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Most people think that a girl enters womanhood when she gets her period. But that was true way back when marriages were arranged, girls were having babies at thirteen, and the average life expectancy was forty. Now most of us get our first real glimpse of what it means to be a woman during our first pelvic exam.

Let's face it; divulging private info to your doctor, someone you probably don't know that well, taking your clothes off, wearing the ugliest-colored gown they could find, putting your legs in stirrups and spreading them, only to have silver instruments and long Q-tips inserted up your holiest of holies, will never make your Top-Ten-Fun-Ways-to-Spend-an-Afternoon list.

But we all have to do it, and you know what? I think in some way it makes us stronger! This is an important step in taking control of your own health. And the truth is, it's not that bad, especially if you have a nice doctor who goes slowly and talks you through it. If you've used tampons before, that, too, will make things easier.

Nightmare! Do I really need this exam?

I can't stress enough how important this exam is. If you are having problems with your period, a pelvic exam can help to determine the cause. Even if you are not having any problems that you know of, the exam allows your doctor to look for early signs of any conditions that might affect your reproductive organs and to treat them before they do become problems.

For example, the Pap smear, which is a routine part of any pelvic exam, can detect abnormal cells in the cervix. If the condition is not treated, these cells may turn into precancerous cells and eventually cancer. But by giving an early warning, Pap smears have dramatically reduced the number of cervical cancer cases in our country.

If you are sexually active, the pelvic exam can detect most diseases that you might have contracted and allow your doctor to prescribe the proper medication. Since almost everything can be treated, this can save you much trouble and pain in the future.

When should I get one?

You should have your first exam by the age of eighteen. But if you are sexually active, you need one regardless of your age. Many women schedule an appointment with their doctor before they leave for college. Some women prefer seeing a doctor they already know.

Do I still need one if I'm in the V Club (a virgin)?

The answer is yes. And you thought membership had its privileges! Every woman needs to have a pelvic exam and Pap test by the age of eighteen, regardless of her sexual status. Here are a few other reasons to get one:

• Your period has stopped and you don't know why.

• You've never had a period to begin with (you should have an exam if you haven't menstruated by the age of fifteen).

• You have bleeding or spotting between your periods.

• You have a funky discharge or weird odor coming from down under.

• You have itching, sores, or swelling (same region).

• You have pelvic pain and/or bad abdominal cramps that really, truly hurt (not the kind you used to get out of gym class in high school).

Who performs this exam?

The exam can be performed by doctors, nurse-practitioners, midwives, and physician assistants. Some women feel strongly about having a woman examine them. If you do, make sure to voice your preference clearly. If at all possible, your request should be honored.

What will happen to me?

The first step is to relax! You are not going to be tortured; I promise. Since you're going to need this exam every year, it's best to get used to it as soon as possible. Let me paint you a picture.

The nurse or doctor will show you into an examination room, where you will need to disrobe. You'll most likely be handed some ugly paper gown that really doesn't fit anyone properly. Someone will measure your height and weight and check your blood pressure. You may need to give a urine or blood sample.

The doctor will start off with a general physical exam for women. She will listen to your heart and lungs, examine your abdomen, and perform a breast exam. Now is the time to learn how to do one on yourself; self breast exams (SBE) should be performed on a monthly basis. Make sure to ask questions; most doctors have handouts or cards to reinforce how to do an SBE.

Remember, your exam should include all of these parts, and if the doctor skips something, give a gentle reminder.

Now comes the fun part. Since you're lying down already, it's a good time for the pelvic/Pap exam. Most doctors leave this until the end to give you a chance to relax. You'll be asked to slide down to the end of the table. (Be careful sliding. Most tables have a little extension, and during my first exam, my doctor forgot to extend it, and I literally slid right off the table into the loving arms of my gynecologist. Not a shining moment!)

You will need to put your knees on a knee rest or your feet in stirrups, in order to keep your thighs open for the exam. You will definitely feel a little awkward, but I assure you, your doctor has seen it all, and it comes in many shapes, colors, and sizes. It may be a defining moment for you, but it's just another exam out of thousands for her.

The doctor will quickly examine the outside of your vagina for abnormalities or infection. Then she will use a speculum, a small metal or plastic device that is used to spread the internal walls of the vagina in order to see the cervix. Taking deep breaths will help your muscles relax and make the exam easier for everyone. Important note: speculums come in all different sizes; smaller ones can be used for anyone who is in pain or uncomfortable. If you're in the V Club (virgin), make sure your doctor knows so that she uses a smaller speculum.

At this point, a Pap smear is performed. The doctor uses a long Q-tip and/or a brush to gently gather cervical cells, which will be sent to the lab. If you have been sexually active, samples may be taken to make sure you have not contracted any sexually transmitted diseases. Additional samples can be taken if you have discharge or other signs of infection. It sounds like a lot, but most often this part of the exam is really quick. The doctor has done it so many times that it may take only seconds to perform—especially if you can allow your pelvic muscles to relax.

Are we done yet? Almost—you can see the finish line. The final part of the pelvic is a bimanual exam. Your doctor will insert a gloved finger into the vagina while putting pressure with the other hand on your tummy. This lets her feel your uterus and ovaries.

Now you're done. Yippee, you made it—congratulations!

Is it okay to have sex before the exam?

Most doctors will recommend avoiding sex for twenty-four to forty-eight hours prior to your exam. While we're on the subject, you should also avoid using douches, vaginal medications, or creams for at least twenty-four hours before the exam. They can mess up the results, and you'll end up having to repeat the exam.

Pelvic/Pap exams should never be done during your period. Make sure to schedule your appointment accordingly. If your pe- riod arrives unexpectedly, cancel the appointment and be sure to re- schedule.

I'm a nervous wreck; can I take someone with me?

Absolutely. Feel free to take along your mother, sister, roommate, professor, or dog—whoever makes you feel calm. They can stay with you for the entire or any part of the exam, holding hands or paws. Also, a nurse can stay with you for the exam if you so request. Make yourself as comfortable as possible.

I'm leaving for college, and my mom insists on coming with me for this exam. Help!

If you want to be alone for the exam, it is entirely your choice. Just inform the doctor, and she will help facilitate this. Some offices have waiting rooms for anxious mothers, and if need be, your mom can be handcuffed to the wall. (Just kidding, so don't get any ideas.)

I don't want anyone to know the results.

In general, most doctors will keep the secrets of your sexual life under wraps. You should be able to speak freely and openly to your doctor without worrying about your parents or anyone else finding out. The college health center should speak directly to you and only to you. If you have any concerns about this, ask the doctor for confirmation that this will be a strictly confidential visit.

If you need to be treated for a sexually transmitted disease, you should share the information with your partner; he or she may need to be treated, too. And remember, hiding a serious medical condition from your parents is never a good idea.

Questions You Must Ask the Doctor

Now that the hard part is over, you can breathe a sigh of relief. The end of the visit is your chance to bring up any concerns that you might have. Usually the doctor will have you get dressed first and then come to her office. Use this time to ask about anything you want to know.

Contraception. If you are considering birth control, this is a good time to ask about your options.

Pap smear results. Make sure to ask when the results will be back and if you need to call the office or health center to get them.

Diseases that run in your family. Discuss your family history with the doctor, and ask what types of lifestyle choices can help protect your health. (For example, if there is a strong history of breast cancer in your family, ask what you can do to protect yourself.)

Self-breast exam. Don't forget to ask how to perform a breast exam on yourself, and request handouts to remind you.

Sexual history of you and your partner. Be open and honest with the doctor about any infections you or your partner have had. This information will help the doctor take the best possible care of you.

Sexual abuse. If you have a history of being sexually abused or raped, you will want to let your doctor know. She can help you work through any physical problems you might be experiencing as a result and may suggest counseling to deal with any emotional problems.

Copyright © 2006 by Jennifer Wider, M.D.. Excerpted by permission of Bantam, a division of Random House, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

Tags: Women's Health

About the Author

Jennifer Wider is a doctor and medical journalist who was formerly managing editor of the ivillage Health Channel website, and is currently a news service reporter for the Society for Women's Health Research, a non-profit organization dedicated to improving the health of women. Her column for SWHR covers a variety of women's health/medical topics and is syndicated to newspapers, magazines, and websites across the country. She lives with her physician husband, and daughter and son, in Westport, Connecticut.