What to expect at the Gynecologist:

No doubt about it: Scrunching onto an examination table with your feet in metal stirrups is nobody's idea of a good time. But a gynecological exam is something a smart woman endures once every year to protect her reproductive system—and her life. If you're 16, or if you're sexually active, it's time for your first exam.

Here's what to expect. A routine gynecology exam has three parts: the breast exam; the internal exam, sometimes called a pelvic; and the rectal exam.

First, you empty your bladder; your doctor may ask for a urine sample. Then you strip—everything but your socks. You put on a short paper gown with the opening to the back and a nurse may take your weight and blood pressure. See that examination table? Climb up, lay back and cover your lap with a paper sheet.

Next, your doctor may "palpate," or feel every inch of your breasts. She's on the lookout for lumps and bumps which could indicate something as common and benign as a dense patch called a fibroid cyst or as serious as a malignancy. You should be performing a breast self-exam after every period. Ask your doctor to show or remind you how. Becoming familiar with your breasts means you'll be able to report to your doctor any changes in their appearance or texture. To learn more, call the American Cancer Society at: 800–ACS–2345.

Next you'll have the pelvic. That's pelvic, not panic. Simply relax as much as you can: The less tense you are, the more comfortable you'll be.

You'll slide down and put your feet in the padded metal stirrups. Your doctor will probably ask you to "scoot" your butt closer to the edge of the table. The position is awkward, but its duration is brief—the exam takes just two to five minutes. If you're curious about what the doctor is doing or what your reproductive organs look like up close and personal, ask for a mirror.

At the beginning of the pelvic exam, your doctor will insert one or two glove—covered fingers into your vagina and reach up toward your cervix. She'll feel your uterus and ovaries from the inside with this hand while she pushes down on your abdomen with her other hand. This way, she can tell the location, position and size of your organs and may be able to detect any tumors or cysts.

Next comes the Pap test or "smear," which collects a tissue sample to detect cervical cancer. To perform the Pap test, which is only a swipe with a cotton swab, the doctor inserts a plastic device called a speculum into your vagina. The speculum opens you wider for examination. It feels weird but it doesn't hurt. The speculum is removed and the cervical tissues on the cotton swab are put in a sterile container for a lab. Your doctor will ask you to call in a week for your Pap test results, which she will discuss with you then. The last step of your visit is the rectal exam. The doctor inserts a gloved and lubricated finger into your rectum to check for hemorrhoids and other disorders. Again, relax, and you'll be merely (slightly) uncomfortable.

That's it. You can get dressed!

So how do you plan your first gynecological exam? If you're in college and have a health service, it's a cinch. Otherwise, you'll need to choose a doctor—or be assigned one by your HMO.

A family physician can perform the exam, but an obstetrician/gynecologist specializes in women's health. And if you think you'd feel more comfortable being examined by a woman, choose one. (Many women say they wouldn't even consider a male gynecologist.) Ask for recommendations from women who seem in control of their health. Even the Yellow Pages can be a source. Be a savvy consumer. You have every right to expect support and respect, not brusqueness and condescension, from your gynecologist. "For your first pelvic," says San Francisco ob/gyn Maida Taylor, M.D., MHP, "you should be given the courtesy of meeting the examining doctor or nurse while you're wearing your clothes." If you don't like a particular doctor's attitude or treatment, keep looking.

Most practitioners, says Nancy Sanders, R.N., FNP, of Palmdale, California, will be happy to meet with you privately before your exam so that you'll feel comfortable when you have it. You also don't have to go it alone on exam day. "It's perfectly appropriate to have someone present during the exam," says Dr. Taylor. "Even if your doctor is a woman. It's OK to ask, 'Could I have one of your staff come in with me and hold my hand?'" You'll probably have a dozen questions for your doctor, and she'll have some for you. She'll ask about your family history of breast, uterine, ovarian or cervical cancer. Your doctor will also write down when your last menstrual period began. It's a good idea in general to record your first day every month. (Incidentally, try to schedule your exam for when you're not menstruating.) Your doctor will ask you about cramps and about your menstrual flow. Now's the time to ask her any burning questions about your periods. If you've been sexually active, even with one partner, tell your doctor. It's in your best interest to ask for a chlamydia and a gonorrhea culture. Dr. Taylor estimates that up to 25 percent of all infertile women suffered from tubal infections before they were 25 years old.

Chlamydia is an epidemic. If you're concerned about it, or about HPV (human papilloma virus—genital warts), which is also rampant, say so. If you're embarrassed to bring up the topic of sexually transmitted diseases (STDs), Dr. Taylor suggests you say: "I've heard that chlamydia is a problem for young people today. My boyfriend is monogamous, but let's just do these tests for my protection."

The Centers for Disease Control also recommend that all sexually active people be protected against the hepatitis–B virus, which causes a potentially fatal disease that attacks the liver. Immunization by a series of three injections will keep you safe.

Your gynecology appointment is the time to discuss contraception. Remember, whatever kind of birth control you choose, you must also use a condom every time you have sex.

Keeping healthy is a way of life. The more you do it, the easier it gets. And soon your annual gynecological exam will be just another appointment on your calendar.

FYI
Any of the following medical specialists can perform a pelvic exam.

Obstetrician/gynecologists are medical doctors who specialize in women's health. They have passed an extensive formal review by other doctors. May be in private practice, work for an HMO or at a municipal clinic. Fees vary.

Family practitioners are physicians with special educational training in women's health. They also treat children and men. You'll find family practitioners in private practice or in clinics. Fees vary.

Nurse practitioners are registered nurses with advanced education and clinical training in women's health. They work under the supervision of a physician, either in private practice or in a clinic. Many also work as counselors in high schools.

Planned Parenthood is a national, nonprofit organization dedicated to women's health. It employs both physicians and nurse practitioners. Its offices have education departments and offer videos of the pelvic exam. Planned Parenthood offers all types of birth control, teaches breast self–exams and STD prevention, gives pregnancy tests and performs abortions. Fees are on a sliding scale, depending on the patient's income. Call: 800–230–7526.

Women's clinics, which administer gynecological examinations, abound. Check the Yellow Pages or call a local hospital, a nearby university's health services department or your county health department for referrals. Fees vary.