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Frequently Asked Questions

10 questions your gynecologist wants you to ask: don't be shy; speaking up could save your life

The less time your annual gynecology checkup takes, the better - breast exam, pelvic, Pap smear and you're gone. Wait - not so fast! Maybe you should take a few minutes longer with the gynecologist. You may think all doctors are in a rush to get to the next patient, but most want to give their patients the best care.

However, doctors can't address what you don't tell them. "The 20s and 30s are basically a healthy time of life, and young women tend to come in to the gynecologist's either to get a form filled out or to get a new prescription for contraception and then leave," says Ann Davis, M.D., assistant professor of obstetrics and gynecology at Harvard University and Beth Israel Deaconess Medical Center in Boston. What gets lost in the quick shuffle are potentially crucial health (and happiness) issues, from HIV testing to sexual satisfaction. Here are 10 top questions that your gynecologist would love to discuss with you - if only you'd ask.

1. Should I be tested for sexually transmitted diseases?
"I wish patients would ask and be completely frank about risk-taking sexual activity, which really begins with anything other than abstinence or a long-term, monogamous relationship," says Jill Maura Rabin, M.D., chief of ambulatory care and head of urogynecology at Long Island Jewish Medical Center in New Hyde Park, N.Y. "We want to be able to educate them about how to keep themselves alive and safe." Besides being on the lookout for symptoms of chlamydia, gonorrhea, syphilis, pelvic infection and more, that might also mean: increasing the frequency of Pap smears if so-called high-risk human, papillomavirus (HPV, the virus that causes genital warts) is detected, since it predisposes you to cervical cancer; annual HIV tests (condoms are not fail-proof AIDS prevention, Rabin points out, because 13 percent of them will break or leak); and hepatitis C tests in case you've been exposed through your own or a partner's drug use, or had a blood transfusion or C-section prior to 1992, when donated blood was not routinely screened for the disease.

2. What about a different contraceptive?
Just because a contraceptive's worked for you in the past doesn't mean it's still the best choice, Rabin notes. If you've used condoms only, for instance, you can ask about going on the pill or another hormonal method for contraceptive backup. Or, if the pill causes symptoms you're unhappy with, look into a different formulation and balance of hormones. If you're terrible about remembering to take the pill on schedule, ask about the new, virtually goof-proof contraceptive patch.

3. Should I have a prescription for the "morning-after pill"?
"Having either an undated prescription or the actual medication on hand for emergency contraception is an excellent idea," Davis suggests. Note, however, that this is a lousy choice as a regular contraceptive method, cautions Gerald F. Joseph Jr., M.D., medical director for women's services at St. John's Regional Health Center in Springfield, Mo. But for unanticipated encounters it can be one huge headache-saver. And in cases of rape (date, spousal or other), while the ideal is for a woman to go to an emergency room for help and to call the police, not every woman in fact does, and either way, knowing you have the means to prevent a resultant pregnancy can eliminate at least one worry, Joseph notes.

4. What can I do about incontinence?
"One thing we know young women are not bringing up is incontinence," Davis reports. Up to 20 percent of women experience urinary incontinence at some point in their teens, 20s and 30s, according to Rabin. But only about half of women of any age with the problem raise the issue with their doctors. Childbirth, and the weakening of the urethra's sphincter muscles that can result, accounts for some stress incontinence, where external pressure on the bladder (such as with a sneeze or cough) causes a little leakage. But more common among young women is urge incontinence, where one feels the need to urinate even though the bladder isn't full. The problem can stem from a complex process in which artificial sweeteners, stress, caffeine, iced drinks, hot peppers or other triggers cause nerves governing the bladder to set off a spasm, making it contract. Treatment -- avoiding triggers, "retraining" your bladder, Kegel exercises, medication and other approaches -- works 80 percent of the time, so it's definitely worth putting shyness aside to ask.

5. Why are my periods irregular?
It's perfectly normal for a woman's cycle to fluctuate occasionally: Stress -- even small changes in routine, diet and exercise -- can throw a minor monkey wrench into the works. "Menstrual irregularity is something young women tend not to pay much attention to beyond making sure they're not pregnant," Joseph says. "But even with a negative pregnancy test, a missed period or spotting could indicate a dangerous ectopic pregnancy." Irregular bleeding -- what you might mistake for an out-of-sync or especially light period -- also can signal infections or cancer of the cervix or uterus, or a panoply of other problems including thyroid disease, endometriosis, fibroids and hormonal disorders. "Furthermore," Joseph notes, "if you're going along hardly ever ovulating or having periods, we're concerned not only because this could be a symptom of anorexia or polycystic ovary syndrome, but also because the lack of estrogen could be impairing your ability to store up the bone mass that will be crucial later in life, or you could even be losing bone already." Don't panic -- most of these symptoms usually mean nothing -- but do ask.

6. What can I do about sexual problems?
Hard to imagine a bigger squirm factor, for patients and some physicians, than with this question. But it's precisely because your gynecologist is a good bet to have some answers that it's worth asking. "A lot of women are reticent to bring up sexual difficulties, which I certainly can understand, but most problems can be answered or at least addressed by an OB/GYN," Joseph says. The culprits easiest to identify for low libido among young women are medications -- for instance, many of the most widely used anti-depression and anti-anxiety drugs can chill sexual response, and some women report decreased libido from oral contraceptives. Discomfort or pain during intercourse can lead to sexual problems, and the underlying cause can range from serious medical issues such as endometriosis or pelvic inflammatory disease to something as simple as a yeast infection, sensitivity to spermicide or cyclic fluctuations in vaginal lubrication. And if he or she can't find a physical cause, your gynecologist is a smart choice to initiate a referral to a sex therapist.

7. Can I talk to the nurse?
Your gynecologist is not the only one in the office of whom it's worth asking questions. "One of the best resources, and one that patients don't utilize well, is the office nurse," Davis observes. "Office nurses are usually very experienced, and a lot can be handled directly through them." The best case is when your doctor has his or her own nurse or two, with whom you develop a good relationship and who knows that if you say it's a urinary-tract infection that cannot wait, it's a urinary-tract infection that cannot wait. With a less simpatico nurse, or a more anonymous one from a larger practice, you can still get valuable advice about how concerned to be about a certain symptom, how to treat run-of-the-mill ills (menstrual cramps, morning sickness), what the standard instructions are for medications and to which specialists your doctor usually refers patients. Nurses often can take care of pregnancy tests or UTI screens without your spending the time or money for a doctor's visit. And if you have a long laundry list of concerns, the preliminary chat with the nurse is an ideal time to go over them and winnow them down to the most important to bring into the examining room.

8. I was abused or assaulted (sexually or otherwise) in the past -- what effect does that have on my health?
"Statistics on the abuse of young females -- especially sexual abuse -- are just astounding," Joseph says. For example, according to the Rape, Abuse & Incest National Network, someone in the United States is sexually assaulted (including rape and attempted rape) every two minutes; 90 percent are female and 80 percent are under age 30. There could well be lasting physical effects to take into account, but more insidious are the psychological scars that manifest themselves as physical ills. "A young woman who has been traumatized by such an event tends to hold in her anxiety or depression about it, and then to somatize those feelings -- that is, develop physical symptoms, frequently pelvic pain, that reflect her mental pain," Joseph says. As troubling or uncomfortable as it may be to speak up, mentioning past sexual trauma can be extremely helpful to your gynecologist in making a diagnosis, Joseph points out. "It's very difficult to get these kinds of histories from patients, so sometimes they've been seen by several doctors, and numerous tests and procedures have been done, and no good explanation is really found. But if a physician is aware of a past problem like abuse or assault, then instead of getting involved exclusively with the physical aspect, he or she can also perhaps counsel the patient directly, or refer her to a psychotherapist, and meanwhile at least prevent more procedures and tests from being done."

9. What were my test results?
Sure, most doctors have a protocol in place to notify patients of positive test results. They also have protocols to keep appointments from getting mixed up, charts from getting misfiled, etc., and you know how foolproof those aren't. 'Ask what the policy about patient notification is," Rabin recommends. "Many offices send a note to patients no matter what -- that they need follow-up or that they got an all- clear -- but others have a 'we'll let you know only if something's wrong' policy. In the latter case, it's fine to ask that they notify you either way and how long you might expect to wait to hear from them. Then check back if you don'L" To make sure you remember, put a note on your calendar at the same time you schedule your appointment to call three weeks later to follow up on test results.

10. How does smoking affect my sexual and reproductive health?
Of course, like other doctors, gynecologists want you to quit smoking for lots of health reasons. But smoking has a direct, potentially devastating, impact in their bailiwick too. For starters, smoking may limit your choice of contraception. Smokers, especially those older than 35, aren't ideal candidates for the pill because of their increased risk for potentially fatal blood clots, heart attack and stroke. More important, smoking acts as an immune blocker, Joseph explains, which increases the chance of getting cervical cancer (and probably also means that HPV is more virulent among smokers) and may make smokers more susceptible to other infectious diseases. Also, smoking decreases fertility and accelerates the onset of menopause. Among the risks to smokers and their babies during and after pregnancy are higher rates of miscarriage, bleeding problems, premature delivery, stillbirth, low birth weight (which raises the odds of neonatal death by a factor of 40) and sudden infant death (the latter two to four times more likely than for nonsmokers' babies). Children of mothers who smoked during pregnancy have higher rates of brain damage, cerebral palsy and behavioral disorders. Nothing would make a physician happier than spending a few minutes discussing ways to help you quit.

So, ask! You'll feel better -- and live healthier -- if you do. When it's your gynecologist asking you the questions, please, they all plead, please have the following information ready: The start date of your last period Asking the date of your last period should elicit a number, not a ballpark estimate. "It always frustrates me a bit when women don't keep track of their cycles, then suddenly there's a problem and they have no idea when their last period was," laments Gerald F. Joseph Jr., M.D., medical director for women's services at St. John's Regional Health Center in Springfield, Mo. "That information can be so important -- for a missed period, pregnancy, tubal pregnancy -- having a good menstrual history can start the doctor thinking in the right realm." Your medical history Know exactly when it was that you had that ovarian cyst or which oral contraceptive it was that gave you headaches. No one expects you to carry all this in your head -- just in your hand. Keep a written medical history, and then bring it to appointments. Your family's medical history "Women will say, 'My cousin has some weird disease that her kid has too, but I don't really know what it is,'" says Ann Davis, M.D., assistant professor of obstetrics and gynecology at Harvard University and Beth Israel Deaconess Medical Center in Boston. "Well, get the information, so that if you become pregnant, your obstetrician can do the proper screens."

Catherine Clifford is a freelance writer living in Chevy Chase, Md.; COPYRIGHT 2003 Weider Publications; COPYRIGHT 2003 Gale Group

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