Developing a relationship with a qualified obstetrician/gynecologist and visiting regularly are important components to a woman’s healthcare and peace of mind. Although it may be difficult to find and choose a competent and caring doctor, this is one of the most important health care decisions a woman can make — and well worth the effort.

A good relationship with a doctor can be described as a partnership. The relationship between a doctor and a patient is both intimate and practical. Both parties must be able to trust one another. When there is an atmosphere of easy communication, a woman can feel comfortable at her routine visits as well as when problems arise.

Finding the right obstetrician/gynecologist (ob/gyn) can be a challenge. The following are some suggestions on how you might begin.

Ask friends, family, neighbors, or other doctors (like your primary care physician) for recommendations. Keep in mind that many health insurance plans have restrictions, so it may be necessary to choose a physician from their “approved physician” list. Most insurance companies provide a directory that lists their enrolled physicians. Once you’ve compiled a list of potential doctors, determine which ones are close by or convenient for you to visit. Some women like to set up a meeting with a potential doctor before they make their choice. It is important to remember, however, that many insurance companies will not cover these interviews. You can call your insurance company to verify this before making an appointment. Also, if you are willing and able, you can pay for this interview out of your own pocket. If you choose to forego this interview, you can still consult the doctor’s secretary to find out some valuable information about the doctor.

Some questions that you may want to consider asking include:
• How long does it take to schedule an appointment for a non-routine visit?
• Where did he/she attend school? Complete training?
• What hospitals is he/she affiliated with? This is especially important to know in case of emergency or if you are planning to become pregnant.
• Will nurses, nurse practitioners, or any other healthcare professionals be performing tests or examinations?
• What special training does the doctor have? Certain specialty training includes maternal/fetal medicine (care of high-risk pregnancies), reproductive endocrinology (hormonal disturbances infertility and menopause), oncology (gynecological cancers), urogynecology (urinary disturbances).
• Is the doctor board certified?
• How long has the doctor been in practice?
• Does the doctor have specific times when he/she can be reached by phone? When are these?

All of the questions listed above can be answered by an administrative person from the doctor’s office. While the answers to these questions will not tell you whether or not you will like the doctor, they can assure you that he/she is a competent and available physician.

If you do opt to interview a physician in person, you may also want to evaluate the office. The following questions may be helpful:
• Does the staff or doctor ask for your records from your previous ob/gyn?
• Does the office seem to run smoothly?
• Is there any educational material or good magazines available to read while you wait?
• Is the staff friendly and helpful?
• Is the office clean and well equipped?

Unless this is your very first time to the gynecologist, you will more than likely be familiar with this visit. Although these visits may have become fairly routine to you, they can still be somewhat uncomfortable and embarrassing. However, a visit to the obstetrician/gynecologist (Ob/Gyn) can be an empowering experience. An ob/gyn can provide valuable information about how the reproductive system works. These doctors can also provide a woman with information about what to expect as she grows older. By acknowledging that you are a little nervous or embarrassed, it may clear the air and set the stage for honest, straightforward communication.

The first few minutes with your obstetrician/gynecologist are fairly predictable. First, there will be a consultation during which the doctor will inquire about your medical history and any recent symptoms or changes in your health. In addition, he/she will focus on gynecological issues, such as “Are you sexually active?” or “Do you ever experience any menstrual irregularities or problems?”. Be sure to tell your doctor if you are taking any new medications. You will want to tell your doctor if you have any questions or if there is a specific reason for this visit. Then, the nurse will come into the room once you have changed and record your weight and blood pressure. Soon after, the doctor will come back into the room. She or he may listen to your heart and lungs, examine your thyroid, and abdomen, and, in some cases, take blood and urine samples. The doctor will also examine your breasts.

The majority of the visit will consist of a pelvic examination. Before the pelvic exam, remember to urinate. With a full bladder, it is more difficult for the doctor to feel your pelvic organs. The doctor will perform the pelvic exam and a nurse will be present. During the pelvic exam you will be on your back with your bottom at the very end of the table. Your feet will rest in stirrups. The doctor sits at the end of the examination table, allowing him/her to examine your external and internal reproductive organs. This exam can feel awkward and embarrassing. There are several things that you can do to make the experience more comfortable:

• Ask for a pillow for your head.
• Ask that the stirrups be covered so they are softer and not as icy cold. Or, you might want to keep your socks on for the exam.
• During your first visit, or later visits when you may feel more comfortable, you might want to ask for a mirror so that you can watch and follow as the doctor examines the vulva, the urethra, and the clitoris.
• Ask your doctor to tell you what he or she will be doing next so you know what to expect.
• Take deep breaths and try to relax. (The pelvic area consists of several muscle groups, so you will feel better if these muscles are loose and relaxed.)
• If you are embarrassed, express your feelings to the doctor. Remember that this is routine for him/her and that he/she should try to make it as quick, comfortable, and minimally embarrassing as possible.

After looking at the vulva, the doctor will begin the pelvic examination. The initial part of the pelvic exam is done with a speculum. The speculum is an instrument that is inserted into the vagina and allows a doctor to see the vaginal walls and the cervix. It may be plastic or metal. If it’s metal, it may be cold. You can ask the doctor to run it under warm water to make it more comfortable. When the doctor begins the exam, you will feel the speculum and the doctor’s hands in the area of your vulva and vagina. It may be uncomfortable, but it should not be painful. It feels more like a pressure. Again, it is helpful to be relaxed so that the muscles will be less tense. Take several deep breaths, close your eyes, and try to think about something else. If it will make things easier, ask your doctor to explain each thing that he or she is doing.

It is possible that the doctor will perform a rectal exam. Take a few deep breaths and relax. He or she will insert one gloved finger into your rectum while the other remains in your vagina. The purpose of this exam is to confirm the findings of the pelvic exam and to get additional information that will help the doctor complete his or her evaluation of you. Also, the doctor may use this test to look for “occult blood” which is imperceptible blood that is found in a stool. If any indication of occult blood is found, the doctor will recommend further evaluation of your intestines.

Another test that your doctor may conduct is a sonogram. Sonography has become a very important tool in completing a thorough evaluation of a patient. Some doctors will be able to perform this test in their own offices. If not, they will refer you to a specialist. A sonogram is used to evaluate a patient for any abnormalities, complaints, or symptoms found in the pelvic area.

The best way to stay healthy is by visiting the gynecologist before you have to. It’s important to your overall health to schedule at least one well-care visit every year.

Routine checkups should be initiated at either age 18 or when a woman becomes sexually active, whichever comes first. In addition to scheduling routine checkups, you should schedule an appointment:

• If you are 14 and haven’t noticed any pubertal changes.
• If you are 16 and haven’t had a period.
• If you are experiencing severe menstrual cramps or any other pelvic pains.
• If bleeding is very heavy, unusual, or lasts more than seven days.
• If you are bothered by vulvar or vaginal itching, redness, sores, swelling, unusual odor, or discharge.
• If you think that you are pregnant.
• If you’re contemplating becoming sexually active and need to discuss contraception and safe-sex habits.
• If you have irregular menses or have missed more than three periods (you can only wait three months if you are certain that you are not pregnant. If there is a chance that you may be pregnant, you should see a doctor right away).
• If you experience a burning sensation or frequent urination.
• If you suffered an injury to your pelvic area.
• If you have had nonconsensual sex.
• If you may need a prescription for the “morning after pill.”
• If you believe that you have been exposed to a sexually transmitted disease.

As mentioned above, abnormal vaginal discharge is an indication of a potential problem. An abnormal discharge is defined as any discharge that differs in consistency, color, or quantity from what is normally seen during the menstrual cycle. It can be a sign of common vaginal infections, such as a yeast infection. It may also be the first sign of a sexually transmitted disease (STD). A sexually transmitted disease is an infection transferred between sexual partners with intimate contacts. If you think that you may have a STD, please see your doctor immediately. We have provided an outline of the most common STDs.

There are many reasons to visit your gynecologist, only some of which are listed above. Others include contraception counseling, infertility, menopause, breast exam, or preconception counseling with a screening for hereditary risk factors. No matter what the reason for your visit, we recommend that you review the following questions before you see your doctor so that you can be fully prepared for your visit:

• Did you bring the dates of your last period?
• Did you bring your list of questions for the doctor?
• Are there any new medications that you are presently taking? You may want to write down the name of the medication and the dose you are taking, or you may want to place the bottle in your purse to show the doctor.
• Did you bring records from previous visits with other doctors?

By Dr. P. Sarrel

Do you, like so many women, approach a visit for a gynecologic “pelvic “ or “internal” exam with dread and leave feeling annoyed that your concerns weren’t addressed? It doesn’t have to be like that. There are steps you can take to change the experience into something you approach with confidence and leave understanding more about yourself.

In these days of HMOs and managed care, the biggest problem is lack of time. Your family practitioner, internist, gynecologist, or nurse practitioner may be allotted only ten minutes per patient visit. That is not enough time for anything more complex than a very routine, well-woman examination. If you feel that you need more time, for example you have a particular worry or problem or new symptom, you can request a longer visit. Sometimes it helps to get the doctor’s last appointment of the day so there won’t be the time pressure of the next patient.

The preexamination talk is best done in the doctor’s office while you are still dressed, but this is becoming less common because it takes more time. Now the usual procedure is to have you undress and sit on the examination table for the talk. If this is your first pelvic exam or your first visit with this doctor you can ask to meet first in his/her office. Your request may or may not be accommodated. Some women feel so strongly about this that they decide not to see a particular doctor if he/she denies this request.

A study, done a few years ago, found that, on average, doctors interrupt within eighteen seconds of a patient’s beginning to describe why they are there. If you need to tell your doctor about a problem or about symptoms you must do it assertively and in a carefully planned, condensed way. You might wish for a friendlier, more relaxed atmosphere but that is, unfortunately, rarely available these days. So plan on getting down to “business” right away. If you have signs or symptoms to report, come with a written list or, better yet, keep a diary of your symptoms for a week (or, if related to your menstrual cycle, for a month or two months) and hand a copy of the diary to your doctor. She/he will be very impressed, and it can go with your medical record.

If you have questions, go with a written list so you don’t forget to ask something important. If the doctor uses a word you don’t understand, say so. If an explanation is unclear, speak up. This is your time, you are the customer and you deserve good service.

When it comes to the actual examination, you probably understand that there are two parts to it. First a speculum (usually plastic) is inserted in the vagina and opened. Then a pap smear is taken by scraping some cells from your cervix with a wooden stick. After the speculum is removed, the examiner “palpates” (feels) your uterus and ovaries to check for internal abnormalities.

The examination should not hurt, except for when the doctor presses on your abdomen to feel your ovaries; this might be slightly painful. If the exam hurts at any other time, say “ouch.” Your pain may be important information for the doctor. Unfortunately, some doctors may do an exam too quickly or not gently enough. Again say “ouch.” You should not put up with any unnecessary pain or discomfort.

We have some additional suggestions that may sound unusual to you but they really work to transform a pelvic exam into a very positive experience. Some health care providers, particularly nurse-practitioners, use these methods already. Others are likely to be receptive to these ideas.

1) Ask to have the “head” of the examining table elevated so that you are in an almost sitting up position. This way you feel less vulnerable and passive, you and the doctor can have eye contact, you can see what’s going on and can talk more easily. It does not compromise the doctor’s ability to examine you and, in fact, may make the exam easier by relaxing your abdominal muscles.

2) Ask to have no “drape” (sheet or paper) across your knees or, if one is put in place, push it down somewhat, between your legs, so you can see the doctor.

3) The next procedure is not something that needs to be part of every pelvic exam but we strongly recommend it for every woman at least once. Ask if the doctor has a mirror you can hold to observe the process of the pelvic exam. Better yet, bring a mirror (at least six inches across) with you. Hold the mirror inside one knee so that your genital area is reflected in it clearly.

Then ask your doctor to explain the process of the exam as it proceeds, including showing you any instruments. The ‘speculum” and the wooden stick or cotton applicator are usually the only instruments and if you have never looked at the instruments you will probably think, “Oh, those don’t look so bad at all. What I imagined was actually scarier than the reality.”

4) If you have never looked carefully at your own genitals you may not know what all the parts are. Feel free to ask. One of the most commonly misunderstood parts is the hymen. Did you know that all women still have some hymeneal tissue even after they give birth? With the speculum inserted and you holding the mirror, you should be able to see into your vagina. Shining lamp light on the area helps. If you have never done this, we highly recommend it. This part of a woman’s anatomy is often mysterious and poorly understood. You will probably be able to see your cervix (the bottom part of the uterus — also called the “womb”). You will see the pink, glistening walls of the vagina.

We have talked with literally thousands of women after a mirror exam and they are almost always extremely positive about the experience. The whole experience of a pelvic exam is changed because you really understand the procedure. A pelvic exam can and should be a positive experience. You can help make it one.