Learn what types of exams, questions, and comments are normal and appropriate.
When you go to a dental cleaning appointment, you can expect your hygienist to scrape, brush, and floss your teeth. At an annual check-up, you know your physician will take your vitals, measure your height and weight, and check your eyes, ears, nose, and throat. At these types of appointments, it’s easy to recognize inappropriate behavior by your doctor, but this line gets blurred when gynecologists perform exams of a more intimate nature. In light of the recent sexual abuse cases in the news, it’s become increasingly important for patients to fully understand what should — and shouldn’t — occur during a consultation or exam with a gynecologist. Dr. Evelyn Minaya, a board-certified obstetrician and gynecologist believes that learning how to spot any dubious behavior at an appointment and empowering yourself to speak up will prove one thing: “We’re not going to be victims.”
What happens at a routine visit to the gynecologist?
Whether it’s your first appointment with a gynecologist or your 40th, your doctor will start off by thoroughly reviewing your medical history with you, discussing the medications you’re taking, your menstrual cycle, if you’re experiencing any genital pain or problems, and if you’ve had a sexually transmitted infection (STI) or Pap smear. The gynecologist will also listen to your heart and lungs with a stethoscope, examine your breasts for any lumps or irregularities in the tissue, and perform certain exams, depending on your age. Women who are under 21 don’t need invasive vaginal exams, like a Pap smear, unless they have specific conditions or medical risks, and if you’re older than 50, your doctor may perform a rectal exam.
While your doctor may not use gloves while checking your breasts, as they can make it more difficult to detect abnormalities, Dr. Minaya says they should have gloves on when performing any other exam.
Should you be left alone with your gynecologist?
You should always feel comfortable asking for a second person in the room during an exam, and having another doctor or nurse present can ensure there aren’t any misunderstandings, Dr. Minaya says. According to the American Medical Association, a chaperone must be in the room during a physical exam if it’s requested by the patient or physician. Likewise, your doctor should provide you with as much privacy as possible while you’re undressing; they should either leave the room or close a curtain to allow you to disrobe.
How much touching is normal and in which appointments is it unnecessary?
Per the American Medical Association’s ethical principles, exams “should be performed with only the necessary amount of physical contact required to obtain data for diagnosis and treatment,” and your doctor should also explain what they’re doing during the procedure. If you’re getting a consultation about irregular menstrual cycles, birth control, or hormone replacement therapy, your gynecologist likely won’t need to physically examine you. “Anytime you feel it’s strange for your doctor to be touching you, you’re probably right,” Dr. Minaya says. “I think women have a sixth sense.”
When should you get a Pap smear and what happens during the exam?
The American College of Obstetricians and Gynecologists recommends women get their first Pap smear at 21 years old and be screened every three years, and if you’re over the age of 30, Dr. Minaya will do a separate HPV DNA test during the exam. Before the doctor begins the Pap smear, they will have you lie on your back on the exam table and rest your heels in supports called stirrups. Then, the doctor will slide a plastic or metal speculum — a small tool that opens to separate the walls of your vagina — inside the vagina and collect cell samples from your cervix using a spatula and brush that Dr. Minaya describes as smaller than a light tampon. “It shouldn’t be painful,” she says. “It can be intimidating or uncomfortable, but never painful.”
During the exam, it’s appropriate for your doctor to tell you about anything that’s abnormal, but they shouldn’t be making any sexual innuendos or comments based on your physiology, Dr. Minaya says. According to the American Medical Association, “physicians should avoid sexual innuendo and sexually provocative remarks.” For example, a doctor shouldn’t ask you how many partners you’ve had because of the size of your vagina. Aside from refraining from making uncomfortable comments, your gynecologist shouldn’t be touching all of your genitals, only your vagina.
When should you get a pelvic exam and what happens during it?
Unlike in a Pap smear, the doctor won’t have a speculum placed inside the vagina during a pelvic exam. The gynecologist will place one or two gloved, lubricated fingers of one hand inside the vagina and up to the cervix; the doctor will gently press their other hand on the outside of your abdomen. The pelvic exam will check your uterus for any abnormalities and look for enlarged ovaries or fallopian tubes, ovarian cysts, or tumors. “I’m always talking to the patient and letting her know what I’m doing and feeling for,” Dr. Minaya says. “That’s how I give them power.”
The exam should last less than two minutes, and the doctor should explain their findings to you; Dr. Minaya will sit her patients up and discuss what she discovered if it’s something they can’t see, and if it’s something outwardly visible — like an abnormality on the labia — she’ll give them a mirror and show them while they’re in the stirrups.
The gynecologist may ask you if you’re currently sexually active and if you use a condom, but any further intimate questions may be suspect, Dr. Minaya says. They shouldn’t be asking anything non-medical, such as if you currently have a partner, what their age is, how many sexual partners you’ve had, or your race.
Though pelvic exams have traditionally been performed at annual visits after the age of 21, the American College of Obstetricians and Gynecologists now recommends patients make a shared decision with their gynecologist to have the exam done, as there is limited data on the potential benefits and harms of the test. Still, if you’re under 21, your doctor should only recommend a pelvic exam if it would be beneficial because of your medical history or you have particular symptoms, like pain and bleeding during sex.
When should you get an STI test and what will happen during the exam?
Dr. Minaya recommends her patients get tested for STIs every year or if they have a change in partners, and she’ll typically take a swab during a Pap smear. Because she’s the “show-and-tell” type of gynecologist, Dr. Minaya will show her patients the Q-tip she will be using and explain how the test works. The test doesn’t require much touching, so signs of inappropriate conduct would include if your gynecologist isn’t using gloves, is touching or rubbing genital areas that aren’t the normal test sites for STIs, like the clitoris, or is lingering.
What should you do if you feel uncomfortable or thought something your gynecologist did was inappropriate?
If you aren’t sure if your doctor’s actions or comments were inappropriate, Dr. Minaya says trust your gut: “Even simple things like they were not listening, those are things you should bring up and don’t go back.” Tell your mom, partner, or friend about your experience and how you’re feeling and consider addressing your doctor about the situation, which will hold them accountable and perhaps provide some clarification, Dr. Minaya says. Overall, if you feel unsafe or uncomfortable with anything during your exam, notify your state’s board of medical examiners.