to stop at the reception desk to let them know that you are there. You don’t have to do any specific preparation for a physical exam; however, part of the exam cannot be done if you are having your period. While you are waiting you may be given a questionnaire to fill out about your past medical history. A receptionist or nurse will take you to the examination room where you will likely have your height and weight recorded. You may have your blood pressure and pulse measured at this point, as well. You will then be given a paper or cloth gown and asked to change. You will need to change out of all your clothing, including your bra and underwear, since the doctor has to examine you from head to toe.

What questions are asked?

When the doctor arrives, he or she will want to start by asking you a number of questions. You’ll be asked about your previous medical problems, such as whether you have asthma or diabetes. If you have ever had any major illnesses or been admitted to hospital, be sure to let your doctor know. If you are on any medications, or taking any supplements, tell the doctor about them. It is important to know about over-the-counter medications (one that you can buy without a prescription), as well.

Let your doctor know if you’ve ever had a reaction to a medication or if you have any allergies.The doctor will likely ask you about your family and about the health of your close relatives, such as brothers, sisters, parents, aunts and uncles. If any unusual diseases run in the family, make sure your doctor knows.

Your doctor will want to know a bit about your habits, both good and bad. Topics of discussion often include smoking, alcohol and street drug use, eating habits and diet, exercise and physical activity, sexual practices, and accident prevention (such as seat belt use). Try to be as honest as you can – the doctor can only help if he or she knows the truth. Remember that anything you tell your doctor is completely confidential.

Enough with the questioning – what’s next?

At this point, the doctor will want to examine you. This will likely include most or all of the following:

• Height and weight measurement (if not already done)
• Blood pressure and heart rate check
• Checking for lymph glands in your neck, under your arms, and in the groin
• A vision check and eye examination
• Looking in your ears
• Peering into your mouth to examine your teeth, gums, and the back of your throat
• Feeling your thyroid gland (which is located in the front of your neck)
• Listening to your breathing
• Listening to your heart
• Feeling your belly for any lumps or painful spots, and checking the size of your liver and spleen
• A pelvic exam, to check your vagina (the birth canal), uterus (where a baby develops) and ovaries
• A breast exam, looking for lumps or other abnormalities
• Examining your skin, looking for abnormalities such as moles, growths or rashes
• Checking your joints, such as your knees, hips and shoulders
• Checking your back for any abnormal curves
• Checking your reflexes, strength, and sensation

What was that about a pelvic exam?

This is the part of the examination that most women dread. However, if you know what to expect and you’re relaxed, it shouldn’t be uncomfortable. If you are a virgin, you may not need to have this part of the examination done. The doctor will ask you to lie down on the examination table and to place your feet in the stirrups that are positioned at the end of the table.

Don’t be worried by the stirrups. They are simply there as a place to put your feet while you are being examined so that your legs are comfortable. You will have a drape covering the lower half of your body. The doctor will ask you to slide your bottom down towards the end of the table.

The doctor will be seated at the end of the table and will ask you to open your legs and relax. Relaxing is probably the last thing you feel like doing at this point, but try your best as it will make the examination much more comfortable. The doctor will first examine your vagina on the outside, looking for any sores or rashes.

Then your doctor will examine you inside to look at your cervix, which is the bottom part of the uterus. To do this, a speculum is used. A speculum is a thin metal or plastic instrument that has a hinge on one end to allow it to open up. It is gently inserted into the vagina and then opened, allowing the doctor to see the inside of your vagina and your cervix.

If you are relaxed, the insertion of the speculum should not be painful, but it may produce a slight pressure sensation. If you find that you are tensing up while the doctor is trying to insert the speculum, taking some deep breaths may help you relax. Once the speculum has been inserted, the doctor will open it to see the inside of your vagina and cervix. He or she may have to move the speculum around a little bit in order to see the cervix properly.

Once the doctor can see your cervix, a Pap smear will be done. A Pap smear is a procedure where some of the cells of your cervix are placed on a slide to be looked at later under a microscope. This test is done to look for anything abnormal that could possibly lead to cervical cancer.

The cells are taken from your cervix using a brush that looks like a long mascara brush. The doctor inserts the brush into the opening of your cervix and turns it a little bit in order to collect the sample. It is then removed from the cervix and brushed onto a microscope slide, which is then sprayed with a special preservative. Although you may feel a slight twinge when the Pap smear is done, you shouldn’t feel any pain.

In addition to the Pap smear, the doctor may also take some swabs from the vagina and cervix to check for infections such as chlamydia and gonorrhea. These are taken with a long cotton swab. After the Pap smear and swabs are taken, the doctor will gently remove the speculum.

Following this, the doctor will need to examine your uterus and ovaries. Since these cannot be seen using the speculum, he or she will perform a procedure known as the bimanual exam. Your doctor will insert two gloved fingers of one hand into your vagina and place the other hand on your belly. He or she will then feel your uterus and ovaries between the two hands. Again, you may feel some slight tugging, but this procedure should not be painful. Be sure to take slow deep breaths if you’re tensing up or feeling nervous.

And the breast exam?

Every woman should get into the habit of doing a breast self-exam each month. If you’re not sure how it should be done, ask the doctor to show you. In the office, the doctor may examine your breasts both while you are seated and while you are lying down. He or she may ask you to press your hands together in front of you or to do another similar move to see if this changes the appearance of your breasts in certain ways.

Pressing gently with the flat of the hand, the doctor will touch all parts of both breasts, feeling for any abnormal lumps or bumps. He or she will feel in your armpits to check the lymph glands there, as well. If you have any concerns about lumps you have felt yourself, be sure to bring them to the doctor’s attention. Most of the time, these turn out to be normal breast tissue or simple cysts.

What happens now?

After examining you, you and your doctor may discuss any number of things, including nutrition, growth and development, exercise, birth control and sexuality, smoking, alcohol, and any problems he or she has identified. If you have any questions or concerns, be sure to ask. If your doctor feels that any other tests are needed, he or she will discuss these with you at this time.

At this point, you will be left alone to dress. Sometimes, women notice a small amount of blood after having a Pap test done. This is entirely normal, and should only last a short time – nothing like having a period. You may want to wear a panty liner if you are concerned about this.

The results of your Pap test and swabs should be available in one to two weeks. If there are any problems that need further attention, your doctor’s office will call to let you know. If you are otherwise feeling well, you don’t need to have another full physical exam for a year.

Tell me why I’m doing this again?

It may sound like a lot, but the entire examination usually doesn’t take more than 20 or 30 minutes from start to finish. No one enjoys having a physical exam, but it’s almost never as bad as you might imagine it to be. Knowing what to expect and trying to be relaxed will make the entire process much more comfortable for you – something you won’t dread each year.