Never Feel Awkward at the Ob-Gyn Again!

Written By: Sam Savage

Published Date: June 22, 2007 Last Edited: June 22, 2007

By Topp, Elizabeth

In a recent Shape poll, more than 6,000 readers confessed they feel a little clueless at the gynecologist’s office. Stop fretting and follow these get-comfortable tips from doctors nationwide. BY ELIZABETH TOPP Visiting the gynecologist is hardly the highlight of any woman’s year. And it’s even worse when the appointment involves a long wait, awkward conversation, and an ice-cold speculum. But developing a good relationship with your doctor is one of the best things you can do for your health, and for your peace of mind. “You let your gynecologist in on some of the most private parts of your life, both physically and emotionally,” says Nancy J. Cossler, M.D., ob-gyn and assistant professor at case Western Reserve University School of Medicine. “She listens to your sexual-health issues, screens you for cervical and breast cancer, and supports you through nine months of pregnancy.”

According to a recent study in the journal Medical Care, about 15 percent of women under age 45 see no other doctor, making their gynecologist also responsible for a host of other health matters, from stress management to cholesterol. So before you head to your next ob-gyn visit, consider these five suggestions.

1 Switch to a doctor you like

Our survey showed that 40 percent of women had signed up with a new obgyn because they were unhappy with their current care. Among the top complaints: judgmental or unfriendly doctors, hard-to-make appointments, and offices that always run behind schedule. “Your doctor should never make you feel guilty about your lifestyle,” says Shape advisory board member Carol Livoti, M.D., a New York ob-gyn. “But it is her job to express concern about things that compromise your health, like smoking cigarettes or having unsafe sex.” It’s also important that you both share similar health-care philosophies. “Some doctors make you visit the office for everythinggetting referrals, renewing prescriptions, receiving test results. And others may prefer to address less-pressing needs over the phone,” says Livoti. “Some are very serious and never crack a smile; others may be so casual, they seem more like a friend than a physician. But you will have a better rapport-and a more comfortable visit-with a doctor whose values match yours.”

Beyond the doctor-patient relationship, note the office environment. “You shouldn’t tolerate excessive waiting, which could indicate a practice that’s poorly managed,” says Emily Godfrey, M.D., an assistant professor of family medicine at the University of Illinois at Chicago. If the total wait time from when you arrive to when you actually see your doctor consistently exceeds 45 minutes, consider shopping for a new physician. Ask friends for recommendations, but be sure your questions are specific: Can you discuss minor health concerns, like a yeast infection, with a nurse over the phone? In an emergency can you see the doctor that day? How easy is it to get an appointment?

2 Make it an annual event

About 20 percent of you said that you hadn’t seen your ob-gyn in the past year, but your overall health will benefit from an annual visit. It’s not just about STD screening and Paps, says Cossler. “Manual breast exams may detect breast cancer more effectively than self-checks, and pelvic exams can turn up life-saving information,” she explains. “Ive even found melanoma near the vagina, where many woman would never look for it.” Once you’ve booked your appointment, come prepared. Know when your last period started, the medications you’ve begun or stopped taking, and any other changes in your health since your last visit. Don’t overlook family medical records, either. “If your grandma was just diagnosed with diabetes, your doctor should know,” says Cossler. Or, for example, if your doctor knows heart disease runs in your family, she’ll pay more attention to a high blood-pressure reading.

3 Know your Pap

More than 70 percent of women don’t have a clue what type of Pap smear they get. The newer, liquidbased tests (ThinPrep is one) filter out blood and other fluids, which makes cervical cell samples easier to read. “This test is especially relevant for young and sexually active women who are at a higher risk of contracting HPV the virus that can cause cervical cancer,” says Cossler. According to a study published in the American Journal of Obstetrics and Gynecology, more than 80 percent of doctors’ offices have adopted the liquid-based Paps, but you should still ask what kind your doctor uses. If it turns out that you do receive conventional Pap smears, you can ensure you get a more accurate reading by not scheduling your appointment during or right after your period, because blood can cloud the results. And put a stamp on your sex life the night before your exam. “Having vaginal intercourse may irritate and inflame the cells that line your cervix, which makes the Pap smear harder for labs to interpret,” explains Godfrey.

4 Be open about your bedroom behavior

Almost 40 percent of you confessed to not always being completely honest with your doctor about having unprotected sex. It’s not easy to admit that you forgot to use a condom while getting busy with a brand-new guy in your life, but it’s crucial that your gyno knows so she can screen for sexually transmitted diseases. “The most common bacterial STDs, like chlamydia and gonorrhea, often don’t have symptoms, so you won’t know you’re infected unless you’re tested,” says Judy Chang, M.D., an assistant professor of obstetrics, gynecology, and reproductive sciences at the Magee-Womens Hospital at the University of Pittsburgh Medical Center. “And many doctors won’t test for STDs unless you specifically request it.” These infections are easily treated with antibiotics, says Chang, but should be found as early as possible because they may cause infertility over time. Should your results come back positive, follow the medication treatment instructions exactly, and then book a second appointment as requested by your doctor. According to a study in the Annals of Internal Medicine, more than 25 percent of women who were infected with chlamydia had developed a new infection (sometimes with a different STD) when they were reexamined within a year. The researchers believe that many of these women became reinfected because they continued to engage in unprotected sex or because their partners weren’t treated for their own conditions.

Lastly, follow up on any tests that your doctor performs. “A patient should always hear over the phone or in writing that an STD test or Pap smear is negative,” says Cossler. “It’s an unfortunate fact that busy offices sometimes misplace or forget to call about positive test results. You can’t ever assume that no news is good news.”

5 Bring up the tougn stuff first

About 30 percent of women said that they’ve been too embarrassed to ask their ob-gyn about sexual-health issues. It sounds counterintuitive, but one way to get over any anxiety about discussing, say, your sluggish sex drive or an unusual discharge is to bring up the subject at the very start of the appointment, says Jeffrey Robinson, Ph.D., an associate professor of communication at Rutgers University. According to his research, patients rate their office visits more positively when they can discuss their biggest concerns at the beginning of their visit. More than 75 percent of women reported that their visits lasted for IS minutes or less, so if you talk about those personal issues right away, you make certain you have adequate time to address what’s most important to you. Make a nerve-racking conversation easier by starting out with “This is a bit embarrassing for me, but…” or “I’d really like to talk about something, but it’s uncomfortable for me.” Says Chang, “These phrases signal to your doctor that the discussion is emotional.”

Dont be shy: Holding back can affect the care you get

Forgot a condom with the new guy in your life? Your ob-gyn needs to know

Do you need a birth-control update?

Just because you’ve been taking the same pill since college doesnt mean if s still right for you now. If you’re considering a change, brush up on your options here, then ask your doctor what’s best for you.

You’re no longer in a monogamous relationship

* Try using latex condoms. They’re the only contraceptive proven to reduce the risk of all sexually transmitted infections, including HIV1 as well as pregnancy.

You have painful, heavy periods

* Take continuoususe or extended-regimen pills. Seasonale and Seasonique give you just four periods a year (you take three months’worth of pills before popping a week of placebos). With Loestrin 24 Fe and Yaz, you still get periods each month, but they’ll be a few days shorter.

You want a reversible method that doesn’t involve a daily pill

* Use a vaginal ring. Called NuvaRing, this flexible plastic device releases hormones over three weeks; you remove it for one week to get your monthly period.

You don’t want birth-control hassles, and you aren’t looking to conceive for a few years

* Try an intrauterine device (IUD) or lmplanon. Your ob-gyn inserts the T-shaped IUD, which can prevent pregnancy for 5 to 10 years, into your uterus, or implants the matchstick-size lmplanon into your upper arm. The rod is effective for up to three years.

Seasonal can help reduce PMS symptoms

You’ll stress less If you ask those embarrassing questions first Always call for test results. Never assume that no news is good news

ELIZABETH TOPP is a writer and documentary filmmaker in New York City.

“The number-one thing I learned while researching this story is to create a game plan before your appointment,” says Elizabeth Topp, who wrote “Never Feel Awkward at the Ob-Gyn Again!” page 130. “These days, you typically only get a few minutes of face time, so you have to make every second count.” lbpp has recently started exercising regularly, thanks to her boyfriend’s encouragement. “We go to the gym together and do cardio and yoga,” she says. She lives in New York and is the co-author of Vaginas: An Owner’s Manual.

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