Excerpts from Changing Bodies, Changing Lives
The Physical Examination
After you've given your medical history and talked to the health professional the physical part of the examination will usually take place -- though sometimes the order is reversed.
Urine. You will be asked to go into the bathroom and urinate into a paper or plastic cup. Let a little urine run into the toilet first, then catch some midstream in the cup. Most people fill the cup about halfway and then let the rest of their urine, if there is any, run into the toilet. Girls hold the cup under them while they sit on the toilet. Boys stand and direct their urine into the cup. Your urine will be tested in various ways to make sure your kidneys and bladder are functioning properly.
Measurements. Then you will go into the examining room and undress. You will be alone while you undress, and there will be a hospital gown or paper robe for you to put on. A medical professional will come in and take your blood pressure and measure your height and weight. If you've never had your blood pressure measured before, don't worry -- it doesn't hurt. A pressure sleeve is wrapped around the upper part of your arm and pumped up to create pressure. Your blood pressure is measured as the pressure is relaxed. (Your blood pressure may sometimes be measured before you undress.)
Blood Test. Your exam should include a blood test, during which a sample of your blood is taken from your arm with a needle. The nurse will make a tiny puncture in your vein, and blood will flow into a small glass vial. Very little blood is taken. The initial puncture may sting, but the hurt should not last more than a few seconds. You can hold someone's hand if you are afraid. This is a very important part of the exam, especially for teens who are sexually active.
Your blood will be tested to see if signs of any disease are present. Syphilis and hepatitis show up in the blood, as do many other diseases and medical conditions. There is a blood test for HIV/AIDS and also a blood test for pregnancy.
If you are terrified of needles, tell the health professional.
Head Check. Your eyes, ears, nose, throat, and teeth will be checked. The doctor or nurse may give you an eye test to check your vision. This usually involves reading from a chart placed about twenty feet from where you are asked to stand. Your hearing may be tested using a machine called an audiometer. You'll be asked to put on a pair of earphones and listen to sounds.
General Body Check. The doctor or nurse will look your body over, checking for swelling, rashes, or anything else out of the ordinary. He or she will feel around your neck and under your arms and along your body, looking for enlarged glands. This is the part of the exam during which the health professional may poke you a little here and there. He or she isn't trying to hurt you -- it's just to check certain vital places on your body.
Your heart and lungs will be checked. The health professional takes your pulse and listens to your breathing with a stethoscope.
If you are having any pain or itching or other symptoms, this would be a good time to talk about that. These are clues to help the medical professional determine what, if anything, needs special attention.
The health worker will feel around your testicles, scrotum, and penis, checking for lumps or pain. He or she will be wearing surgical rubber gloves. Ask him or her to show you how to check your own testicles for lumps (see p. 23). He or she may ask you questions about genital development and about whether you have ejaculated during masturbation or during your sleep. This is completely normal, and although it may seem embarrassing, answer honestly. It's a natural part of a boy's sexual development.
Rectal Exam. Sometimes the doctor or nurse will do a rectal examination -- that is, feel inside your anus to check for lumps or swelling or obstructions. First he or she will put on a thin rubber glove and lubricate his or her finger with some lubricating jelly. He or she will ask you to relax your bottom and then will gently insert the finger into your anus. One doctor told us the best way to relax is to take a deep breath and bear down, just as if you were trying to have a bowel movement, then breathe out and let your body go limp. If the health professional is gentle and you are relaxed, the rectal exam shouldn't hurt at all. If you are tight and nervous, it may feel uncomfortable. Be sure to say if it hurts, so that he or she can slow down and be more gentle.
Sexual Functioning. The health professional should explain to you about the male role in pregnancy and about birth control. You can ask him or her to show you how to put on a condom.
If you have had sexual intercourse or oral sex, you should have a test for gonorrhea, syphilis, HIV/AIDS, and other STDs (see Chapter 9, beginning on page 253).
The health worker will feel around your breasts, checking for lumps, swelling, and/or pain. She or he will ask you questions about when your breasts started developing. Ask him or her to teach you how to check your own breasts for lumps each month after your period (see page 30).
The doctor or nurse will also look and feel around the groin area. He or she will examine the vulva, checking the urethra and the outside of the vagina. He or she will check to make sure there is enough of an opening in your hymen (see page 34) to allow menstrual flow to escape easily. If you have a very small opening, the doctor may discuss with you ways to ease open the hymen yourself.
Menstruation. You and the health professional may have discussed menstruation during the "time to talk" part of the exam. Otherwise, this is the appropriate time to talk about when your period first started, if it has, and how often it comes. The health professional will want to know how heavy your usual flow is, and how long each period lasts. Tell her or him about any discomfort you may experience during or before your period. If you haven't started your period yet, this visit can reassure you that everything is fine. Some girls don't start their periods until they are seventeen or eighteen.
We recommend keeping a menstrual record. Write down when you started menstruating, and then write down the date of the first day of each period. After a while, you'll be able to see a pattern forming to help you predict when to expect your next period. Also, for medical tests and treatments, it's good to know when your last period began.
Internal (Pelvic) Examination. A girl's organs of reproduction are on the inside. Unlike a boy's penis and testicles, the uterus, ovaries, and fallopian tubes cannot be seen or examined externally. In order to examine a girl's organs, the health professional must look and feel inside your vagina. She or he puts on surgical gloves before the examination.
Health professionals often choose to omit the internal exam with younger teenage girls unless there is a specific need for it, or unless the girl is already having sexual intercourse, because many girls and women feel uncomfortable about this exam. Many boys and men feel the same way when the doctor examines their genitals. Throughout this book, we've recommended that you get to know your own genitals, that you look at them, touch them, and learn about their functions. If you haven't done so already, we hope you will read the chapter entitled "Changing Bodies," beginning on page 369, which will help you to discover and appreciate that part of yourself.
To do an internal exam the health worker will ask you to push yourself down to the end of the examining table with your buttocks just at the edge and your knees bent and spread apart. Your feet will go into metal stirrups placed at the foot of the table. It is an awkward position to be in, but doctors and nurses say it is the most convenient way for them to check you. Here is how eighteen-year-old Mary described it:
I think that position is really undignified. There's something about lying there on my back with my legs up and spread open that I just think is gross. But I try to psych myself up. I tell myself, "This is OK. It's just normal. It's just a doctor. He does it all the time." I think about it that way and then it's OK for me.
There should be a female health professional present in the examining room while a male practitioner is performing an internal examination on a girl or woman. If the practitioner is a woman, no other person need be present.
The Speculum Exam. Since the walls of the vagina are touching, the health practitioner won't be able to see inside without holding open the two sides of the vagina. There is a special instrument, called a speculum (speh-cue-lum) made just for that purpose.
The speculum comes in both plastic and metal in several different sizes. There is a small size especially for young girls and for women who have small vaginal openings. The doctor or nurse inserts the speculum by holding the two branches of it together and easing them gently into your vagina. If it is a metal speculum, it should be warmed before insertion. Once the speculum is inside, the practitioner opens it and presses down to lock it in place.
Putting in a speculum can be uncomfortable for you if the doctor or nurse is not gentle or if you are nervous and tensed up. Be sure to say if he or she is hurting you. Ask him or her to give you a chance to relax.
The best way to relax the muscles in your pelvic area is to take a few deep breaths and blow all the air out after each one. Then take one deep breath and hold it. At the same time bear down on your pelvic area. Then breathe out slowly and relax your body totally. Let you mouth drop open. Relax your fingers and toes. Concentrate on opening your vagina.
Once the speculum is in place, your cervix and the inside of your vagina can be easily seen. The health practitioner can hold a mirror in front of your vagina so that you can look too if you'd like. It's fascinating to see what you (and all females) look like inside. It helps you to understand how you body functions. (See page 33 for a description of what you'll see.)
The examiner will be looking for redness or inflammation in the vagina, which can be a sign of infection. Normally, the walls of the vagina are pinkish brown. He or she will also look for any unusual discharge and will check for cuts or tears or cysts on the cervix. He or she will also check the color of the cervix. It is normally pinkish or brownish pink, although there is a wide variation among different individuals. During pregnancy the cervix takes on a slightly bluish tint, so the color of the cervix can indicate a possible pregnancy.
Pap Smear. With a long Q-tips-like stick bound with cotton at the tip, the health worker will gently scrape some cell tissue from the cervix.
The cell tissue will be sent to a laboratory to determine if there are any abnormal cells present. This is helpful in checking for precancerous conditions. Another sample may be used to determine the presence of some STDs. You will be notified within a few days if any abnormalities appear in your test.*
Named after Dr. G. N. Papanicolaou, the physician who developed the test, a Pap smear should not hurt, although you might feel it. As with everything else, some people are more careful than others. Let the health practitioner know if he or she hurts you.
Pap smears are recommended for girls eighteen and over or for girls, no matter what age, who are having sexual intercourse. If you fit either of these categories, have a Pap smear once a year. If you take the birth control pill o use an IUD for birth control, if you have genital herpes or some other STD, or if you have more than one sexual partner, women's health advocates recommend having a Pap smear every six months.
Bimanual Vaginal Exam. After the doctor or nurse closes the speculum and eases it out of your vagina, she or he will want to examine your internal organs manually. He or she will put a thin rubber glove on one hand and lubricate one or two fingers of that hand with lubricating jelly. Gently, he or she will insert the finger or fingers into your vagina while placing the other hand on your lower abdomen. In this way, the doctor can feel the size, shape, and position of your uterus, ovaries, and tubes. He or she will be looking for unusual swelling, tenderness, or growths. When the examiner presses down in certain places, it may feel a little uncomfortable, but it usually doesn't hurt. Ask the examiner to explain what he or she is feeling for. Be sure to say if you experience soreness or pain.
Try to relax during this exam by breathing slowly and deeply. Remember to keep your fingers and toes loose and let your mouth drop open.
Rectal Exam. Sometimes the health worker can feel the organs better by inserting a finger into the anus. (See page 249 for an explanation of a rectal exam.)
After the Examination
When the exam is over, the health professional will leave the room so that you can have privacy while you put your clothes back on.
He or she will tell you if you should have another appointment soon, or whether you won't need to return for another year. If there is a medication to prescribe or if he or she wants to discuss some part of the exam with you, the health professional will spend a few minutes after the exam talking with you.
At a clinic or HMO, they may be able to fill prescriptions on site. Otherwise, if you are given a prescription, take it to a pharmacy and the druggist will fill it for you.
If you have any questions or comments about the exam, feel free to speak up. You have a right to have your questions answered and your comments heard.
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