Your first visit to a gynaecologist: what happens, what it costs, what to bring

Most women who come to our OPD for a first gynaecology consultation have put it off for months — not because of the problem, but because nobody has told them what happens in the room. This article sets that out: what you will be asked, what an examination involves and when it is not done at all, which tests must wait for the right day of your cycle, and what a first visit costs at our Naroda OPD. Nothing is done without being explained first and agreed to by you.

What to bring

None of this is compulsory, but each item saves a repeat test or a second appointment.

• The date your last period started — the actual date, not “last week”. It is the single most useful thing you can carry, and much of what the doctor decides depends on it.
• Old reports in whatever form you have them — scan films or CDs, blood reports, discharge summaries, operation notes, earlier prescriptions. A report from two years ago is still useful.
• Your current medicines — the strips themselves, not the names from memory. Include thyroid, diabetes and blood pressure tablets.
• If you are coming about fertility: your husband’s semen report if one has been done, and roughly how long you have been trying.
• A written list of your own questions. People forget them at the door.
• Photo ID, and your insurance or TPA card if admission or surgery is a possibility.

The conversation comes first

More is decided by the history than by any test. Expect to be asked how long your cycles are and how regular, how heavy the flow is and for how many days, whether there is pain and when in the month it comes, about pregnancies and how each one ended, about past surgery and medical illnesses, about your medicines, and — if you have come about conceiving — how long you have been trying. Some of these questions are personal. They are asked because the answers change the diagnosis, and what you say stays in your file.

Privacy, and who comes in with you

Patients are seen one at a time with the door closed. You may bring your husband, your mother or a friend in with you, and you may equally ask them to wait outside for part of the consultation — say so and it will be arranged. If you would prefer to see a woman doctor, ask at the reception desk when you book: Dr. Bhargavi Khatri consults from 1.00 pm to 4.30 pm and 6.00 pm to 8.00 pm, Monday to Saturday.

The examination — what it is, and when it is not done

An abdominal examination — the doctor pressing gently over your lower abdomen while you lie flat — is done at almost every visit. It is quick and needs no preparation.

An internal examination means a speculum examination to see the cervix, and sometimes a bimanual examination to feel the size and position of the uterus and check for tenderness. Three things are worth knowing:

• It is not routine. It is done when the complaint needs it — discharge, bleeding between periods or after intercourse, pelvic pain, a smear that is due, a suspected infection or prolapse. For many complaints an ultrasound answers the question instead.
• It is explained before it is done, and you may decline or defer it. Saying “not today” is a normal thing to say. Most women find it uncomfortable for a few seconds rather than painful; tell the doctor if it hurts and it will be stopped.
• A female attendant is present throughout, whichever doctor you are seeing. You do not need to ask for it.

If you have never been sexually active, an internal examination is usually not performed at all. A transabdominal ultrasound answers most of the same questions, and that is the route used for young and unmarried patients as a matter of course.

Tests, and why the day of your cycle matters

This is the part that surprises people. A gynaecology test done on the wrong day is not merely less accurate — it is often meaningless and has to be repeated. The commonest reason a work-up takes two months instead of two weeks is a test done a week early.

Ultrasound at the first visit

A pelvic scan is often done in the same sitting. There are two routes, and which is used depends on what is being looked for rather than on preference.

For a transabdominal scan, drink three to four glasses of water an hour before and do not pass urine — a full bladder pushes the bowel aside and gives a clear window to the uterus. For a transvaginal scan the bladder should be empty; it gives a much clearer view of the ovaries, the endometrium and an early pregnancy, and it is not used in women who have never been sexually active.

What a first visit costs

Laboratory tests and procedures are charged separately and the cost is told to you before anything is done. Consulting hours and the full list of services are on our gynaecologist in Naroda page.

How long it takes, and what you leave with

A general consultation usually takes twenty to thirty minutes; a first infertility consultation takes longer, because both partners’ histories are gone through. You should leave with four things — a written note of what was found, any prescription, the list of tests with the day each is to be done, and a date to come back. If any of those is unclear, ask before you leave the room.

When a first visit should not wait

Some symptoms should be seen within days rather than whenever the month allows: bleeding heavy enough to soak through protection every hour or two, bleeding after intercourse, any bleeding at all after menopause, severe one-sided pelvic pain with a missed period, fever with foul-smelling discharge, or pain and bleeding after a positive pregnancy test. We have written about these separately in five signs you should see a gynaecologist without waiting.

If you already know what you are coming about — irregular cycles with weight gain, or period pain worsening over years — reading PCOS and fertility or understanding endometriosis first lets the consultation start further along.