Gynecologist had just begun practicing medicine in Utah when a patient showed up at her clinic requesting a "premarital exam.
A what?
It's a term unique to Utah and was totally new to Smith, yet it's something that many women here — especially ones who are waiting for marriage to have sex — request from their doctor before tying the knot.
Smith's confusion was short-lived. Her nurse, a Utahn familiar with the lingo, explained what women expect when they schedule one of these exams, which usually take place a few weeks or months before the wedding date.
So, what is a premarital exam anyway?
Since there's no real definition, it can be anything a woman wants it to be, Smith said.
In many ways, Smith said, the objective of a premarital exam is not much different from that of a woman's first annual exam: establish a relationship with a doctor she feels comfortable with. At a typical annual exam, a patient might discuss family health history, ask questions about her period and receive a pap smear.
One difference is that premarital exams are very much focused on the fact that a woman will soon be having sex for the first time. While it's not vital that a soon-to-be bride sees a doctor before becoming sexually active, it's important to do so if she would like to begin contraception.
Birth control, Smith said, is one of three topics that often come up during premarital exams.
The second common request at premarital exams is for antibiotics — just in case a woman needs to fight off an ailment known to pop up during honeymoons.
"When you've never been sexually active before and you go straight to a honeymoon where there's frequent sexual activity, you might be at risk for a bladder infection," Smith said. "Some women will want an antibiotic to have on hand in case they get one — every physician has different feelings about that."
Finally, a woman may schedule a premarital exam to confirm that her body is ready for sex and take steps to reduce discomfort and frustration associated with the first few times. Some will choose to take home a set of varying-sized, sterile dilators.
"The idea of the dilator is that, if they open their vagina a little, gently at home, 5-10 minutes a day, then their first few intercourse attempts won't be so difficult or painful," Smith said. "I have some that come in who have a mother and lots of aunts and sisters, and they're very open about it. They kind of know what they're looking for."
Such stretching or enlarging is a personal decision and one not common outside of Utah. But, says Smith, it can be beneficial for some women who have chosen to remain abstinent until marriage whether for religious or other reasons.
"Based on the way they live their young adult lives, I think [dilation] can make for a much smoother wedding night because you're starting off on the right foot sexually with your new husband. If you have difficulty with your first sexual experience, it could affect your sex life long-term."
Whether married or single, sexually active or abstinent, it's important for women, starting at age 21, to receive a regular pap smear, a screening test for cervical cancer.