As for most problems, consult your GP first if you have any problem concerning the reproductive organs. However, we are aware that some GPs are less keen to investigate and treat gynaecological problems than others. A clue which you may find useful is that those GPs who provide a full range of contraceptive services or are on the ‘Obstetric List’ are more likely to be interested in these problems. You can find out which GPs in your area provide contraceptive or obstetric services from the ‘Medical List’.
If, for some particular reason, you do not want to see your own GP about a gynaecological problem there are some occasions when you can seek help elsewhere:
• Contraceptive advice: You may go to a Family Planning Clinic, usually run by the local Area Health Authority (Health Board in Scotland). You may also go to see a GP other than your usual doctor, just for contraceptive advice and supplies. This can be especially useful if your usual doctor does not fit the full range of contraceptive appliances (although most will prescribe the pill). You can register with the second doctor just for contraceptive services under the terms of the NHS. Find the names of doctors who are prepared to do this from the local Medical List. There will be no charge for advice or supplies.
• Pregnancy: You may register with a GP, other than your own, for advice and care during pregnancy. This would normally only be advisable if your usual GP does not carry out maternity care.
• Possible Venereal Disease:. Consult a hospital Venereology Department directly.
The Gynaecological Examination
Your doctor will take a history and in most cases will then need to perform a vaginal examination. Don’t be scared of having this done. You may be shy about it but most women are at first. If you have a male doctor and would like another woman present whilst the examination is being performed, ask your doctor to provide a chaperone. Some doctors will do this routinely.
You may be asked to lie on your back with your knees bent, feet together and knees dropped apart, or alternatively you may be examined lying on your side with the knees drawn up towards the chest. Whichever way your doctor examines you, the important thing for you to do is relax. If you find this difficult, take some slow, deep breaths. The vagina is a muscular organ and if the muscles are tense a difficult and uncomfortable examination is inevitable.
Your doctor will usually examine you with an instrument and manually. If a ‘smear’ is to be taken, the examination with the instrument comes first but otherwise it may be the other way round.
The ‘speculum’ is the instrument used to inspect the vaginal walls and the mouth of the womb (the cervix). It spreads the vaginal walls apart but is not a clamp. It may be made of metal or plastic and is usually lubricated with some clear jelly. Contrary to popular opinion, speculums are not kept in the refrigerator but are usually warmed before use.
Wearing a glove, the doctor will also examine the vagina with two, lubricated fingers. He will be able to assess the size and position of the ovaries and the uterus (womb). The amount of information the doctor can gain from this examination depends upon you.
The more relaxed you are the more accurate will be his assessment. Fat women cannot be examined as easily as thinner patients, another good reason for not being overweight.
The Cervical Smear (Smear test, Cyto- test, Pap smear) Most women will be familiar with the object of this test. Cancer of the cervix, whilst rare, is one of the more common cancers in women. This test aims to detect microscopic changes in the cells of the cervix which precede the development of a true cancer. If such changes are seen in the smear, treatment can be undertaken to prevent the development of a cancer.
The change from a ‘pre- cancerous’ smear to a real cancer is however very slow, may be ten or twenty years, so there is no need to have cervical smears done too often, unless your doctor advises you otherwise. The important thing is to start having them done. You will then usually be recalled at regular intervals for repeat smears. Smears can also sometimes show an infection. If you get a letter a week or two after the smear has been done asking you to attend your doctor it could simply be that you have an infection. Do not worry. This is nothing to do with cancer.
There is still some controversy amongst doctors as to the correct frequency for smears to be taken. Cervical cancer is rare under 25 years of age, but the first smear should normally be taken when regular sexual activity commences. Thereafter it is usually advised to have one done every 3 or 5 years. There is no evidence that use of the contraceptive pill requires more frequent smears.
Your own GP may make arrangements in his surgery for smears to be taken or, if not, the Area Health Authority (Health Board in Scotland) will probably hold regular clinics in your area. Ask at your GPs reception desk for information about this. Patients attending Family Planning Clinics will usually have their smears done there.