Gynecological (GYN) Visits

What are the current guidelines for GYN visits?

Regardless of your sexual orientation or whether you are sexually active, GYN visits are an integral part of a woman's comprehensive health care. In recent years, there have been many changes in the recommendations regarding the frequency of PAP smears (taking a sample of cells from the cervix to look for cervical abnormalities including cancer and pre-cancer) and the necessity of internal pelvic exams. The current guidelines, which are followed by medical providers at Health Services, are as follows:

  • A PAP smear is not necessary until age 21. After this initial screening, the frequency of subsequent PAPs is determined by the result of the test. In many cases, the next PAP will not be due for at least 3 years.
  • When a PAP is due, an internal pelvic exam (to check the uterus and ovaries) may also be performed by your provider.
  • Otherwise, if there are no gynecologic issues that concern you, and no symptoms of pelvic or menstrual problems, a pelvic exam may not be needed.
  • The decision to do a pelvic exam can be a shared decision between you and your provider.

You should visit your medical provider for a GYN problem visit if, at any point, you are experiencing:

  • Unusual or severe abdominal, vaginal or pelvic pain
  • Abnormal vaginal bleeding or discharge
  • Pain or swelling or the vulva and/or vagina
  • Sores, lumps or itching of the vulva and/or vagina
  • Thickening, dimpling, puckering or other changes in the breasts
  • Unusual or severe menstrual pain

What can I expect at a GYN visit?

You can schedule a GYN visit because you are due for a PAP smear, wish to start a birth control method, or to discuss any gyn concern or questions you may have. Here are the details about what you can expect during each part of a GYN visit:

Medical History
In a private exam room, your medical provider will ask you about your medical and sexual history. Important questions your provider will ask include:

  • When was your last period?
  • How regular are your periods and how long do they last?
  • Do you have any spotting between periods?
  • Do you experience any pain or discomfort during sex?
  • Do you have any unusual genital pain, itching or discharge?
  • Do you have any other medical conditions?
  • Are there family members with significant medical conditions?
  • If you are sexually active, do you use methods to prevent STIs?
  • If you have sex with men, are you using birth control?

You can use this time to bring up any concerns you have or questions you'd like to get answered. Talking openly and honestly with your provider is important to ensure that you get accurate information and appropriate health care. Try not to be embarrassed about asking sexual health questions - your medical provider will likely have heard similar questions before.

You can discuss whether you would like STI testing. Talk to your provider if you are worried about symptoms you may have experienced or if you are concerned about a sex partner. An internal exam is not required for STI tests, which can be done with urine or blood samples.

Your provider will also ask about past health issues and whether you smoke, drink, or use other drugs. To round out the medical history, your provider will take your blood pressure and weight. Your provider may also ask you to give a urine sample if there is any chance of pregnancy.

Physical Exam

You and your provider will discuss whether a breast exam, physical exam, or internal pelvic exam are necessary for you based on your age, medical history, and preferences.

Next, the provider will ask you to get undressed and put on a paper gown. You can leave your socks on if you like. Sometimes you will only be asked to undress from the waist up.

Your medical provider will return to the exam room once you've changed, and will start by listening to your heart and lungs and checking your thyroid. Next, if indicated, s/he will ask you to lie back on the exam table and will perform a breast exam. S/he will feel your breasts to detect any lumps or thickening. If you don't know how to perform breast self-exams (BSEs), your provider will show you how.

Pelvic Exam and STI/Lab Tests
Next, if a pelvic exam and/or pap is to be done at the visit, the provider will ask you to move to the end of the exam table and place your feet in the footrests. Let your knees and thighs spread wide open and relax. The more relaxed your muscles are, the more comfortable your exam will be.

Your provider will first examine your vulva - your external genitalia - looking for any symptoms of irritation, growths, cysts, genital warts or discharge. You will feel your provider's gloved hands touching your vulva.

Next, your provider will use a speculum -- a plastic instrument that s/he will gently insert into your vagina. The speculum spreads the vaginal walls slightly apart so that the cervix can be seen. At this point there is usually some pressure, but if you feel pain, let your provider know so s/he can adjust the speculum for greater comfort. Your provider will look at your cervix to make sure it looks healthy. (If you would like to see your cervix you can ask your provider for a mirror at this point.) Once the speculum is in place, your provider will look for any irritation, growths or abnormal discharge from the cervix.

If you are due for a Pap Smear, your provider will use a small plastic spatula and a small, soft brush device to take a Pap Smear, a quick sample of your cervical cells. This test will be sent to a lab to determine if there are any abnormal cervical cells. The frequency of Pap Smears is determined by your age and whether you have any history of past abnormal Pap results. Sometimes, STI or other GYN tests are done after the PAP by taking samples with a Q-tip. All of these steps only take a few minutes.

Next, your provider will gently remove the speculum and perform a bimanual exam. With a gloved hand s/he will insert 2 fingers into the vagina and with the other hand on top of your abdomen will feel your uterus, fallopian tubes and ovaries. S/he is feeling the size, shape and position of the uterus and whether there is any tenderness or swelling. Again, some pressure is felt here and you may experience the sensation of having to urinate, but it is quick. Your provider will sometimes perform a rectal exam, again with a gloved finger, to feel if there are any abnormalities in the muscles that separate the rectum and the vagina or to get a better feel of the uterus.

Counseling
At this point the exam is complete. Your provider will tell you that you can get dressed, and will return to discuss any remaining questions you have. Use this opportunity to ask about any issues which were not addressed during the rest of the exam. Before your visit you can write your questions down if you think you'll forget or be too embarrassed to ask. You can learn a lot from your provider during your visit - make the most of it. You may have questions about:

  • Sexuality
  • STIs
  • Birth control
  • Pregnancy
  • Abortion
  • Infertility
  • Breast self-exams
  • Any other general health topic

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What if I have my period?

If you are having your period at the time you are scheduled to have a GYN visit, call your provider to see if you will need to reschedule. (If you are a Brown student with an appointment at Health Services, call 401-863-3953. When you're having your period it can be difficult for the provider to clearly see your anatomy and it can obscure test results, but many times a pelvic exam or PAP may not be needed at the visit and it will still work to keep the appointment.

How long does it take?

The entire visit including paperwork and the question and answer session with your provider will usually take 45 minutes to an hour, especially if you have questions or are seeking a contraceptive method. A pelvic exam and/or PAP smear as part of the visit may take about 5 minutes - not long at all.

Does it hurt?

For most women, pelvic exams and PAP smears are at worst mildly uncomfortable and a bit awkward. You can tell your provider what you're feeling during the exam so s/he can slow down or make adjustments so that you'll be as comfortable as possible. Your medical provider will take the time to describe what s/he is doing. If at any point you decide that you don't want to go further with the exam, that is ok. You are in complete control of the exam and can ask your provider to stop at any time you are uncomfortable.

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How often do I need to have GYN exams?

After your first GYN visit, your health care provider will tell you how often you should have exams, including pelvic exams and Pap tests. How often you need your exams will depend on your medical history and individual health needs.

Do I have to be tested for STIs?

You don't have to be tested for STIs, but if you have been sexually active your medical provider may recommend that you have a chlamydia and gonorrhea test performed. Usually, these tests are done with a urine sample. HIV testing is also recommended annually if you are sexually active, so this is another STI test that will be discussed with you.

Can I make an appointment at Health Services?

If you are a Brown student, you can make a confidential appointment for a GYN visit at Health Services by calling 401.863-3953.  Health Services provides a range of services including general health care, STI testing, and emergency medical care. We are located at 13 Brown Street on the corner of Brown and Charlesfield Streets.

Can I request a specific medical provider?

Yes, of course. At Health Services, you may request a specific provider by name or by gender. If you choose, you may request a second staff person to be present during the exam. For example, a woman seeing a male provider could have a female UHS staff member present as well.

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Do I need to have a GYN visit if I want to get a birth control method?

If you are under 21 and are interested in using a hormonal method of birth control, you may not need a pelvic exam, but your provider will still need to do a brief physical exam and take a medical history. If you are over 21 and have had a GYN exam in the past year, you will usually not need to have another exam to obtain prescription birth control. If you had this exam with a medical provider outside of Health Services, you may need to have your records sent here. You can link to the "Medical record request/ release authorization" form to authorize Health Services to obtain your records from another medical provider. If you are over 21 and it has been over a year since your last exam, or if you have experienced other sexual health problems, your medical provider may need to perform a GYN exam. Your provider will assess what's needed and discuss this with you.

What if I'm still afraid to have the visit?

If, after reading this page, you still have concerns about the GYN visit and are nervous or unsure, that's ok. For example, women who have experienced sexual abuse in the past may have specific fears that relate to their experience, or in some cultures, women do not have pelvic exams. You can schedule a visit with a provider to discuss the exam and to increase your comfort with that particular provider. It is important to talk openly with your provider about your fears, about any pelvic pain you have and to talk about your experience. Your provider can work with you to tailor the exam to help you feel as comfortable as possible. Also know that you can have a trusted friend or a second UHS staff member with you during the exam.

How much does the visit cost?

The health fee you pay each year covers the cost of your GYN visit to Health Services. Depending on the type of health insurance plan you have, your coverage for lab tests like PAP smears and STI tests will vary. Brown sponsored health insurance covers the costs of PAP smears and STI screening. For private insurance, contact your health insurance customer service representative to find out which lab tests are covered and which are not. You can also visit the Health Services page on fees and insurance.

Can anyone find out about my visit?

Health Services places a high value on confidentiality. This means that information in your medical records or even the fact that you've visited Health Services cannot be released to anyone without your written permission (this includes parents, partners, friends, professors, advisors, etc.). There are a very few exceptions when information is required to be released without your written consent in the cases of emergencies or when required by law. Your medical provider can address any concerns you have during your visit.

Links you can use

To learn more about GYN exams, you can visit:

Planned Parenthood

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Disclaimer: Health Education is part of Health Services at Brown University. Health Education maintains this site as a resource for Brown students. This site is not intended to replace consultation with your medical providers. No site can replace real conversation. Health Education offers no endorsement of and assumes no liability for the currency, accuracy, or availability of the information on the sites we link to or the care provided by the resources listed. Health Services staff are available to treat and give medical advice to Brown University students only. If you are not a Brown student, but are in need of medical assistance please call your own health care provider or in case of an emergency, dial 911. Please contact us if you have comments, questions or suggestions.