Il ginecologo è una figura molto importante nella vita di una donna: è (anche) a lui, infatti, che ci rivolgiamo nel caso di problemi e patologie legati all’apparato genitale e riproduttivo, ma anche per monitorare la nostra salute.
Infatti, in un’ottica di prevenzione, le visite dal ginecologo sono importanti anche se non abbiamo nessun sintomo preoccupante o nessuna patologia specifica: ma cosa succede durante una visita ginecologica? Ogni quanto sottoporsi a un controllo? Quando bisogna fare la prima visita dal ginecologo?
Vediamolo insieme!
Quando fare la prima visita dal ginecologo?
Dipende: l’ideale è cominciare ad andare dal ginecologo quando iniziamo ad essere sessualmente attive, indipendentemente dall’età in cui questo accade.
E’ con l’inizio dell’attività sessuale, infatti, che è necessario mettere in atto strategie di prevenzione contro le gravidanze indesiderate e le malattie sessualmente trasmissibili, senza contare che con i rapporti sessuali siamo più esposte a tutta una serie di disturbi che possono interessare la zona genitale.
Una visita dal ginecologo è consigliata anche se non siamo ancora sessualmente attive ma manifestiamo uno dei seguenti sintomi:
- perdite vaginali anomale (potrebbe trattarsi di un’infezione micotica)
- dismenorrea eccessiva
- cambi repentini del ciclo mestruale (mestruazioni che saltano, mestruazioni troppo ravvicinate, etc.)
Se non siamo ancora sessualmente attive e non abbiamo nessun disturbo, verso i 18 anni è comunque consigliabile fare la prima visita ginecologica.
Cosa succede durante una visita dal ginecologo?
Bisogna prima di tutto fare una distinzione fra la prima visita dal ginecologo e una visita dal nostro ginecologo di fiducia in occasione di un controllo di routine.
Le visite di controllo con un ginecologo che già ci conosce saranno di norma più rapide, poiché il medico è già al corrente di tutta una serie di dettagli che – invece – dovrà chiederci durante la prima visita.
Quando andiamo per la prima volta dal ginecologo (o quando andiamo per la prima volta da un nuovo ginecologo) ci farà diverse domande di carattere personale; alcune riguardano la sfera della salute:
- peso
- altezza
- eventuali allergie
- eventuali patologie e/o disturbi (sia legati all’apparato genitale e riproduttivo sia in generale)
- data del menarca
- data dell’ultima mestruazione
- “regolarità” del ciclo mestruale
- eventuali gravidanze
- eventuali aborti (spontanei o indotti)
- eventuali trattamenti farmacologici in corso
Ed altre, invece, riguardano le nostre abitudini e lo stile di vita:
- inizio dell’attività sessuale
- partner fisso o rapporti occasionali
- eventuale uso di un metodo anticoncezionale
- eventuale consumo di alcool/droghe/fumo
- sport
- alimentazione
Per quanto possano sembrarci imbarazzanti e personali queste domande è necessario rispondere con assoluta sincerità: il ginecologo non giudica e utilizza le informazioni che forniamo per poter tracciare un quadro più definito del nostro stato di salute ed intercettare eventuali problemi con più facilità (se soffriamo di particolari patologie possiamo portare con noi i referti medici durante la prima visita).
Dopo queste domande iniziali, ci verrà chiesto di denudarci dalla vita in giù e di accomodarci sul lettino ginecologico, un lettino munito di poggiagambe: saremo quindi sdraiate con le gambe alzate e divaricate (l’incavo delle ginocchia si appoggia sui poggiagambe).
Il ginecologo quindi procederà con l’osservazione degli organi genitali esterni (la vulva, ovvero il monte di Venere, le grandi labbra, le piccole labbra, le ghiandole di Bartolino e il clitoride) per valutare che non sia presente nessuna anomalia o patologia; in seguito, continuerà con l’analisi dei genitali interni (vagina, collo dell’utero, utero, ovaie).
[E’ totalmente comprensibile essere un po’ a disagio in questo momento: se il ginecologo sarà in grado di metterci a proprio agio, con il passare del tempo questo passaggio della visita ci risulterà perfettamente normale e privo di qualsiasi imbarazzo.]
Per esaminare i genitali interni il ginecologo può:
- procedere con la palpazione bimanuale: il dito indice e il medio di una mano vengono inseriti in vagina mentre l’altra mano preme il basso ventre verso il basso; in questo modo è possibile valutare dimensioni, posizione e consistenza dell’utero
- utilizzare lo speculum: è uno strumento che viene inserito in vagina e permette di mantenere aperto il canale vaginale ed osservare con precisione la cervice uterina; è anche utilizzato per eseguire il pap test (di cui parleremo più avanti)
- utilizzare una sonda ecografica: una volta inserita in vagina questa restituisce l’immagine dell’utero, dell’endometrio e delle ovaie
Di solito il ginecologo esegue anche una palpazione del seno per controllare che non vi siano anomalie che potrebbero far pensare a un tumore al la mammella; la palpazione va eseguita almeno una settimana dopo la fine delle mestruazioni.
Una volta terminata la visita, ci si riveste e si procede a parlare con il ginecologo riguardo al nostro stato di salute, eventuali preoccupazioni, dubbi, domande, etc.
Cos’è il pap test e quando va fatto?
Si tratta di un esame di screening, quindi di prevenzione, e serve per individuare possibili tumori al collo dell’utero o lesioni precancerose che nel tempo potrebbero svilupparsi e degenerare in neoplasie.
Il pap test viene eseguito durante la visita ginecologica: viene inserito lo speculum in vagina e il ginecologo – servendosi di una spatolina e un bastoncino cotonato – preleva una piccola quantità di muco cervicale; si tratta di un esame molto rapido e totalmente indolore.
Il campione viene poi inviato in laboratorio ed analizzato.
Quando fare il primo pap test? E’ bene farlo dopo aver avuto il primo rapporto sessuale o, comunque, una volta compiuto il venticinquesimo anno d’età sebbene non ci sia attività sessuale.
Di solito il pap test si esegue ogni tre anni ma può essere realizzato più di frequente (nel caso di una paziente particolarmente a rischio) o meno di frequente: sarà il ginecologo a indicare la cadenza di questo esame, a seconda del caso specifico.
Per esempio per le e donne con più di 65 anni senza nessun rischio (quindi senza che dai pap test precedenti risultasse nulla di allarmante) non è più necessario fare il pap test.
Questo esame si può eseguire senza problemi se:
- si è vergini
- si prendono contraccettivi ormonali o si utilizza la spirale
- si è incinta
Non si può invece eseguire il pap test se abbiamo le mestruazioni: se siamo nella fase mestruale dovremo quindi posticipare il test poiché è necessario realizzarlo lasciando passare almeno 3 giorni dalla fine delle mestruazioni.
Siccome il pap test è un esame per individuare i tumori del collo dell’utero, è importante sapere che la maggior parte di questi tumori sono causati da alcuni ceppi del Papillomavirus umano (HPV).
Fortunatamente per i ceppi più diffusi è disponibile un vaccino che si è dimostrato molto efficace nel prevenire il cancro al collo dell’utero, soprattutto se somministrato prima dell’inizio dell’attività sessuale (ma è possibile farlo anche più tardi).
In Italia la vaccinazione è gratis sia per i maschi (possono essere portatori del virus e contagiare le femmine) sia per le femmine e di solito viene effettuata intorno al dodicesimo anno d’età; dopo questa età è disponibile a pagamento.
Ogni quanto bisogna andare dal ginecologo?
Anche qui non c’è una risposta univoca poiché dipende dal caso e dalle esigenze specifiche.
Di solito è consigliata una visita all’anno ma i controlli periodici possono avvenire più o meno spesso, a seconda delle caratteristiche della paziente (tipo di attività sessuale, patologie specifiche che richiedono maggiore controllo, stile di vita, etc.)
Ancora una volta, sarà il ginecologo stesso a indicare la cadenza delle visite di controllo a seconda del caso specifico.
Come scegliere il ginecologo?
E’ importante scegliere una persona competente che ci faccia sentire a nostro agio: capita che le ragazze comincino ad andare dal ginecologo di fiducia della madre, continuando con lui/lei anche negli anni a venire.
Tuttavia alcune ragazze preferiscono andare da un ginecologo diverso e, nel caso di non avere riferimenti (amiche che possono consigliare in base alla loro esperienza) è possibile fare una ricerca online e controllare i professionisti disponibili nella nostra zona.
Spesso per i medici specialistici è facile trovare online le recensioni dei pazienti che hanno in cura: questi feedback ci possono aiutare ad orientarci nella decisione.
La prima volta possiamo sentire il bisogno di essere accompagnate da qualcuno: se desideriamo che entri con noi ricordiamoci che:
- il ginecologo ci farà una serie di domande molto personali a cui dobbiamo rispondere con completa sincerità
- dovremo denudarci dalla vita in giù
Se pensiamo che la presenza di una terza persona ci potrebbe mettere in ulteriore imbarazzo, chiediamole di aspettarci fuori.
Una figura spesso sottovalutata: l’ostetrica
Il ginecologo non è l’unico che può aiutarci nel tenere sotto controllo la salute del nostro apparato genitale e riproduttivo.
Quando si pensa all’ostetrica si pensa alle donne in gravidanza ma questa figura professionale può aiutarci in tantissime altre situazioni.
Un’ostetrica si occupa di educazione sanitaria, sessuale, mestruale ed affettiva, già durante l’adolescenza; è grado di formare e informare su contraccezione e prevenzione da gravidanze indesiderate e malattie sessualmente trasmissibili.
E’ in grado di visitarci ed esaminare i genitali esterni ed interni, indirizzandoci a uno specialista (come il ginecologo) nel caso di patologie o disturbi.
Può anche dissipare vari dubbi legati al ciclo mestruale, alla fertilità e più in generale alla sfera intima e può aiutarci nella scelta del ginecologo.
Prima di andare dal ginecologo per la prima volta, quindi, possiamo rivolgerci a un’ostetrica e chiedere a lei tutto ciò che desideriamo sapere: un’ostetrica (generalmente donna, ma ci sono bravissimi ostetrici uomini) ci può far sentire meno in soggezione e prepararci al meglio per una futura visita ginecologica.
Di cosa fa l’ostetrica e della sua importanza nell’educazione mestruale ce ne ha parlato Barbara Colombo – ostetrica di professione – in un’intervista sul nostro blog!
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