Gyn Care 101: What to know about seeing a gynecologist

When should you see a gynecologist? The answer is simple in some ways, more complicated in others. If you're a woman or a person with female reproductive organs, experts recommend that you start seeing a gynecologist when you become sexually active, or at least once before the age of 21.

Good gyn care, as this type of health care is known, is important for many reasons. Depending on your needs and insurance plan, you may receive gyn care from a gynecologist, or a primary care provider (PCP) such as a doctor or nurse practitioner. Think of this post as Gyn Care 101. In it, I'll describe basic reasons for a gyn care visit and how to decide whether to see a gynecologist or PCP. I'll also explain what happens during a visit to a gynecologist, what to discuss, and how to be as comfortable as possible throughout the visit.

Common types of gyn care

Good reasons to see your health care team or a gynecologist for gyn care include:

• a Pap smear to help prevent cervical cancer (this screening test checks cells on the cervix for abnormalities or precancer)
• discussion of birth control options
• solutions for painful, heavy, or irregular periods
• changes in vaginal discharge, which could be a sign of a vaginal infection (for example, a yeast infection or bacterial vaginosis)
• testing for sexually transmitted infections (STIs), such as chlamydia, gonorrhea, or trichomoniasis
• symptoms of a urinary tract infection (UTI), such as burning when you urinate, cloudy or bloody urine, urinating more often than usual, or feeling an intense urge to urinate
• pain or discomfort during sex
• rashes, bumps, or irritation on the vulva (outside portion of the vagina)
• perimenopause or menopause symptoms, such as irregular periods, hot flashes, or vaginal dryness.

Should you see a primary care provider or a gynecologist?

Many primary care teams, especially family medicine providers, are well equipped to handle basic gynecology care. They can perform Pap smears and STI testing; prescribe medicine or advice for UTIs, vaginal infections, and urinary tract infections; and help you decide which birth control methods are a good choice for you.

However, certain concerns are best handled by a doctor who specializes in gynecology. For example, you should see a gynecologist if you have

• painful or irregular periods
• severe pelvic pain or pain during sex
• recurring vaginal infections, such as yeast infections or bacterial vaginosis
• recurring urinary tract infections
• experienced sexual assault.

It's also helpful to see a gynecologist about birth control if you'd like to use long-acting methods, such as an intrauterine device (IUD) or a birth control implant, or if you have health issues like high blood pressure or lupus that make some methods of birth control unsafe for you.

What happens during a visit for gyn care?

Like any doctor, a gynecologist will ask questions about your medical history. They'll also ask about sexual activity — such as when you started having sex and whether you're sexually active — and whether you hope to have children.

When I see a new patient for a gyn exam, I do a full exam including a breast exam, belly exam, and pelvic exam. A pelvic exam involves examining the vulva and labia (lips) that form the outer genitals, inner thigh, and buttocks. I then use a speculum to examine tissues inside the vagina. This exam can be slightly uncomfortable, with a pressure-like sensation, but should not be painful. You should always tell your provider if you are having pain during any part of the exam.

If you are experiencing symptoms, you may be tested for vaginal infections, STIs, or urinary tract infection. Any vulvar skin issues may require a small skin biopsy or sample of a lesion or bump.

What should you discuss during your visit?

There are a few important things to remember to discuss during your visit. It is best to write these down ahead of time, as people often feel nervous and anxious during these types of sensitive visits:

• your sexual history (number of partners, any concerns for exposure to STIs)
• problems with leaking urine or difficulty controlling your urine
• low sex drive or desire to have sex
• discomfort or pain during sex
• heavy or irregular periods
• any vaginal odor, discomfort, or abnormal discharge
• rashes or bumps in the pelvic area
• concerns about or plans for having children in the future.

How can you make yourself as comfortable as possible during gyn visits?

It is normal to feel nervous. You're discussing sensitive topics and may feel vulnerable and even uncomfortable during the exams. Here are a few strategies to try to maximize your comfort during these visits:

• If you are anxious or nervous at gyn visits, let your provider know.
• Ask all your questions before the start of the physical exam.
• Tell the provider if this is your first pelvic exam.
• If you have experienced sexual assault or trauma in the past, tell your provider that these types of exams may be difficult for you given your history.
• Practice mindful breathing or other relaxation techniques during your exam.

Additional ways to help make gyn visits a better experience

You can also ask your provider

• what to expect from the exam before they begin to help you feel more prepared
• to explain why each portion of the exam is necessary and tell you about any tests or labs that they plan to perform
• to let you know when a portion of the exam may feel uncomfortable or when to expect a sensation of pressure.

You have the right to refuse any part of the exam, and your desires should be respected by your provider. You also have the right to ask for a chaperone during the exam if this makes you feel more comfortable.

Trust your gut. If your experience with a particular provider feels uncomfortable or you didn't connect with them, seek out a different provider. Ask friends if they have anyone to recommend.