The First Visit
The client will first meet with a support worker who will take a health history and briefly discuss why the client has come to Links. The support worker will talk with the client about their questions and concerns before going into the exam room.
The support worker will introduce the client to the health care professional, who may be a physician, nurse-midwife, or a nurse practitioner. Typically, the support worker will accompany the client into the exam room to provide additional support. If the client prefers not to have the support worker accompany her into the exam room, that's okay too.
The client will then have the opportunity to talk with the health care professional about her concerns. The patient will then sit on the examination table, where the health professional will explain any examinations which will be performed. This may include listening to the heart and lungs, and examining the breasts, thyroid, abdomen, and pelvis.
In order to examine the genital tract, including the external tissues, vagina, cervix, uterus, and ovaries, the health professional will ask the client to place her feet into stirrups at the bottom edge of the examining table and push herself down to the end of the table, knees bent and spread apart. It is awkward, but it should not be painful. The professional will explain exactly what is happening, first putting on medical gloves and inspecting the outside of the genital area for anything unusual. A speculum will be gently inserted into the vagina so the medical professional can see the cervix and vaginal walls. Again, this is awkward but should not be painful.
The professional will be looking for any sign of irritation, inflammation of the vagina or unusual discharge. In clients over 21, a pap smear will be done by gently taking some cells from the cervix, which will be sent to a laboratory to check for abnormal cells. If any precancerous cells are found, they can be safely treated. A test for chlamydia and gonorrhea will be done using a cotton-tip swab. Testing for sexually transmitted infections (STIs) is done during the initial visit and annually thereafter. We also recommend STI testing when changing partners.
During the last part of the exam, the health professional will do a bi-manual examination, inserting one or two gloved fingers into the vagina. The other hand will be placed on the low abdomen. In doing this, the practitioner can feel the size and shape of the pelvic organs. The practitioner will be looking for size, position, and any tenderness. This may feel a little uncomfortable, but it should not hurt. The entire exam takes about 5-10 minutes. When the physical exam is complete, the client will have time to discuss any further issues with the health professional and ask any questions she may have. The support worker will also spend as much time with the client as needed after the exam, to provide any needed clarification or discuss any concerns.