At least once a day, a patient apologizes to me that she hasn’t shaved her legs or had a pedicure before climbing into the stirrups. In addition to being worried that I am going to find some dreaded disease, they think I am judging their hairy legs, unwaxed crotch or chipped toe polish. It reminds me that what is a very routine exam for me is anything but routine for the women who are experiencing it.
But unlike the dentist, where brushing and flossing is essential, women need not do anything to prepare for an exam with their gynecologist. Truly, my only expectation is basic hygiene – a shower or bath within 24 hours is always appreciated.
In some cases, a woman’s efforts to “prepare” for an exam could actually diminish my ability to get accurate test results. If a Pap test is on the agenda, it’s important that a woman hasn’t done anything to wash away or obscure the cervical cells that need to be screened for pre-cancerous changes. It is also impossible to evaluate an abnormal discharge or odor if the environment has been altered. That means no spermicide, no medications, no lubricants and no douching (you should never douche under any circumstance!) for 24 hours before your appointment.
And, ideally, no sex. Having intercourse without a condom the night before a Pap will not make a normal Pap smear abnormal, but it might obscure cervical cells so that it cannot be accurately read.
Should you cancel if you “forgot” the night before? Realistically, after waiting two months for an appointment, asking for the afternoon off work, or desperately needing a refill on your birth control pills, it may not be practical to take a pass. Be sure to mention to your gynecologist that you had sex, and be aware that you may get a call back if the Pap can’t be read accurately.
On the other hand, if you are coming in specifically to check out an abnormal discharge or odor, you should probably reschedule. It’s pretty much impossible to figure out what is going on if you had intercourse hours before your visit.
If you are coming in for another problem, say abnormal bleeding, an STD check or pelvic pain, it really doesn’t matter.
Is it ever a good thing to have sex before your appointment? Actually, yes. If someone tells me they bleed every time they have sex, it is helpful for me to see where it is coming from – the uterus, cervix, or vagina. (Just don’t “prepare” in my waiting room or bathroom.)
And no, I really don’t notice and don’t care if you have shaved your legs and gotten a pedicure. Tattoos … now that’s another story (and a topic for another blog).
Speaking of Pap smears, recommendations for frequency of Pap smears have changed again. Click here to read this article for new guidelines.
Dr. Lauren Streicher is an Assistant Clinical Professor of Obstetrics and Gynecology at Northwestern University’s medical school, The Feinberg School of Medicine, in Chicago. Her clinical interests include all aspects of gynecology but Dr. Streicher has a particular interest and expertise in menopause, sexual health, minimally invasive surgery, laparoscopic hysterectomy, and alternatives to hysterectomy.