If you can’t tell your GYN, who can you tell?
As a gynecologist I meet people all day every day who within a few minutes of our interaction disclose some of the most intimate details of their lives and fully undress so I can examine some of the most private parts of their bodies. I have 15 minutes for patients who have seen me or one of my partners at any time within the past few years and 30 minutes for a brand new patient. This includes the patient registering, being triaged by a medical assistant, going to the bathroom, and undressing. Realistically, in the best circumstances, I have around 10 minutes to make someone comfortable with me, gain their trust and confidence, and give them the space to speak and be heard without appearing rushed. I apologize in advance if I am running late, but now you know it isn’t because I don’t value your time and was out getting coffee. I must gather a full history, ask sensitive details about my patients’ lives including if they have a history of trauma or abuse, their mental health, how they identify, who they have sex with and what kind of sex they have, if they use birth control and/or protection from sexually transmitted infections, if they have ever had a sexually transmitted infection, an abortion, or a miscarriage, and often tease out details such as if they have pain with intercourse, abnormal discharge or bleeding, or leakage of urine. Learning to communicate and interact with patients in a way that makes them feel safe and welcome to share things with me that not even their closest family or friends may know is an art that I will continue to work on improving for the rest of my career.
I want anyone going to the gynecologist to know that we have seen and heard it all, and even though at times it may be difficult for you to say what is on your mind, please trust that although I may not always have the best answer immediately I will do my best to make you feel heard and help you understand what is going on in your body. Do not be embarrassed or scared to be truthful or ask the questions you really want to ask. I am not there to judge you and am also a human with a personal history full of issues that I have had to share with my own doctors over the years. I am here to help you stay healthy and address your concerns, however I am not a mind reader and if you wait for me to ask the exact right question to illicit what you really are worried about I might miss something important. Please ask me about the bump on your labia that is probably an ingrown hair but you googled and are panicking because google tells you it is herpes (and if it is herpes you are not alone and I will help you come to terms with the diagnosis). Let me know about your history of sexual abuse so that I am aware when performing an exam or assessing your chronic pelvic pain and can be sensitive to how a pelvic exam can be triggering and that I may need to make different treatment recommendations for your pain. When we are talking about your fertility don’t feel so guilty or fear judgement that you do not tell me about the terminations you had in the past- this helps me in your workup and assessment and also makes me aware that you may need extra emotional support during your pregnancy. Please don’t wait for me to ask the question about your pain with intercourse after menopause- vaginal dryness is not fun for anyone and I want to help you get your sex life back on track
I am not there to critique your body, just to help you stay healthy, and when I exam you I want to make sure there have not been any concerning changes since your last exam, provide education, and reassure you. I frequently tell patients who apologize for not having a recent pedicure or wax to think of me as you do the nail technician or the waxer (who contorts clients in way more compromising positions than you would ever get in for a speculum exam). We do breast and pelvic exams all day every day and honestly even though I am thorough in my exams at the end of the day it all blurs together and I could not pick your parts out of a lineup. I say this with love and reassurance because we can all be so insecure and critical of our own bodies, way more critical than anyone else including our partners and especially more than our gynecologists would ever be. Do not worry that I will think the mole on your labia is weird- I just want to make sure it hasn’t changed in shape, color, or size recently. Do not worry if you have heavy bleeding or have a bad smelling discharge- it is literally my job to assess these things. If you have questions about your IUD strings or the bump in your vagina that turns out to be your urethra, I will happily educate you on your anatomy and how to feel where everything is located on your own body. Knowledge about your anatomy is empowering and will increase your self confidence. I want to help you get to know and accept your whole self.
I hope this helps you feel ready to go to your next gynecology appointment and empowered to not hold anything back so that you feel you have had all of your questions and concerns addressed when you leave. I hear you, I see you, and I know what a privilege it is to be trusted with some of the most intimate details of your life.
With love and empathy,