I'm 20 years old, and the other day, I went to the gynecologist to have my first pelvic exam. Upon learning that I was a virgin, my gyn told me that she would be unable to perform an internal exam on me. Needless to say, I was kind of shocked, but later, I called a friend, and she told me that she had had the same experience. In her case, the nurse practitioner told her that performing an internal exam would be like her "paying to take away her virginity."

Now I'm not American, and in my culture, there is still a strong association between the hymen and virginity. What I wanted to know was if American gynecologists would balk at the idea of performing an internal examination on a virgin. Also, isn't it important to get a Pap smear done even if you aren't sexually active and probably haven't contracted HPV?

I've looked at this question a few times already, and I have been trying to figure out the best way to approach it. It's an interesting question for sure, and I don't want to be insensitive to anybody's cultural beliefs and practices. Forgive me if I misunderstand and get it wrong. Chalk it up to bias and ignorance?

With that said, I kind of know where you're coming from, so I'll speak from my own experiences. My parents are medical professionals from the Old Country. They came to America almost 40 years ago, but they brought their own beliefs and traditions with them. My mother was totally averse to the idea of me using tampons. And while my father has probably had to administer pelvic exams on girls who were my classmates, I'm sure the idea made him uncomfortable. Culture definitely affects the way people perceive health and practice medicine.

Culture conflicts arise in the US, too, such as the occasional pharmacist who refuses to dispense birth control.

The best you can do is to find a physician who is willing to examine you when you want an exam. It is definitely in your best interest to have a reproductive health checkup annually around your age, and that's something a healthcare professional should support you in. If and when they do not -- or when they do not want to give you a specific service you're asking for -- they should have a medical reason why, which they explain to you, as your physical health is their job. If a given healthcare provider has moral or personal issues with pap smears or pelvic exams, they are responsible for leaving those outside the office, and the kind of thing said to you is NOT what you should be hearing from a healthcare provider.

You are right to want to take care of your health, and you are following the same precautions we would here in the States. If you can't change physicians, let your gyn know that it is important to you to know that your reproductive organs are healthy and in working order. If you assure your doctor that you won't miss your hymen (if it's even still there), your doctor might be more amenable to examining you.

And yes, at your age it is important to have a pelvic/bimanual exam, or at least a general check up and consultation with a reproductive healthcare provider, especially if you're having any issues you need addressed such as menstrual problems, unusual bleeding, cramping or concerns about development, or if you want to begin or obtain a birth control method in advance of sexual activity. Per the pap smears, pap smear guidelines in terms of age typically suggest a first smear between the ages of 18 and 21. While a small percent of cervical cancers are caused by other things, HPV accounts for the vast majority of cervical cancers, and most recently, when you're talking about docs in the states, 21 is the suggested age by many American medical organizations for a pap smear. But if that was the issue, then again, your healthcare provider should have simply said that at their practice, they would prefer starting pap smears a year from now for you because of that guideline, and treated you professionally.