Exams

 

Intro to Sexual Health Exams 

for Folks with Vulvas (FwV) | for Folks with Penises (FwP)

About Sexual Health Exams:

Sexual health is as important as general health. Just as periodic general health check-ups are necessary, so is sexual health maintenance. Although basic sexual health may begin with the health care provider, it continues to be an important factor in everyday life, so it is critical that everyone starts in a safe and comfortable place with their doctor or examiner.

Sexual health exams should begin at the age of 18 or when first sexually active, and are especially important for FwV. STIs and other disorders of the urogenital tract, contraception, and cancer surveillance are three main issues addressed during the exams.

In FvW, cervical cancer has been linked to viral agents (HPV) and other low grade inflammatory effects on the cervix, and is easily screened for by a Papinicalou smear (”Pap smear”). Since HPV is extremely common and cervical cancer can be deadly if not treated, all FwV over 18 should have an annual exam that includes a Pap smear. Because HPV is transmitted through skin-to-skin contact, even FwV who have not engaged in penile-vaginal intercourse can still be at risk. Breast, ovarian, and endometrial (uterine) cancers, although uncommon in a younger population, rely on accurate history taking and thorough examination of the breasts and pelvic organs at the time of an annual visit.

For FwP, the annual exam is less mandatory and may be performed every few years instead. However, having a testicular exam performed and being instructed in the technique of self testicular examination is of great benefit to ensuring early detection of this treatable cancer.

Sexual health exams can be very intimidating. Try to relax and remember that the doctor is there to help you maximize your health. To do this they need to know about your concerns and factors or situations that may impact your health. If you do not feel comfortable revealing these things to your doctor or examiner, they may not be able to help you as fully. You should have a physician you trust and feel comfortable talking to. If you don’t feel right with a certain doctor, find another.

An understanding physician should:

  • Be willing to listen, attentive and open, and should take time during each visit
  • Use gender neutral language instead of assuming patients are heterosexual and/or cisgender
  • Show respect for the individual patient and gentleness during the physical exam
  • Be willing to include your partner in health care visits and discussions if that is your wish

If you have specific health considerations, make sure you feel comfortable that they will be properly addressed.

Remember:

  • It is important to give your doctor a complete medical history
  • It is not your sexual identity that puts you at risk, it is your specific behavior
  • If you are engaging in un-safe anal sex, it is a good idea to discuss an anal pap smear with your doctors during your check ups.

FwV Reproductive Health Exams:

Needed once each year or more frequently with symptoms.  As a person with a vulva, you  should have a gynecological exam if you:

  • Have reached the age of 21
  • Are sexually active or is about to become so
  • Desire a prescription for oral contraceptives
  • Want to have an IUD inserted
  • Need to be fitted for a diaphragm or cervical cap
  • Experience unusual pelvic symptoms (pain, unusual discharge, abnormal bleeding)
  • Want to learn how to give yourself a breast self exam

To prepare for an exam you should

  • Make an appointment with someone you’re comfortable with (a woman? Someone you’ve seen before?)
  • Know your own health history, your family’s health history, your current (if any) symptoms, and any questions you would like to ask (sometimes writing these things down helps)
  • Not have intercourse, douche (you should never douche), use any vaginal medications (including spermicides and lubricants), or use tampons for 24 hours before the exam
  • Avoid scheduling during your period; it’s best to schedule in the middle of your cycle, around the time of ovulation
  • Urinate before the examination (a full bladder makes the bimanual exam uncomfortable)

What to expect:

  • Family and medical history
  • General physical exam (blood pressure, weight, abdominal exam)
  • Breast Examination — The practitioner will palpate the your breasts, looking for abnormalities and teaching the patient how to examine their own breasts.
  • External Examination — The practitioner will look at the external structures of the vulval area. If you are having any unusual symptoms, this is a good time to bring them up.
  • Speculum Examination — A plastic or metal speculum is inserted into the vagina, and it is opened. The vaginal walls and the cervix (opening to the uterus) are examined. If a Pap test is planned, the examiner uses a small spatula-like instrument to gently scrape the cervix. This test microscopically examines cervical cells in order to detect abnormalities, including pre-cancerous changes.
  • Bi-manual Examination — The practitioner inserts one or two fingers into the vagina, and using the other hand on the abdomen, palpates the uterus and ovaries.
  • Recto-vaginal Examination (sometimes performed) — The practitioner places one finger in the vagina, one finger in the rectum, and the other hand on the abdomen. This exam allows palpation of more of the internal structures, and is especially useful for some FwV whose uteri are tilted towards the back of their bodies.
  • Pregnancy testing and tests for sexually transmitted infections and HIV are also available. See Pregnancy fact sheet or the STD testing fact sheet for more information.

Does it hurt?
FwV who have never had vaginal intercourse are often concerned that a pelvic exam will be painful or even impossible. It is important to know that speculums come in very small sizes, and that the practitioner can insert only one finger into the vagina if necessary. All steps will be taken to ensure that the exam is painless.

FwP Reproductive Health Exams:

Needed routinely once every few years, or more frequently if there are symptoms or concerns. FwP should have a sexual health exam if they:

  • Are sexually active or about to become so
  • Want to know specifically about status with respect to sexually transmitted infections (see STI Testing fact sheet for more information)
  • Experience unusual symptoms (sores, discharge, pain with urination)
  • Want to have a testicular exam, or to learn more about giving doing testicular self-exams.

To prepare for an exam

  • Make an appointment with someone you’re comfortable with (a man? Someone you’ve seen before?)
  • Know your own health history, your family’s health history, your current (if any) symptoms, and any questions you would like to ask (sometimes writing these down helps).

What happens during an exam

  • Family and medical history
  • Sexual activity (number of partners, gender orientation of partner(s), protection)
  • Current symptoms (if any)
  • General physical exam (blood pressure, weight, abdominal exam)
  • External Examination — The practitioner will look at the external structures of the penis and testicles, looking for abnormalities
  • External Manual Exam — The practitioner will palpate the penis and testicles, feeling for lumps and tenderness. Includes testicular exam.
  • Rectal Exam (sometimes) — Practitioner puts one finger in rectum, feeling for swelling, tenderness)
  • Possible tests include a urine test for chlamydia and gonorrhea and a blood test for HIV.

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