You may feel nervous or awkward about your first appointment with a gynecologist, a physician who specializes in women's reproductive health. Let's face it: The entire appointment focuses on your private parts, and the private nature of that area of the body and topics discussed at this type of appointment makes this unlike other visits to the doctor. But seeing a gynecologist is an essential part of women's health. To put your mind at ease, Northwestern Medicine OB/GYN Arjeme Denise Cavens, MD, answers frequently asked questions about the first visit to a gynecologist.

Q: When should I have my first visit to a gynecologist?

A: You should start getting annual Pap tests at age 21, but start thinking about scheduling your first visit to a gynecologist in your late teens or early 20s, even before you need your first Pap test. If you are not ready for your first physical exam, you should still make an appointment with a gynecologist or provider who deals with female reproductive health so that you can start the conversation about your reproductive health and plan for your care.

Q: What can I expect from my first visit at the gynecologist?

A:

• Review of your family health history: This includes any conditions or cancers that run in your family. Even if a condition may not seem directly related to reproductive health, the condition may still have an impact.
• Breast and pelvic exams: Your physician will feel for any abnormal masses in your breasts, pelvis and abdomen. If something abnormal is detected, further testing might be recommended. 
• Pap test: A Pap test involves taking a swab of your cervix in order to test for abnormal cells and human papillomavirus (HPV). Pap tests used to look only for abnormal cells in the cervix. Now Pap tests look for HPV as well, because HPV can be a more important predictor of cervical cancer.
• Sexually transmitted infection (STI) tests: The Pap test does not test for STIs beyond HPV. Depending on your sexual history, your physician may recommend testing for additional STIs. This is typically recommended if you have had new sexual partners since your last visit. In general, sexually active people should consider testing for STIs annually.
• Discussion of safe sex practices: Your physician will ask you questions about your personal history, including your sexual history, and discuss safe sex practices. It is important to be open and honest about your sexual practices with your gynecologist.
• Discussion of birth control options: Your physician will answer any questions you may have about:
• Your fertility
• Your period and any abnormalities you experience with it, including pain and excessive bleeding

Q: What type of birth control should I be on?

A:

• If you are interested in birth control, it is important to be fully informed about all your options.
• Gynecologists typically prefer long-acting reversible contraceptives. These are birth control methods that do not rely on you having to do something when you have sex, like put on a condom or take a birth control pill every day. With long-acting reversible contraceptives, you are less likely to have unintended pregnancies.
• However, that does not mean other forms of birth control, including condoms, can't work for you.

Q: What should I do If I'm nervous?

A:

• Know that you are not alone. I am a gynecologist and still feel apprehensive when I go in for my yearly gynecological exam. As a gynecologist, I can also assure you that I have seen it all and that you have nothing to be embarrassed about.
• Let your gynecologist know that you are nervous. They will work with you and will never do anything that you are not comfortable with.
• Discuss goals for each visit with your gynecologist so you are prepared for what will happen ahead of your appointment.

Q: Am I too old for the HPV vaccination?

A:

• The HPV vaccine is now approved for people up to the age of 45. Talk to your provider if you haven't gotten it yet. The Centers for Disease Control and Prevention (CDC) recommends HPV vaccination for preteens of all genders starting at ages 11 or 12. Ideally preteens should get the vaccine before they are exposed to HPV through sexual activity.
• The HPV vaccine is one of the most important vaccinations you can get to fight cervical cancer, as nearly all cervical cancer cases are caused by HPV.
• Even if you have HPV, you should still get the vaccine.

Q: What else can I talk to my gynecologist about?

A:

• Sexual assault: Ideally, this is something your gynecologist will ask you about.
• It is important to note that you should go to the emergency room immediately after a sexual assault if at all possible.
• As a gynecologist, I encourage my patients to feel empowered to tell me about any sexual assault they may have experienced, regardless of when it occurred. We care. We will do something about it and make sure you have the appropriate treatment and resources.
• If you are a victim of sexual assault, the pelvic exam or other exams your gynecologist may conduct may be uncomfortable for you. We will make sure that you feel comfortable during the exam and omit or modify these portions as necessary.
• Mental health: Some aspects of mental health can be related to your monthly period. Some gynecologists prescribe and adjust psychiatric medications. If your gynecologist does not, they will still be able to refer you to a provider who can help with your mental health or direct you to other mental health resources to best fit your needs.

Q: How often should I see my gynecologist?

A:

• You should see your gynecologist annually.

If you have issues you would like addressed, do not wait until your next annual appointment. Schedule an appointment with your gynecologist to discuss these health issues as soon as possible.