Having your first pelvic exam at age 38? Trimmed Question: I?m 38, and I?ve never been to a gynecologist to have a pelvic exam. I'm extremely shy. My periods are changing and I need to check this out. My first obstacle is getting to the appointment. I cannot seem to get past the idea of being so vulnerable to a complete stranger. Second, I'm concerned that the fact that I'm a lesbian (and have never slept with a man) may be uncomfortable for both the doctor and myself. Can you offer any advice?

--- Karen

Many women are terrified of the gynecologist or other health care providers (personally, I hate going to the dentist!). The GYN exam can be difficult for the shy woman; removing your clothes and placing your feet in stirrups puts you in a very vulnerable position, after all. But the GYN exam is so very important it is worth trying to overcome your fears.

I suggest a two-pronged approach. First, make an initial get-acquainted visit with the doctor. Explain that you have never had an exam before and you are extremely nervous. The doctor can discuss any problems you are having and obtain a complete personal and family medical history at this visit. The doctor can also explain what he or she does at a first exam. If you do not feel comfortable with this doctor, look for another.

Second, if you do not feel ready to have the physical exam at the time of the initial consultation, make another appointment to actually have this done. You will have met the doctor already and may feel more comfortable. Enlist a friend to come along to hold your hand and provide moral support. At the time of the exam, remind the doctor that this is your first pelvic.

It is important that you are open with the doctor about your sexual orientation. Most gynecologists are not bothered by a person's sexual orientation; again, if you find yourself seeing a doctor who is judgmental, look for another doctor. Lesbians who have never had sex with a man are at extremely low risk of having cervical cancer. Lesbians who have not had children, however, are at higher risk for breast and uterine cancer, like any other woman who has never had a pregnancy. Appropriate screening should be done.

Some women are more comfortable seeing another woman, while others prefer a male doctor. The gender of the doctor doesn't matter. What does matter is that you are treated with respect and that your fears are acknowledged. You are the only one who can take the first step and make an appointment, but once you do, you'll probably find that your fears of seeing a gynecologist were much worse than the reality.