Q: If you had an STI, would it show up in an annual gynecologist visit, or do you always have to get an STI test in order to tell?
Ah yes, the annual gynecology visit. Sometimes called the “well woman visit” or “well woman exam” or “pelvic exam” or “annual exam.” Or, in my house, “the visit with the friendly duck.” (Because I have to do something to make that speculum friendlier!) But whatever you call it, there’s a lot of variety to that annual gyno visit — so it makes sense that you might be wondering if your gyno will test for STIs while you're in the stirrups.
First, let’s talk about the things that can happen at a gynecological exam. Planned Parenthood recommends that people with vaginas and/or breasts start having an annual exam when they’re in the 13 to 15 year old age range. If you’re not sexually active at that age, the appointment can be a good time to check in with your doctor, talk about your period, and just get a general assessment of your height, weight, and blood pressure. It’s also a good opportunity — at any age — to talk about any relationship issues or domestic abuse you may be facing. Your provider might also recommend the human papillomavirus (HPV) vaccine, which protects against strains of the STI that can cause certain cancers, especially if you’re not sexually active yet.
If you are sexually active — whether in your teens or in your 20s or beyond — then your gynecological exam is a great time to talk about birth control options and STI testing. Your provider will ask you about the type of sex you have (oral, anal, vaginal), who you have it with (people with penises, people with vaginas, both), and what you do for STI and pregnancy protection, if anything. They’ll also ask if you’ve had any changes in discharge, itching, or smells from your vagina. Based on your answers, they’ll recommend — or not — that you get STI testing. Many providers will also ask if you want testing, although not all do. Finally, they may conduct a pelvic exam.
The Pelvic Exam
Let’s talk about the pelvic exam, because it can be a little freaky if you're new to it. The pelvic exam starts with you in a hospital gown (and maybe a sheet over the lower half of your body), and may start with a breast exam. Then, your provider will ask you to scoot down to the end of the table so your butt is right at the edge. Your feet go into the stirrups on either side and your knees fall open. Your health care provider will then do a visual examination of your vulva, checking for any redness or swelling or abnormal discharge. Basically, they’re just making sure everything is as it should be.
Then comes the internal part of the exam. You health care provider will insert a lubed (and maybe warmed) up speculum into your vagina and open it up so that they can see your cervix and vagina. If they’re doing STI testing, they may take a swab for gonorrhea and chlamydia at this point. It’s also when they’ll take a swab for your Pap smear, which is a test for abnormal cells on the cervix. This is the only way to detect and catch cervical cancer, so while having a super long Q-tip swabbing your cervix isn’t the nicest feeling, it’s important.
Following the visual examination, your provider will take out the speculum (phew!) and then insert two fingers in lubed gloves into your vagina. This is so they can check on the rest of your reproductive organs — the ones they can’t see with their eyes. They’ll push lightly on the outside of your abdomen while pushing back lightly from inside your vagina. They’re checking the size and shape of your uterus and ovaries and also seeing if you have any tenderness. They whole process takes just a couple of minutes, and then you can put your clothes back on again!
Which STIs Do They Test For?
But let’s circle back to STI testing, because that’s really what this question is about. If you’re sexually active and have had sex with new partners since your last exam — or if you’re under 25 — it’s standard to test for gonorrhea and chlamydia. This can be done either via a swab taken during the pelvic exam or from a urine sample. Those, plus the Pap smear, are the only tests that are done kind of automatically at a gynecological exam.
But! There are circumstances under which you might get tested for other STIs. First, if your health care provider notices anything “off” — like a strong smell or abnormal discharge or sores or warts — then they’ll recommend additional tests. For example, open sores might be a symptom of herpes, and they can take a swab to test. Bumps might be warts, which might be a symptom of HPV, which can be tested with acid. And swelling and redness might be trichomoniasis, which is a tiny sexually transmitted parasite that's super common, but not automatically tested for.
And please note: herpes and HPV tests are really only recommended if there’s a visual symptom, because many people have been exposed but don’t ever show any symptoms. For those people, the stigma of a positive test is oftentimes greater than the reality of carrying the antibodies. People tend to freak out when they get a positive STI diagnosis because there's a lot of judgement about these types of illnesses, even though they're fairly common and all are treatable. So, providers generally may not recommend blood tests.
Other tests your provider might recommend, based on your answers to their questions, are HIV and syphilis. Both can be done with a blood test, and there’s also a rapid-result oral test available for HIV now. You can also ask for these tests, especially if you think you may have been exposed to one or the other.
So, will an STI show up during an annual gynecological visit? Yes — if your health care provider does a thorough exam. And remember: If you’re concerned that you’ve been exposed to something specific, you an always ask for a test, whether it’s time for your annual checkup or not.
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