Questions about first visit to gynecologist when not a teen

[reese678]

I'm 22 and have never been to a gynecologist before, but because of some really concerning symptoms, I've finally bit the bullet and booked an appointment. It's not for another 2 months, but I feel terrified with it looming over me, and would like to ask a few questions that may be a bit silly (sorry).

1. I booked the appointment as a problem visit and not a "well woman's" exam. I know based on the symptoms I'm having I will have no choice but to have a pelvic exam, but will I still have to do a pap smear in that visit too? I'm not and have never been sexually active or anything, but I'll be 23 by the time my appointment comes. I know having the test is important and good for my health, but I'm just worried it will be too much at once for me as I have an extreme amount of anxiety related to this area of my body. I'd much rather focus on the issues I'm currently facing and getting through the bimanual exam and such first before being tested for something I'm at a very low risk for (never taken birth control, no family history of cervical cancer, don't smoke, never and don't plan on ever having sex, never had a baby, physically active, etc). Can I ask to do it at a later date and schedule a time to come back specifically for a pap test instead? I know I need it but I just don't think I'll be able to handle it that day in addition to everything else.

2. What are you supposed to do when you're having a pelvic exam? Like, what am I supposed to do with my hands and where should I be looking? I have a lot of difficulty with this sorta thing and it makes me feel anxious and like I'm weird. Basically, what are the unspoken social rules I'm meant to follow in this situation?

3. How upfront should I be with my new doctor when discussing what might be causing my symptoms? I feel I have good reason to believe I might have endometriosis, but I'm afraid that if I mention that as "I'm worried the symptoms might be pointing to something like endometriosis" when talking about them I will be shut down and told not to consult "doctor google" (even though google isn't the thing that suggested that diagnosis to me! my friends have been begging me to see a gynecologist for years because they are concerned I may have it, and so has my mom). I'm also just generally afraid that when I talk to them about what's happening I won't be believed or my severe pain will be diminished. I know in this case I will have the right to seek out a new doctor for a second opinion, but I don't know if I could work up the courage to do all of this stuff again. It's just so hard and overwhelming.

4. Will the doctor judge me for waiting this long to make an appointment? I know the guidelines say you're meant to have a consultation visit between the ages of 13-15 and start going regularly at 21, but I just couldn't do that. I'm worried they will think I don't care about my health (which isn't the case!!) or that I'm bad. I'm also scared they will judge me for not being or wanting to be sexually active (or alternatively, not believing me when I say I'm not) at my age.

5. How do you cope with the stress of it all and make it through the exam? I know all the steps of every exam I will definitely have to have (bimanual, speculum, and potentially rectal) and even things I may or may not have to deal with in the future (transvaginal ultrasounds, MRIs, laparoscopy), but it honestly didn't make me feel any better. Knowing the steps hasn't made the idea of any of those things less mind-numbingly scary to me like everyone has told me it would. I've even found videos of the exams and procedures online that I've watched but still feel so scared. I just don't know how to cope! I can't bring a support person with me, I'm too embarrassed to bring a plushie (I don't want them treating me like a baby), and I don't want to listen to my favorite music in case I associate it with the experience and ruin it forever. My therapist told me to do breathing exercises, so I've been practicing them a lot, but I don't know if that will be enough. I don't want to cry in front of the doctor or during everything. Can anyone recommend some things that have helped them stay calm?

Sorry if these are weird questions I just don't know how to talk about this with anyone I know irl

[Heather]

Hey there, reese, happy to help you with these questions.

1) I want to make clear that ALL of this is a choice for you. In other words, as an adult, you have the right to refuse ANY care you don't want or feel like you can't handle, or to schedule it in ways that feels best for you, so long as those also mesh with the schedule/policies of your provider. So, for instance, yes, you could schedule your pap separately if you wanted (more on that in a second, though, since I actually think that will make things harder for you instead of easier), and you could say no to a bimanual/pelvic in that first visit if you felt better just first having a consultation.

Two things about that, though: one, the pap is actually the quickest and easiest part of a pelvic exam, so since you'd already be there, in the exam, I personally think that if they suggest one for you (and they may not, given your lack of sexual history) doing it at the same time rather than having two different pelvic exams (since all the same steps would have to happen again) would probably be less to handle, all in all. Too, I don't know how you pay for healthcare, so you will need to consider how many visits you can pay for and how many different visits any insurance or public health could cover. Dividing things up into multiple visits can get expensive.

2) These exams are almost always weird socially. The doctor is usually making some kind of conversation, and that's always odd, since, you know, we don't normally just shoot the shit when someone is between our legs having something to do with our genitals. So, in my personal and work experience, I think you can just accept it's awkward, do whatever weird small talk is happening and look where you want to look. You can also do whatever you want with your hands. To make it less weird, this is often a good time and opportunity to ask any questions you have about this anatomy or this arena of health, and that also spares you small talk in a situation where small talk feels weird.

3) You should be as upfront as you want. I can't say what a doctor will say to you because they're all different, like any giant group of diverse people, but I don't think you should choose what you say based on what you are trying not to hear. Instead, I think what we want to do with any healthcare is do our level best to give our providers as much information as we can about what's going on. Saying what you think it is is something you can do, but since endo, for instance, isn't something you can self-diagnose, and it will certainly be on the radar of an OB/GYN, it just generally isn't super productive to suggest a diagnosis, since that part is their job and expertise. Your expertise, and how you can best contribute, is to give them information they don't have and can't know unless you share it. Make sense? I hear you about the anxiety you're having, but I also wonder if maybe you're not helping yourself here by overthinking/overplanning, or by thinking there is some right way to do or say things so you can control how a provider responds to you. Unfortunately, we don't have that kind of power, we can only meet providers, see what they are like, and then choose to keep seeing them or not from there. That said, NO provider should diminish or dismiss the pain you are having, and I would say you should expect they won't do that rather than expecting they will.

You can also always ask to have a conversation first where you tell them your concerns, and those can include the concern your pain won't be taken seriously. Before you have an exam, that's a way you could see if a provider is someone who feels like a fit for you in this way. If in that conversation, you don't catch the vibes you want to to feel good with someone, then you can skip the rest of what was scheduled and reschedule with someone else.

4) You're not actually late for this healthcare in this era. In fact, were you not having any problems, since it doesn't sound like you have sexual partners yet, there wouldn't actually be a need for you to have this kind of healthcare yet. In 2025, it's not suggested anymore people go get consults or exams in their early teens unless, again, there's a problem, or unless someone does have sexual partners. So, no, no one is going to judge you for when you started this care, including because there's nothing unusual about you starting now and not sooner.

5) This is another place where I can't help but wonder if overpreparing is hurting instead of helping you. It sounds like all this video watching and thinking about this might be stressing you out more than helping you destress. Have you had other kinds of exams before? Can you tell me some of what feels extra stressful about these exams for you?

I also want to add that some healthcare providers will offer anxious patients medication to take with an exam if they know ahead of time that is something you want or need, and telling a provider you feel very nervous is also another thing you can communicate ahead of time and ask them to help you with before an exam. That can include asking for very specific things, like asking them TO explain everything they are doing step by step, or, if you are someone who prefers the opposite, asking them not to. This is a kind of care that a lot of people feel anxious about, so please know that you will be nowhere near the first anxious patient an OB/GYN has, and that's something good providers will generally be very thoughtful about.

[reese678]

Thank you for the reply!

1. That is true. It does make more sense to just do it all at the same time. And I would probably feel better just doing a consultation first, but I honestly didn't know that was an option when I booked the appointment. I think I'll keep it set up the way it is so I don't cause any trouble, and if they recommend I do the test, I'll say yes and get it over with then

2. Ahh okay. I will just try my best to follow along with whatever the doctor tries to talk about then. I don't really have any questions I can think of (at least right now) in regards to my anatomy and stuff, and truthfully I don't know how talkative I'll be able to be during the actual exam (I tend to go into verbal shutdown mode when I get really scared or overwhelmed). As for hands, do you think I'd be allowed to bring something like a small fidget toy with me since there's nothing I'm meant to do with them? I don't know if that's okay or unprofessional or something. I just figured it could maybe help with the eyes thing since I could look at the fidget toy and it would give me something else I can focus on to maybe help me not feel as overwhelmed

3. Oh yeah I'm sorry I didn't mean like suggesting endo was the cause 100% or anything like that. The only way to diagnose that is with surgery, which I obviously can't do, and it's also not something I'm really okay with doing right now. I just didn't know if I was supposed to mention that since it was something I'm worried about based on what my friends and mom have been saying to me for a while. I won't mention endo directly at the appointment just to be safe. And that's a fair point you mentioned about the overthinking/planning stuff. This whole situation has made me feel like I don't have much control, especially because I was kind of forced to book the appointment, so I think my brain is trying to overcompensate. I'm going to talk to my therapist next time I see them about this since I'm not really sure how to stop

4. That makes me feel better. Many of my friends who aren't sexually active have already been, and everything I saw online said I was meant to go by the time I turned 21, so I just assumed I was doing something wrong by not having gone before

5. I've only been watching videos and stuff because I'm supposed to be doing them for my exposure therapy and because all the articles I've found said that learning about what happens during an appointment should make me feel less nervous. I try not to think about the situation and everything when I'm not specifically working on my therapy, but it's on my mind pretty much 24/7 against my will. It does feel very stressful and it makes me feel really sad a lot. My therapist told me that it's okay for me to use distractions to deal with it when I'm not actively doing an exposure exercise, but it doesn't always help. I haven't really had any other kind of intimate exams before. Every time I've gone to a doctor in the past I've been able to leave my clothes on and stuff (except when I had to have my back checked for scoliosis, but even then I was able to leave my sports bra on). I wasn't comfortable with them because I'm not really great with people touching me, but I was able to manage since they were super quick and my clothes made me feel safe. I think the stuff that scares me the most about these exams is how vulnerable, exposed, and not in control they make me feel when I imagine myself having one. I think some of this is probably because I grew up in a very catholic family and went to a catholic school and stuff, so I'm assuming a lot of the purity culture stuff that I was always taught growing up is just sticking in the back of my mind even though I don't believe or agree with it. I don't feel comfortable unless I'm wearing long pants like jeans and my chest is completely covered. I just feel wrong any other way. Logically I know I can't keep those on at an exam, but it just feels bad and like I'm exposed. The position you're meant to lay in also makes me feel that way, and it feels kind of demeaning, too. I don't like it

Yes I heard about the anti anxiety meds being an option before, but from my understanding I would not be able to have them. You can't drive a car if you take the meds, but I don't have another way to get to the appointment. My mom has to work and can't take off, my friends are either working or at school, and an uber ride would be at least $115.84 round-trip from my house to the doctor's office. I think I would really benefit from the meds, but it's just not possible for my situation, unfortunately

I do plan on telling the doctor about my anxiety and I did already leave a note in the booking portal stating that this is my first appointment with a gynecologist and that I am very nervous. I tried to find the person with the best ratings within my insurance that I could, and a lot of the reviews mentioned that the one I booked is very nice and understanding, so I'm hoping she will be nice to me, too.

Thank you for taking the time to help me! I really truly appreciate it

[Heather]

I'm glad to be able to help.

I absolutely think bringing a fidget toy is fine, and I have another thought for you, too. Even having left that note, when you get there -- or you can even call ahead and ask about this -- I'd suggest you let the receptionist know this is your first time with this kind of healthcare, let them know that you are having a lot of anxiety and fear around it, and that you'd appreciate it if before your exam, you could talk with the provider for a little bit dressed and just sitting down together to have a better understanding of what the exam will involve and to just establish a relationship with them first so you can feel more comfortable. This is also something anyone can always ask for, and it sounds like it could go a really long way for you.

I don't know if this helps, but you are actually still totally in control during this exam just like any other healthcare you're not under anesthesia for. You can leave anytime, you can stop anything at any time, you can ask the doctor to stop doing anything they are doing at any time. It might help to remind you of that.

I hear you when it comes to purity culture's impacts, but also when it comes to things like, yeah, the cisgender men who designed the chair and setup for GYN exams clearly were NOT thinking about anyone's dignity (FYI, these exams can also be done lying on your side, and while not all providers will say yes because they don't all know how, that is another thing you can ask for. More info on that and some other things that might be useful to you here: https://www.scarleteen.com/read/sexual- ... dern-guide -- that's one of a few articles here that also explains that yes, it used to be advised to get in earlier, but that hasn't been the case for a while now). You can also ask for an extra gown to cover more of yourself during the exam if that feels better to you, and I do actually think bringing a plushie like you asked about is FINE. When I worked in an abortion clinic, I saw more than one plushie in procedures and exams, including with people much older than you. This appointment is for you, so I'd say if you can set aside worries about what other folks will think about whatever you need to have it go well for you, you should.

And for sure, unless you are doing exposure therapy for THIS, I think it's time to do yourself a solid and stop focusing so much on it. I worry that at this point, you might be blowing it up a bit in your head as something bigger and scarier than it actually is. It is generally only a short period of time -- the actual exam -- and it sounds like you have done all you can to choose a provider likely to be great for you.