As women, we have been trained since the teenage years to have our yearly physical and Pap exam. Some view it as a "necessary evil" while others view it as an opportunity to ask their healthcare provider about ongoing issues. Whatever the case, make sure if you have questions to write them down so that you don’t forget when you’re "in the moment." Here are the most common questions I hear from my patients while doing their exam and why it’s important you feel comfortable asking!
1) What is that bump? Many women experience bumps in the vaginal area for a variety of reasons. Of course it could be something unfriendly like herpes or warts, but it may also be something benign like an ingrown hair or enlarged lymph node. Sometimes even a mirror with excellent lighting is no match against showing your provider.
2) What is that discharge? Ever notice discharge on the lining of your underwear or when you wipe? Discharge can be abnormal such as with gonorrhea, Chlamydia, trichomoniasis, bacterial vaginosis (BV), yeast, or other bacteria. However, normal discharge occurs throughout your month in response to hormones and whether you are ovulating or not. A quick swab test can confirm if it’s normal or not.
3) What is that bulge? Have you ever noticed a bulge or bump up inside your vagina or maybe saw something in the mirror? It could be from prolapsed tissue. There are a few different types, however as the musculature in the pelvic area weakens you can develop a rectocele, cystocele, or uterine prolapse that bulges into the vaginal canal and may cause symptoms. Sometimes they are mild enough that pelvic floor physical therapy can help however more severe cases may require surgery.
4) Why does it hurt? Some women experience pain during intercourse, with insertion of a tampon or during the actual Pap exam when I insert the speculum. This may be due to insufficient lubrication, hormone changes (less estrogen in the area), and damage during childbirth, trauma to the area, or from sexual assault. Whatever the reason, talk with your healthcare provider about getting to the source of the pain. This too may require pelvic floor physical therapy, perhaps it’s from a long standing infection, or counseling sessions may be in order.
5) Why am I spotting? Some women experience spotting around ovulation (generally normal) or just before the onset of their menstrual cycle. However, if the spotting increases, changes, or occurs after intercourse then let your doctor know because it may be something like a polyp visible on exam. Polyps bleed easily especially if bumped (like during sex). Hormone changes may also cause spotting, either from your own hormones or if you are on hormones. You may need to get a pelvic ultrasound or have bloodwork drawn for your thyroid and female hormones.
Please talk with your healthcare provider as soon as you are concerned. While your fears may be over something "normal," it’s better to know for certain and get some testing if need be.
References:
1) Are Vaginal Symptoms Ever Normal? A Review of the Literature
http://www.medscape.com/viewarticle/490226
2) Pelvic Prolapse: Diagnosing and Treating Uterine and Vaginal Vault Prolapse
http://www.medscape.com/viewarticle/722325
3) Stepping Up STI Counseling and Prevention
http://www.medscape.com/viewarticle/746451
Reviewed August 11, 2011
by Michele Blacksberg R.N.
Edited by Jody Smith