EXCERPT FROM “CHANGING BODIES, CHANGING LIVES”
by Ruth Bell and other co-authors of “Our Bodies, Ourselves,” together with members of the Teen Book Project
One important way to take care of yourself is to have a yearly physical examination. Just the way you take your car in for a regular lube and oil change, you want to take yourself in for a checkup before anything really serious happens. A regular medical checkup is a form of preventive medicine; it helps prevent you from becoming seriously ill.
WHERE TO GO FOR A CHECKUP
- Family doctor. Many of you will have a doctor you have been seeing since childhood. She or he will probably continue to serve you until you are sixteen or seventeen, if you do not change doctors. Many pediatricians these days have special training in teenage health.
- Health maintenance organizations. Many families belong to health insurance groups. Check with your parents.
- Local health clinics. You may prefer to go to a local clinic for medical services. Look in the business pages under Clinics, Health Services, Medical Services. Ask friends for recommendations. Check with your school nurse to see whether he or she can recommend a clinic.
- Women’s clinics or women’s health centers. These provide complete services for women and girls. If there is a women’s clinic in your city or town, call them. Ask if they also provide treatment for males.
- Community clinics. Some areas have clinics that run solely on grants and donations. They do not charge anything for their services. If there is a free clinic in your area, that would be a good choice, since they are likely to treat many teenagers and they would therefore be set up to handle special teenage problems. Look in the business pages under Clinics.
MAKING AN APPOINTMENT
You may want to talk to the people at different places before you decide where to go for your checkup. Call them and ask them about the services. Tell them your age.
Here is a list of some questions you may want to ask:
- Do they treat many teenagers?
- How many doctors and nurse practitioners do they have on their staff?
- How long have they been in operation?
- Are they affiliated with any hospitals?
- What do they charge for a complete physical exam?
- Do you need your parents’ consent to be seen by a doctor?
- If you are a girl and would prefer to be seen by a female doctor, ask if they have one on the staff. Many places do.
You’ll be able to determine by their answers and their friendliness whether you want to go to that clinic. They should be courteous and respectful and answer your questions.
Make an appointment for a time that is convenient you. If there is a particular health practitioner you want to see, make your appointment for a time when that person is on duty. Once you make an appointment, be sure to keep it. If you cannot keep it for some reason, be sure to phone the clinic or doctor’s office to cancel your appointment.
Ask for directions to the place. Ask if you can get there by public transportation if you need to.
We advise you to bring a parent or a friend along with you to the appointment. It’s nice to have company while you’re waiting for the health practitioner. If you prefer to go alone, you may want to bring a book or some homework. There is usually a fifteen- to forty-five-minute wait. At some clinics there is a much longer wait.
As a consumer of health care, you have certain rights, regardless of your race, religion, age, sex, or education. These are:
- The right to be treated with dignity and respect.
- The right to privacy and confidentiality.
- The right to have all procedures explained in language you understand.
- The right to have all your questions answered in language you understand.
- The right to know the meaning and implications of all forms you are asked to sign.
- The right to know the effectiveness, complications, and possible side effects of all medications you are given.
- The right to know the results and meanings of all tests and examinations.
- The right to consent to or refuse any test, examination, or treatment.
- The right to see your records and have them explained to you.
Medical professionals are human. They make mistakes. They may be very busy. They are not perfect. They can’t read your mind. In order to get the best treatment possible, be sure to speak up when you don’t understand something. Ask questions. Let them know if what they doing hurts you or makes you feel uncomfortable.
If you feel your rights have been violated, talk to the clinic director or to the health worker in charge of the office. If they aren’t helpful, do not use their services in the future if you are able to go somewhere else. Tell your friends about your poor treatment. You and they may be able to get together and organize a list of good medical services in your area. You can boycott doctors and clinics that do not provide adequate services to teenagers.
If you have a serious complaint — for example, if you were physically mistreated or you were lied to or misled, or if you suspect that you are, or ever have been, the subject of a medical experiment and have questions about it, or if you feel any of your rights have been violated — you can contact your State Board of Medical Examiners for physician grievances or the State Board of Nursing for grievances against nurses. Their office will be listed in the phone book of your state capital (which you can find in the public library), or you can get their phone number from calling directory assistance for your state capital. Describe your mistreatment, and give them the name of the doctors and/or health workers who were at fault. Give them the name and the address of the place where you received treatment.
A TYPICAL MEDICAL EXAMINATION
Lots of people put off going for an examination because they are afraid of what it will be like. They worry about shots or other procedures that may hurt or be uncomfortable. Some people don’t like the idea of getting undressed in the examining room. Here we will explain what to expect from a typical exam in order to take some of the strangeness out of it and to help you to feel more comfortable.
Complete Medical History
An important part of any thorough exam is the medical history. This is a series of questions about your present and past health, and the health of members of your family. You will be asked what diseases you had as a child; what illnesses close members of your family have had; what, if any, special medical conditions you may have, such as diabetes, heart murmur, fainting spells, headaches.; and what kinds of illnesses run in your family, such as cancer, heart disease, diabetes. They will ask you if you have any allergies and whether you are allergic to any form of medication or whether you take any medication or drugs regularly.
Remember, according to the medical code of ethics and in some cases according to the law, the health professional must keep this information confidential, unless it is about sexual or physical abuse. Medical people are required by law to report suspected sexual or physical abuse cases to the appropriate authorities.
In many clinics and doctor’s offices, a trained medical professional will ask you about your medical history. In other places, there will be a form for you to fill out. This will be a checklist naming various diseases and asking you to check which you’ve had and which you haven’t had. Answer only those questions you understand and know the answer to. If you bring a parent along with you to the exam, he or she will be able to help you, especially with questions about your past health and the health of other members of the family.
If you have trouble reading the form or if you don’t know what some words mean, don’t fill out that part. Talk to the health worker and ask for an explanation of any part you don’t understand. If the whole form is confusing to you, ask for help. You have a right and an obligation to yourself to have everything explained to you so you know what you are filling in.
Time to Talk to the Health Professional
The examination should include as much time as you and the health professional need to discuss any problems or concerns you have about your development, your life, your feelings. Bring along a list of questions so you won’t forget what you wanted to talk about. This time should be private so that you can discuss things you might not want to talk about with someone else present. If a parent comes with you to the exam, ask for private time to speak with the health professional alone. Many medical people are sensitive to the fact that teens may want some time to ask questions or discuss private issues without a parent present.
The health professional should discuss with you the process of physical development and explain to you why and how your body is changing. He or she may discuss diet and health habits with you. Some medical people prescribe vitamins; others believe that if you are eating well, you don’t need vitamins. That is still a controversial subject in medical circles. We feel free to ask your health professional to explain his or her approach to the prevention of illness.
One important part of the talk will be about sexuality. Since your body is becoming mature sexually and you are going to be or are already capable of reproduction, the health professional should take this time to discuss birth control and sexually transmitted diseases with you — even if you have no intention of being sexually active with a partner for a long while. It’s essential to know about birth control and STD prevention before you become sexually active. If he or she doesn’t bring these topics up, you should ask him or her any questions you may have about sex. If the health professional hedges, or seems embarrassed to talk with you about these things, you may choose to find another health practitioner for future checkups. Find a medical person with whom you feel comfortable discussing sex. For some teenagers, this person is their only reliable source of accurate sex information.
Be honest with the health professional about whether or not you are sexually active and what kinds of sexual activity you have experienced. It’s for your own protection, because if you are having intercourse or oral sex, you should have STD tests during the exam (see Chapter 9). Also, girls who are sexually active should have Pap smears (explained page 251).
If you are having problems with drugs and/or alcohol and you want help, the health professional would be a good person to ask for assistance. You will have to decide whether you trust her or him enough to share your problem. Since the first step to ending substance abuse is admitting you have a problem, telling the health professional will be a positive move toward recovery.
If you are experiencing panic attacks, frequent headaches or stomach aches, an inability to concentrate school, problems with family members, or any kind of abuse, tell the health professional about it. Keeping these serious problems secret allows them to continue. Though you may feel funny discussing such intimate things with a stranger, sometimes it’s actually easier talking to someone you don’t know very well. Think of the health professional as an important resource person. Even if your concerns aren’t medical, he or she will be able to put you in touch with other people who can help you.
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.
Excerpts from “Changing Bodies, Changing Lives” by Ruth Bell and other co-authors of “Our Bodies, Ourselves,” together with members of the Teen Book Project. Three Rivers Press: 1998. © Ruth Bell.