Monday, Sep 24, 2018

When Should a Girl / Women See a Gynecologist?

As my own daughter turns 16, I am often asked this question by friends, patients, and neighbors, “When should I bring my daughter in to see you?” We have also recently been devastated by the abuses performed by the US women’s gymnastics team physician, Larry Nasser and the USC Student Health Gynecologist, George Tyndall. A visit to the gynecologist should provide relief, comfort and cure. It should never be a time of abuse.

My hope is to provide a basis of understanding of what my profession can help with, and to empower all young women to take ownership of their health and wellness.

When I was growing up, my friends and I all “knew” that we would go to a gynecologist when we were around 18 to start having yearly internal exams and pap smears. Times and knowledge have changed since then, and currently I recommend the first visit under the following circumstances:

• Delayed onset of Puberty

• Difficulty with the Menstrual Cycle: irregular, painful, or heavy flow

• Considering becoming sexually active / Dating/ Has a boyfriend

 • New symptoms of itching, burning, abnormal discharge, frequent & painful urination

• Before graduation from high-school and going off to college

 The first visit no longer necessarily includes a physical exam. Often I will meet the patient, review their history with their family member present, discuss any concerns the patient and mother/family member have and review several important points:

1.) The Doctor/Patient relationship has binding confidentiality. Under no circumstances will our office disclose/discuss private health information with anyone else without the patient’s permission (with the exception of those items that fall under mandatory reporting) The patient should feel comfortable at all times and should feel empowered to express any concerns or decline any aspect of an exam.

2.) The patient should have a sense of trust and has the right to request a chaperone at all times. The patient should feel comfortable at all times and should feel empowered to express any concerns or decline any aspect of an exam. A male provider should always have a chaperone present.

3.) The goal is to treat, educate and improve one’s quality of life.

At this point, I will ask the family member to leave and interview the patient privately. My experience is that I will often learn information that is not readily shared when a family member is present, and it is critical to provide appropriate care.

I usually will have the patient seated in a chair as I show her how the exam table works, what stirrups look like, explain the speculum, the pap smear, culture tubes, etc. I spend the remainder of the visit addressing any individual problems and discussing the many ways I can assist with their future health-care needs.

REPRODUCTIVE CARE

This includes pregnancy prevention: oral contraceptive pills, IUDS (intrauterine devices), implants (Nexplanon), injections (Depot Provera), barrier methods (condoms), and permanent sterilization (vasectomy & tubal) as well as pre-conception counseling and infertility evaluation.

OBSTETRICAL CARE

From conception through pregnancy, delivery and postpartum, we evaluate and manage the well-being of the fetus and mother.

INFECTIOUS DISEASES

This encompasses a variety of disorders including yeast and bacterial vaginitis, urinary tract infections, and sexually transmitted bacteria, parasites, and viruses (the most common being chlamydia, herpes I & II, and HPV). Education on prevention is extremely important, including promotion of the HPV vaccine called Guardisil 9 to prevent cervical and oral cancers.

CANCER SCREENING

Early detection often means cure. The yearly gynecological exam includes screening for breast, ovarian, uterine, cervical and vulvar cancers. We also often detect skin cancers and enlarged lymph nodes or thyroid glands. I streamline my recommendation for mammogram based on the patient’s family and personal history, but in general I order a baseline at age 35, then annually at age 40.

MENSTRUAL CYCLE

From the onset during puberty to the absence after menopause, a gynecologist can help treat painful cramps, heavy bleeding, irregular flow, fibroids, endometriosis, and polyps. This includes education and understanding of a women’s anatomy and physiology to allow the patient to make the best choices to manage her individual cycle.

HORMONE MANAGEMENT

Many disorders fall under this category including polycystic ovarian syndrome (PCOS), low production of estrogen due to eating disorders or excessive exercise, and increased production of prolactin. As hormones vary throughout the cycle, premenstrual syndrome (PMS) or menstrual migraines can affect one’s well-being. As a women heads towards menopause, lack of hormone production can bring on hot-flashes, night sweats, mood disturbances, and painful intercourse.

GENERAL HEALTH

Much of the yearly exam includes discussion of healthy life-style choices including ways to avoid diseases and common causes of morbidity and mortality. This includes regular exercise and activity, healthy eating habits, safe alcohol consumption, smoking cessation, accident prevention (wear seat-belts and helmets), healthy sleep-habits,  and stress-reduction. I emphasize the buddy system, rape prevention, and safe-sex practices. We recommend routine cancer and disease screening through blood tests and other studies. Often we are on the front line of diagnosing anxiety, depression, and other mental health issues. We make many referrals for appropriate treatments.

In Summary

Clearly, this is intended to give a general overview of the items an OB/GYN can assist a woman with throughout her lifetime. It is a privilege and a partnership. A women’s healthcare should be individualized to meet her needs, answer her questions, and provide her with the tools to make the best decisions she can to keep herself strong, vibrant and living her best life.

The current generation of young women I see today are bright, strong and confident. The internet allows access to information and provides accountability. I believe with the right resources, this group of young women will be stronger and healthier than ever!

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