OK, so going to the gynecologist isn't exactly fun. But the good thing about your annual visit is that it's a one-stop, totally confidential way to get your most sensitive questions answered. And it's essential that you ask them! After all, there's nothing more important than keeping your dancer body—every part of your dancer body—in tip-top shape. If you're feeling shy or embarrassed, just remember: Gynecologists have heard it all. Here are the answers to some of the questions they get asked the most.
My periods are irregular. Should I be worried?
Teens often expect to get their period on the same day each month, but normal cycles range from 21 to 35 days. “It's also common to have periods outside this range when you first start having them," says Dr. Raegan McDonald-Mosley, chief medical officer at Planned Parenthood Federation of America. If you've already started your period but it's frequently irregular, check in with your doctor.
Dancers, like many female athletes, often get their first period later than their peers due to their intense activity level. Dr. Colleen Cavanaugh, a gynecologist in Providence, RI, says there's usually no reason to worry (unless you're severely underweight). Getting a first period anywhere between the ages of 10 and 15 is normal. Your doctor may recommend going on a contraceptive pill to help get your periods started or make them come more regularly.
My periods are so heavy and painful. Any advice?
For those prone to painful periods, Dr. Lauren Streicher, a gynecologist and associate professor at Northwestern University's Feinberg School of Medicine, recommends popping an Advil the day before you start menstruating, to ward off excessive cramps and even lighten bleeding. Then continue as needed during your period. A heating pad can also be a lifesaver on painful days.
If your period pain regularly forces you to call in sick to school or the studio, or if you need to change a large tampon or pad every hour, it's time to talk to your doctor. Very rarely, severe cramps during menstruation may be a sign of endometriosis, a condition where uterine lining grows outside the uterus. If you're otherwise healthy, your doctor may prescribe a birth control pill or suggest a hormonal intrauterine device (IUD), a tiny T-shaped object that can stay in your uterus for up to five years—certain types have been proven to reduce bleeding and discomfort.
My body is changing—and I'm not sure if I look normal. What does “normal" even look like?
Every teen wonders if her body looks normal—but this is especially true for dancers, who go through puberty in front of full-length mirrors. Remember that normal development looks very different on everyone.
For vulvas (the visible part of your vagina), Streicher says there's a broad range of normal. “They can differ drastically in color, shape and amount of pubic hair, and they're often asymmetrical," she says. “Just like noses can be short or long, so can your labia—the inner and outer folds of the vulva at either side of the vagina."
The same is true for breasts and nipples, which can range drastically in size, shape and color. Asymmetry is also common, especially while developing, so don't be alarmed if one of your breasts is larger than the other. “Nipples range from light pink to brownish black. Some stick out like buttons, and others look more like slits," McDonald-Mosley says. “Remember, different is normal."
How much vaginal discharge is normal?
Most teens will start to notice some clear or white discharge on their underwear starting during puberty. This liquid, called leucorrhea, is completely natural. It may have a mild odor, but it actually helps your vagina stay clean.
How much you see will change slightly throughout your menstrual cycle, getting heavier when you're ovulating. “That's all completely normal," Cavanaugh says. “But if it's dark, itchy, has an intense odor, or comes with pelvic pain, you should see a doctor to check for an infection."
My doctor recommended birth control (for acne/heavy periods/pregnancy prevention), but I'm worried about gaining weight and other side effects.
According to Streicher, scientific studies say that the correlation between birth control pills and weight gain is a myth! That being said, each type of pill affects each body differently. Your doctor will do his or her best to prescribe the best option for your needs. (Streicher says that's usually a pill with a low dose of estrogen). You're most likely to experience nausea, spotting (bleeding between periods) or breast tenderness within the first two to three months after starting birth control, but then those symptoms usually go away. If you continue to notice unwanted side effects, feel free to ask if you can try something different. Just give it some time before making a switch.
What's the deal with the HPV vaccine? Do I need it?
HPV stands for human papillomavirus, a very common virus that is usually sexually transmitted. Some high-risk types of HPV can cause genital warts or cervical or other cancers, while other, low-risk types don't have harmful effects at all.
The HPV vaccine, called Gardasil, protects against the most common types that cause genital warts and cancer, and it's administered through three shots over a period of six months. “I encourage all my patients to get vaccinated as soon as possible," Streicher says. “Ideally, they'd do it even before they become sexually active, and it's FDA-approved for girls as young as 9 years old." No matter your age or sexual experience, ask your doctor about it—your body will thank you later
Dr. Lauren Streicher, MD, a gynecologist and assistant professor at Northwestern University’s Feinberg School of Medicine in Chicago, IL, says girls come to her at any age if they’re experiencing issues, like pelvic or abdominal pain or infrequent periods. If you don’t have concerns about your health, schedule an appointment as soon as you’re thinking about becoming sexually active. And if neither of those factors apply, you won’t need to have your first visit until you’re 21, the age recent studies recommend starting to screen for cervical cancer and pre-cancer.
No matter when you go or for what reason, the first time you see an OB/GYN you may be intimidated. Fear not: DS talked to Streicher and two other board-certified gynecologists about exactly what to expect, so you can be prepared for—not scared of— your first appointment.
Before Your Visit
When selecting a doctor, you’ll be able to choose a man or a woman—just go with whichever you’ll be more comfortable with. Physically, you won’t need to do anything special to prepare for an appointment—just take a shower like you normally would. But you can do a little research to make your doctor’s job easier. Learn the basics of your family and personal history: Have any relatives had cancer, heart disease or other serious illnesses? Write down the names of any medications you’re taking and anything you’re allergic to. Also, know the date of the first day of your most recent period.
When you arrive, you’ll fill out some paperwork, and the front desk will check your insurance to make sure everything’s covered. If you don’t have insurance—or don’t want to use your parents’ insurance—clinics like Planned Parenthood often have alternative financial plans available.
In the Exam Room
Once you’re in the room, a medical assistant will record your basic vital stats—including blood pressure, height and weight—just like at the pediatrician. When your doctor comes in, the first thing you’ll do is just talk. If you’ve come with your mother, sister or other trusted friend, she’ll often be allowed to stay in the room for a couple questions, but then be asked to step outside for the rest of the appointment. And what you tell your doctor in that room stays in that room. “It’s important to understand that your visit is completely confidential,” says Dr. Gillian Dean, MD, MPH, an OB/GYN who is interim medical director at Planned Parenthood of NYC. “It’s against the law for the doctor to discuss anything that happens without the patient’s permission.”
Your doctor will ask questions about your periods, whether or not you’re sexually active, your general health and your diet and exercise. Then, it’s your turn to ask her questions—and nothing is off-limits. “Being a gynecologist is almost like being a psychologist,” says Dr. Diana Wang, MD, FACOG, of the Seton/University of Texas Southwestern OB/GYN residency program in Austin. “Anything you’re concerned about is fair game.”
If you’re sexually active, you might be asked to pee in a cup or give a blood sample to test for sexually transmitted infections, and you can discuss birth control options. But there may be no need for an actual vaginal exam on the first visit. If you’re 21 years old, or your doctor determines you need an exam, she’ll give you a gown to change into and ask you to get undressed. (That means completely undressed—underwear and bra, too—but you can leave your socks on if you’d like.) She’ll leave the room while you change.
When the doctor returns, you’ll be asked to sit on an examination table and put your feet in a pair of elevated stirrups. There are three main parts to what comes next.
• First, your doctor will place a speculum into your vagina to inspect the vagina and cervix and conduct a Pap test that checks for cancerous or precancerous cells on the cervix. “The speculum is usually made of metal, and people say it looks like a duckbill,” Dean says. “Once it’s inserted and gently opened, the practitioner shines a light inside to see the back of the vagina, where the cervix, which looks like a small donut, is located.”
“The speculum should never be painful, but you’ll feel some pressure,” Streicher says. To make the speculum experience more comfortable, she suggests scooting your butt as close to the edge of the table as possible and letting your knees fall to the sides as if you’re doing a butterfly stretch. “Dancers are strong and they tend to tighten their butt muscles and lift their hips off the table—but that’s the exact opposite of what you want to do,” Streicher says. “Imagine the muscles you tighten to stay in relevé—those are the muscles you need to loosen as much as possible.”
The doctor will swab a soft brush (it looks like a long Q-tip) inside your cervix, which may be a little uncomfortable (although some women don’t feel a thing). Then, the speculum comes out—generally after no more than 30 seconds.
• Next comes the pelvic exam. The doctor will place one or two gloved fingers in your vagina, then gently press down on your belly to feel your uterus and ovaries. Again, focus on relaxing your body, especially your stomach muscles, to avoid any discomfort. And don’t forget to breathe.
• Your doctor will then do a breast exam, moving your arms to different positions and lightly pressing on parts of your breasts. “It shouldn’t hurt,” Streicher says. “But if you know you have tender breasts, try not to drink any caffeine that day, which will help. And if you can, schedule your appointment after your period, not before.”
Throughout the entire exam, it’s important to speak up if you’re feeling uncomfortable, nervous or embarrassed. Remember, there’s almost nothing your doctor hasn’t seen or heard, and for her, looking at you “down there” is just as un-scandalous as when your pediatrician looks at your throat or your ears.
Wang adds that it’s essential to trust your doctor enough to ask questions about what she’s doing. “It’s very empowering for a girl to be educated about her own body,” she says. “Your body is your life, especially as a dancer. You need to know more about yourself than anything else.”