Seeing your General Practitioner

Often seeing your General Practitioner (GP) about intimate issues can be daunting.

We hope that by providing you with some information in regards to GP assessments of your medical history, intimate female examinations and potential investigations will empower women in relation to their gynaecological and reproductive health.

Top Tips for your GP appointment

If it is an emergency, call 999. If you are unsure, call 111. If it is not an emergency, call your GP to book an appointment, discuss with the secretary whether this needs to be an  urgent slot or more of a routine appointment.

When seeing a GP there are certain tips that will enable you to get the most out of your appointment…

  1. When seeing a GP about symptoms you are experiencing, it can be useful to keep a diary of symptoms in advance. This allows an accurate and efficient portrayal of the patterns of symptoms and can help in the diagnosis of conditions and the appropriate choice of treatment.
  2. When calling up and booking an appointment, it can be useful to double check with the secretary who best to see, in some practices, the practice nurse may be able to help or, a family planning clinic may be more appropriate.
  3. Finding the time to see your GP often means we have more than one issue to discuss. When booking appointments it is a good idea to ask if the surgery offer double appointments. This will ensure that there is enough time to cover all concerns without feeling rushed or not mentioning an issue that might be important.
  4. Before you go to your GP appointment, if you feel that you may need support either before, during or after your consultation ask a friend or a relative to support you.
  5. During the appointment it is important to ensure you illustrate all of the topics to discuss at the beginning. This will allow the GP to more easily structure the appointment accordingly and save time where necessary.
  6. Similarly, if you have multiple medications, it can be good to write a list of all of these with the dosage and frequency. This list should include any over the counter medications that are not prescribed by a doctor.
  7. If you have any previous conditions that you are being treated for or that could be linked to your new symptoms, it is important to let your GP know of these. The systems used in hospital and your GP may not be linked. If you have any recent letters or information on your condition or treatment it is a good idea to being these.
  8. If, during your appointment you feel you do not understand something, be sure to ask your GP again to explain it. If you get home and feel you have an important question it can be a good to call up and see if the GP is free to answer your question or give you a call back.

Taking your history…

During a consultation with your GP they will be asked a series of questions.

At first, these will be very open questions such as ‘What has bought you in today’ or ‘What has been going on’. It is important to mention every sign or symptom that you have experienced. Sometimes what might seem minor can be very helpful in diagnosis.

If you have been experiencing a range of symptoms and are struggling to find a pattern it can be useful to both the GP and yourself to keep a diary of your symptoms. This could include when you experience the symptom, how severe it is and if there is anything else you are experiencing.

After establishing what your symptoms are your GP will check what medications you are taking (prescribed and over the counter). They will ask about your past medical history, family history and may ask some more general health related questions.

After the initial history taking, if indicated, your GP may wish to undertake physical examination, the specific examination will correlate to symptoms.

Intimate female examinations are discussed further below.

Your GP will then discuss a management plan going forwards, this may include prescription of medications, referral you to an appropriate specialist or both. If you are acutely unwell, the GP will refer you straight to hospital.

Intimate gynaecological examination

Pelvic examinations are essential in the early detection, diagnosis and treatment of many conditions including cancer and infection. Most women will undergo an intimate examination during their life, this could be for a smear test, during pregnancy or to investigate gynaecological symptoms.

Your doctor may feel it necessary to perform a pelvic examination to investigate symptoms and further aid diagnosis. This examination is a focused assessment of the female reproductive organs (ovaries, uterus, cervix, vagina or labia).

Before the examination, your doctor will explain the examination process and gain your consent to proceed. If you have any concerns, objections or questions about the examination you can talk these through at any point. If you do not wish to undergo the examination you need to inform your doctor or health professional.

If you have a preference of the gender of your examiner you can ask, the practice should be able to facilitate this for you.

Depending on your condition, the examination may require external examination of the genitals or could require an internal examination.

External Examination

  • Firstly, the doctor or nurse will explain the examination and ask for your consent to proceed. If you decide to proceed you will be asked if you would like a chaperone to accompany you during the examination.
  • Next, you will be asked to take off any clothing on your bottom half and lie on your back on the bed with your bottom near the end of the examination table. You will be given a sheet to cover your privacy.
  • The doctor or nurse will then ask you to bend your knees, place your feet together on the table and let your knees relax out to the side. The doctor may use a light to help them with their examination.
  • The doctor or nurse will then begin the external examination. The examination will include looking at the lesion and the surrounding areas. It may then be necessary to palpate lesions seen to examine further. For example, any lumps will be manually examined to assess for size, texture and movement.

Internal Examination

If you require an internal examination there are two main examinations.

The first will be a speculum examination. This is similar to the examination required when you have a smear test. The second is a bimanual examination, this allows the examination of internal organs.

Speculum Examination

A speculum is a small device that is inserted into the vagina and used to see the cervix.

The speculum comes in different shapes and sizes. Your doctor will start with the smaller size (not much bigger than a super tampon) and will change the size if necessary.

  • Your doctor may have already performed an external examination of the genitalia. You will be in the same position on the bed (lying on your back with your knees bent an dropping to the sides).
  • Your doctor or nurse will then insert the closed speculum into the vagina (the doctor will have used lubricant jelly to ensure ease on insertion).
  • Your doctor will then open the speculum about 1cm. This enables the doctor to view the walls of the vagina and to visualise the cervix. If you have a coil in situ then your doctor will be able to visualise the strings.
  • Your doctor will then close the speculum and remove the device.
  • Your doctor may then proceed to complete a bimanual examination if indicated.
  • After the examination you will be time to redress and some tissue to clean yourself.

Bimanual Examination

  • Your doctor may have already performed a speculum examination, you will remain in the same position on the bed (lying on your back with your knees bent an dropping to the sides).
  • Your doctor will discuss the process of the examination. The bimanual examination starts by the doctor inserting one or two gloved and lubricated fingers into your vagina.
  • With their other hand the doctor will press on you lower abdomen to palpate (feel). By doing this the doctor is able to check any pain, swelling or growths on the uterus and ovaries.

Internal examinations are possible when you are on your period however, some healthcare professionals may suggest booking another appointment if your period is heavy.

Top Tips for your Intimate examination

  1. Try and stay as relaxed as possible, this might be by talking to your doctor during the consultation or focusing on deep, relaxing, slow breathing.
  2. Keep your legs relaxed, this will allow for easy examination.
  3. Relax your bottom, if you squeeze your abdomen or bottom it will work against the insertion of the speculum.
  4. If you have any questions, no matter what about, ask! Try to see this as an opportunity to ask the questions that you might have been putting off. Everything is confidential and it is likely that it has been asked many times before!
  5. The examination is painless! If you feel any pain it is important to communicate this you to your doctor.

This page has been written by Wellbeing of Women Contributor Dr Alice Bolton

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