What happens at the gynecologist’s office?

A gynecologist’s office is a place that many women avoid for no good reason. In this article, we will explain what happens at a gynecologist’s office to allow you to let go of your fears. After reading this article, you will also know how often you should visit a gynecologist.

During her extensive career, gynecologist Nonna Heiskanen has examined thousands of women. Thus, she is well aware of the biggest fear women have as they come to the gynecologist’s office. “Many people are uncomfortable with the idea of being naked in front of an unfamiliar person, and this makes them anxious about the situation. Many are also worried about whether the examinations are painful.” Nonna says that these worries are unnecessary. “The examinations are part of our daily work and I can safely say that we have seen and heard it all during our careers. You should not feel embarrassed or ashamed of your appearance as there is nothing we haven’t seen during an examination. The examinations also shouldn’t be painful. We have a wide range of examination and sampling equipment in different sizes at our disposal, from which we choose the right one for each woman’s anatomy and history.”

A good gynecologist performs a thorough examination

The meeting with a gynecologist begins with an anamnesis, i.e. a discussion of your medical history. “I myself begin with the general information. I ask the woman about illnesses, pregnancies, births, and how they went. We also discuss the contraceptive method used by the woman, the length and regularity of their menstrual cycle, the number of days of flow and the volume of flow, and whether the woman experiences menstrual pain. It is also important to know the time of their latest period, i.e. on which day of the cycle they are.” Nonna says that during the discussion the gynecologist may also ask about possible disturbances pertaining to bowel movement or urination, their leukorrhea, and whether the woman experiences pain during intercourse. General information pertaining to the woman’s general lifestyle is also relevant to the gynecologist. In addition, the gynecologist may ask about sexual activity in order to consider examination methods and the necessity of possible screenings, such as Pap test or condyloma virus testing.

After the discussion, Nonna finds out whether the customer would like to have a breast examination. “I usually ask how familiar they are with breast examination. Where necessary, I can show the proper procedure to the woman, or if they wish, I can perform the examination. Breast examination is important for all women, but the significance particularly increases with age.” If the woman asks for a breast examination, they can put on a bathrobe in the changing room of Nonna's office. If a breast examination is not performed, the customer only needs to remove their trousers.

Nomai - Mitä gynekologin vastaanotolla tapahtuu

If this is the woman’s first gynecologist's appointment, Nonna explains the examination procedure and demonstrates the equipment used. “It is important that each woman coming to the office knows what happens at each stage of the examination. They must be able to relax on the examination table without worrying about the details.”

When lying down on the table, the woman does not have to worry about anything. “I instruct the customer to move themselves into the correct position on the table. Only thing they have to do is to make themselves as comfortable on the table as possible.”

A proper gynecological examination includes much more than just a bimanual examination. “I always begin by examining the neck to check that the thyroid gland is not enlarged or lumpy. Next, I check the breasts and underarms, and palpate the abdomen and the groin.”

The next phase includes the examination of the external and internal female genital organs. “First, I visually examine the external internal female genital organs, the external urethral orifice, perineum, and the area around the anus. Next, I use medical lubricant to insert a suitable size spatula into the woman’s vagina, which presses the vaginal floor toward the rectum. I also use a vaginal depressor that lifts the upper wall of the vagina toward the bladder. This allows me properly examine the mucous membranes of the vagina and the external orifice of the uterus.”  During the examination, Nonna lifts the woman's uterus and ovaries using one or two fingers. At the same time, she presses down on the abdomen. “This allows for the discovery of possible findings related to endometriosis, for example.” The examination may also include a rectal examination, particularly if there is reason the suspect endometriosis or the woman suffers from hemorrhoids.

An ultrasound scan is also part of a proper gynecological examination. It can reveal changes in the ovaries, uterus, bladder, and lesser pelvis that may otherwise be difficult to observe. The ultrasound scan can also be used to determine whether the phase of the menstrual cycle, functioning of the ovaries, and the structure of the endometrium correspond to each other.

During the examination, various screenings, such as a condyloma virus/HPV test, Pap test, or STD tests can be carried out where considered necessary. “Adult women should undergo a Pap test every five years. This test is rarely performed for women under the age of 25 without symptoms. A Pap test is carried out for women under 25 years of age if they have an active sex life with varying partners, are a smoker, or have had a sexually transmitted disease. In Finland, all women are also invited to a Pap test organized by the municipality for the first time when they turn thirty. In future, women will be invited to take part in a Pap test once every five years until they turn sixty. I fully recommend taking part in these tests!”

Nonna says that today the human papillomavirus test is recommended as the basis for screening for women over thirty years of age without symptoms. The HPV test is used to examine whether virus types that expose you to cervical cell changes can be found on the external orifice of the uterus. If such findings are made, a Pap test is automatically performed using the same sample. The results are used to consider the need for further examinations or follow-up.

Where the examination includes a breast examination and an ultrasound scan, the visit takes approximately thirty minutes, including the discussion. The actual bimanual examination takes a few minutes depending on whether samples are taken during the examination.

Nomai - kuukuppi - Nonna Heiskanen

The examination can become a pleasant routine

According to Nonna Heiskanen, women should, at the latest, go see a gynecologist for the first time when they start to have sexual intercourse. A painful or prolonged menstrual period or irregular menstrual cycle are also issues that should be discussed with a gynecologist. “Some girls come to my office for the first time when they are 12 or 13 years old. The appropriate time for your first visit to the gynecologist's office fully depends on your personal situation.

Adult women should undergo a gynecological examination once every two years. “The examination provides a good general idea of the woman’s health and is thus necessary for everyone. You also receive advice for breast self-examination and pelvic floor muscle exercises from an expert with relevant medical expertise, which is good. The examination can also provide indication of endometriosis and examine the possibility of symptomatic sexually transmitted diseases that may even cause infertility in the future, thus making it possible to begin treatment where necessary.”

If it has been a while since your last visit to a gynecologist's office, Nonna encourages you to make an appointment. “I always tell my customers who are nervous about their visit that they are likely to find that they actually enjoyed the experience when they leave my office. When the examination is performed correctly it will not hurt, and we gynecologists generally tend to be quite nice!”