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Tackling your first gynecologic visit – No fear!


At your first gynecologic visit, your doctor should introduce him or herself and discuss the reason for your visit.  You should be open and honest about your reasons for needing gynecologic care.  

THE HISTORY: Your doctor will take a complete gynecologic and menstrual history.  Never be embarrassed to bring up concerns regarding bleeding or pain, sexual activities and concerns, current or past sexual or physical abuse, or questions about changes in your body

 **Believe me, you are NOT the first or only person who has these concerns.  Your doctor should be familiar with them and make sure you are comfortable discussing them.  If not, you should consider finding a doctor who DOES make you comfortable.** 

Your doctor will also discuss your medical and surgical history, any medications you may be taking, any allergies you may have to medicines or foods, and will ask whether you drink alcohol, smoke cigarettes, or use drugs.  Your doctor will be able to provide the best of care if he or she receives complete and honest information from you. 

THE PHYSICAL EXAM: The majority of your physical examination will be very familiar to you from visits with other types of doctors.  The examination of your head, neck, heart, lungs, abdomen (belly), and extremities will not differ much from that performed by your primary care physician. 

The parts of your exam which may be new and unfamilar include the breast and pelvic exam

The breast exam includes a visual inspection of your breasts.  Then your doctor will examine your breasts by palpation (touch).  He or she is looking for abnormal lumps or masses.  Many breast lumps are benign (non-cancerous).  Some are malignant (cancer).  Your doctor may order tests such as a mammogram or breast ultrasound if he or she detects abnormalities of the breast during your exam.   

Your doctor should also ask you whether you are performing breast self-examination.  He or she can teach you how to do a good breast exam on yourself at home.   If you have questions about how and when to do this type of exam at home, you should ask them during the breast exam.  

The pelvic exam consists of two parts.  The first part is usually the speculum examination.  This part of the exam is often accompanied by a great deal of anxiety and trepidation.  This is understandable, as the speculum examination can be uncomfortable.  It should not, however, be painful.  It helps if you try to maintain a relaxed, calm attitude as this REALLY can make the exam more physically comfortable. 

A speculum is a metal or plastic instrument that is inserted into the vagina.  It is usually warmed (if metal) and lubricated (with gel) to make the exam more comfortable.  The speculum is not used to ‘clamp’ anything.  This is a common misconception. The speculum is actually designed to gently open the vaginal canal to allow visualization and sampling of the cervix (which is the lowest part of the uterus, protruding into the vagina). Once this is done, the speculum is gently removed. 

The speculum exam


The second part of the pelvic examination is called the bi-manual examination.  The examiner will insert one or two fingers into the vagina, placing the other hand on your abdomen (belly).  This is done so that the examiner can feel the size and shape of your uterus and ovaries.  Ovarian cysts, fibroids, and some types of endometriosis can be detected this way.

A rectal examination may also be necessary to evaluate certain types of conditions and is a necessary part of the examination of any woman over 50 years of age.  The examiner inserts a lubricated finger into the anus (the lowest part of the rectum).  This may occur in conjunction with a vaginal exam (a recto-vaginal examination) or may include sampling of fecal material for blood (a stool sample). 

THE WRAP-UP: After that, you’re all done!  Your doctor may include certain types of testing such as a PAP smear or a cervical culture for STD’s as part of the gynecologic evaluation.  Always ask your provider what tests you require and how you will be informed of the results.

May 7, 2010 at 6:52 pm 2 comments

Do you have endometriosis?

Maybe.  But first, you need to know the basics.

Endometriosis is a common medical condition characterized by growth of tissue resembling endometrium (the normal lining of the uterus) beyond or outside the uterus itself.  The condition is relatively common, affecting roughly 5-10% of women.

Women who suffer from endometriosis often report painful menstrual cycles or even chronic pelvic pain.   Periods may be heavier or longer than normal.  Some women even experience pain with intercourse (dyspareunia). 

In more severely affected patients, endometriosis can exist outside the female genital tract and affect bowel, urinary, or other physiologic functions.  Menses may be accompanied by nausea, vomiting or diarrhea.  Painful bowel movements (dyschezia) may occur.  Sometimes urination is affected, usually causing painful or frequent urination

In rare cases, endometriosis can affect parts of the body far away from the pelvic organs, such as the liver or diaphragm.  It may even occur outside the abdominal cavity altogether.  Endometriosis has even been found in the lungs and nose, causing monthly chest or shoulder pain and nosebleeds respectively. Another rare symptom is monthly bleeding from the belly-button (umbilicus).

Some women with endometriosis don’t see their doctor for pain at all, but are diagnosed only when they have difficulty getting pregnant (infertility).  It is common for women with unexplained infertility to have evidence of endometriosis found at the time of diagnostic surgery

These signs and symptoms are often reported to a patient’s gynecologist or family doctor.  A gynecologist who is familair with endometriosis can help distinguish whether your symptoms are normal, whether they are a sign of endometriosis, or wither other gynecologic conditions may be at fault.

May 6, 2010 at 8:10 pm 2 comments

Linda M. Nicoll, MD

Welcome to my blog! Here you will find information about minimally invasive gynecologic surgery as well as some more general information about common gynecologic disorders such as endometriosis, ovarian cysts, fibroids, infertility, and pelvic pain.

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