Many women feel nervous or uncertain before their visit to the gynecologist. It means accepting that your body has changed and that you've taken the step from girlhood into womanhood. Before going to your first appointment, here are some things you can expect and how you can prepare.

When should you start your gynecologic checkups?

Your first appointment will likely occur between 13 and 15 years old. Some women wait to start their gynecological examinations until they have sexual intercourse for the first time, or until they have a symptom or problem such as an abnormal vaginal discharge, vaginal burning, strong menstrual cramps or irregular periods. There's no need to wait. The sooner you start regular exams the better.

What will happen at your first gynecological appointment?

It's normal to feel nervous, but there is really nothing to worry about. Your first appointment is usually very simple, and your doctor will spend time getting to know you. The doctor will ask about you and your family's medical history and your sexual health. Many women may feel uncomfortable discussing such personal issues, but being honest is important because it will allow the doctor to give you any help you might need.

What are gynecologic exams?

There are four types of examinations that you may have during your visit. Each type depends on the length of your first appointment, your age, your sexual history and whether or not you have any particular symptoms.

If you are going to have any tests, the doctor will explain them first so you don't have to be anxious. The doctor will instruct you to go to the bathroom or a changing room to undress in private and put on a gown. It's normal to feel uncomfortable about being naked, but the gown will cover you, and the doctor will only uncover the areas needed for the examination. Also, remember that all women are tested in the same way.

The four kinds of examinations are:

• General physical examination: As with any medical examination, your weight, height and blood pressure will be measured.
• Breast examination: Your doctor will check your breasts with his or her fingers to detect whether there are any lumps or abnormal discharge.
• Pap smear: The Pap is the scraping off of a few cells that cover your cervix. The doctor uses a special brush and then sends the sample to the laboratory to check for the presence of abnormal cells.
• Pelvic examination: This test is not performed on all women unless they've had sex or have certain symptoms in their vagina or abdomen. To do the test, your gynecologist will ask you to lie on the exam table with your feet in special stirrups and your legs open so he or she is able examine your vagina.  Using gloves, the gynecologist will check your vulva (the outside of your vagina) to rule out signs of infection. Then he or she will open your vagina with a speculum (a metal or plastic instrument) to shine a light inside and take samples of a few cells that will allow her to tell if you have any STDs (sexually transmitted diseases). If necessary, he or she will also take a Pap smear at the same time. Finally, the doctor will insert one or two fingers of one hand into the vagina while pressing on your abdomen in order to feel your cervix, ovaries and womb. This is to assess their size, see if there are cysts present, etc. It can be a bit uncomfortable, but if you're relaxed the examination is usually not painful.

How should you prepare for your first appointment?

• First, choose a doctor with whom you feel comfortable.
• Ask for the appointment on a day when you know you will not be having your period.
• Before going to the doctor's office, think about what you'd like to ask about your sexual and reproductive health. There are no stupid questions. Ask about anything you're unclear of.  If it helps, write down a list of the things that concern you: your vaginal health, contraception, unusual pain in your breasts, questions about your menstrual period, etc.

The first appointment can produce the most anxiety, but the next ones will be much easier. The good news is that if you're uncomfortable with the doctor you chose, you can always choose another one. It's important that you find a gynecologist you trust. You should see your gynecologist on an annual basis to maintain good vaginal health.