There is a great discussion going on in the women's blogosphere, and I thought I would chime in to give a unique perspective. The topic is "What have your experiences been with gynecological care?" I hope to hear from our readers about their experiences at the Gyn and maybe I could learn a bit about how to treat my patients more satsfactorily.
Also check out this blog for a whole bunch of great stories, unfortunately most of which are pretty depressing.
I kind of feel like I am budding in on what is really a women’s discussion, so please forgive me in advance. I like to scan the women’s blogs to know what women are discussing, and it helps me with my own blog. I found this conversation to be very humbling, and I think back to some times that I have probably made women feel uncomfortable in my office.
As a male gynecologist, I have to contend with the fact that many women find that my gender is a barrier before we even have our first conversation. Fortunately, most women that find male gynecologists uncomfortable will not be coming into my office in the first place. Before they see me, they already know that I am a man.
I really don’t see how gender matters when it comes to medical care, although I fully respect the fact that everyone needs to find the doctor that they are most comfortable with. I’ve heard before the claim that a man can’t understand women’s issues, but I never heard that to be a cardiologist you need to have a heart attack first, nor to be an orthopedic surgeon do you have to break your arm first. In the same way, I’m not sure why someone would need to be a woman to be a gynecologist
Thankfully, I am busy in my practice, so it seems that at least my patients realize that the most important thing is to find someone knowledgable, experienced and above all, caring, respectful, and willing to listen.
As far as bad experiences are concerned, let me fess up as to some of the dumb things that I have done in the past.
Early in my career, I discussed the risks of sexually transmitted infections with a 14 year old in the presence of her mother before I even knew anything about her sexual history. I think I freaked her out enough to scare her away forever. I learned then to take it real slow and take on subjects subtly and over time, and only bring up issues when someone is truly ready for them.
The most delicate and difficult encounters are with younger women when they come for the first time. It is rarely necessary to even do an exam the first time. Almost always you can simply speak with the person and develop a comfortable relationship. You have to find out from the patient whether she would rather speak with you alone, or with her Mom or someone else present. You have to reassure her of true confidetiality (assuming you are aware of the laws of parental consent in your particular jurisdiction). The exam can usually wait until next time, or the time after that.
I apologize again for entering this conversation even though I don’t have an experience of my own to share, but I thought you might find my perspective interesting.
I also just found an interesting (non-scientific) internet poll on the MSNBC website. When asked this question:
Do you think patients get better treatment from a doctor of the same gender?
At least at the moment of this writing, 33% said yes, 38%said no, and 29% said it depends on the medical issue. Please tell me what you guys think.
I must agree with Dr. Pablo Rodriguez in his blog post on the POPLINE controversy, but for different reasons. For those of you that haven't been following it, POPLINE is a database run by Johns Hopkins University a publicly-funded database that its administrators describe as “Your connection to the world’s reproductive health literature.”
Apparently, according to Rodriguez, "POPLINE (POPulation information onLINE) had rendered the search term “abortion” a stopword—which directs the database to ignore the term when used in a search. UCSF librarians discovered this deliberate restriction when they were unable to find a single document containing the word “abortion” in POPLINE’s database, and contacted the administrators at the Johns Hopkins Bloomberg School of Public Health to ask them why. Simply put, the UCSF librarians were told that “abortion” was eliminated as a search term by the POPLINE administrators so that the latter could examine the database for information “that might not have been consistent” with guidelines from a government agency that funds the project."
Dr. Rodriguez, is a known advocate of abortion rights. I am an obgyn physician who does not perform elective abortions for religious reasons. I do support however the right of free choice, because I do not believe in religious coercion, and I think the abortion debate should be settled in the church, synagogue, mosque, school, family room and wherever else people have important discussions about things that are important in their lives. I think we need to debate the issue in the open and win in the court of public opinion. I don't think we should be legislating beliefs.
If religious people want to influence the views of society, they need to be open to discuss and understand the opposition. It is so important to recognize the issues, and THEN try to make your point. A zero sum game, trying to paint a complex issue as right vs. wrong, does no one any good, and harms your cause.
This POPLINE incident is just one more instance which demonstrates that the word "abortion" has become a dirty word. Instead of discussing it, people would rather bury the subject. Why Hopkins of all places would restrict access to scholarly articles on the subject is difficult to imagine, especially when elective abortions are performed at Hopkins all of the time.
By restricting access on a scholarly database, they were hurting not only those women who desired elective abortions, they were hurting people who needed them for all sorts of reasons, even for the health of the mother, genetic defects etc...
With such tactics abortion opponents only make it worse for themselves. If they want to convince everyone they are right, let them argue their case openly. They have very important points to make, so why not debate the pros and cons in the open. Restricting knowledge and research hurts everyone and makes it seem like you have something to hide!
Teaching Abortions in Medical schools
April
11 ,
2008
Nicole Wolverton, in her blog post, "Why Won't Med Schools Teach About Abortion Care?" laments the fact that "first and second year med students rarely receive any education at all about abortion. Third and fourth year students hardly ever see abortions performed during their clinical rotations and surgical simulations in the classroom are nearly unheard of. And medical residents spend all their time at hospitals, while nearly all abortions are performed in private clinics, not hospitals."
While I understand her sentiments, I think it is important to make a few points. For starters, many people don't realize that an abortion is an identical procedure to something that all obgyns are trained to do, and that is a D & C which is done for a miscarriage.
When a woman is found to be pregnant and the fetus has no heartbeat, the identical procedure to an abortion is often necessary. Every obgyn is trained to do this, and it is no different than the performance of an elective abortion. So to say that obgyns are not being trained in abortion care is somewhat disingenuous.
Furthermore, although everyone needs to be trained it is also important not to force medical students or residents to participate in something that they find to be morally wrong. While you may disagree with their beliefs, I think you must respect the fact that some people disagree with you in principal.
In my medical school, University of Illinois, we had a cardiovascular lab where we experimented on live dogs. Students that objected on moral grounds were not required to participate. Abortion training should be no different. The opportunity for training should be given, but it should not be required.
A pill that stops your periods? Is that OK?
April
06 ,
2008
Lately there have been several birth control pills put on the market that advertise how they will stop monthly periods. Some will limit you to four periods a year (such as seasonale and seasonique), some will stop monthly periods altogether (e.g. Lybrel). If you are someone who suffers from painful periods, heavy periods or severe PMS, this sounds like great news, right? Is this safe? Aren't women "supposed" to have a period every month? Should we be fighting nature?
Well, in order to understand this, a little history would be helpful. First read up on the normal menstrual cycle. Check out our website here:
Once you understand how periods work you will know that the key event that regulates periods is ovulation, the release of the egg by the ovary at midcycle. Birth control pills work by preventing ovulation. If you don't ovulate, then you are not having real periods. So if you are on birth control pills, the bleeding that you have every month is not a real period at all, it is simply a withdrawal bleed because the pills of the fourth week are not real hormones so you have some withdrawal bleeding.
So then why are pills designed to give you an artificial "period" every month? Because when the pills were originally designed, they thought that women would want to continue having "natural" monthly cycles. Well, women do not necessarily want monthly cycles, especially when they are a pain, cause PMS, and whatever else! So here come the pills that don't give you artificial periods every month!
They have been proven safe in scientific studies, they work, and they are effective birth control, So go ahead and use them! Of course speak to your doctor first to make sure that pills are safe for you. If you have high blood pressure, a history of blood clots, or you are a smoker over the age of 35, they may not be safe.
Do birth control pills cause weight gain?
April
03 ,
2008
Many women and physicians believe that weight gain is associated with birth control pills (we are discussing here only the combination pills with estrogen and progesterone as these are the most common types).
This is one of the most common reasons women give for stopping to take their birth control pills. Is this true? If they truly cause weight gain, certainly that would be a good reason not to be on the pill!
Well, in an important review of the literature published in the Cochrane database in 2004, a scientist named Gallo and colleagues tried to determine if it is indeed the truth that birth control pills cause weight gain. They performed a systematic review of all of the studies they could find. They included studies of at least three menstrual cycles’ duration that compared combination contraceptives with placebo or other drugs, dosages, regimens, or study lengths.
They found no studies that found a significant difference in weight gain between groups. The largest of these studies, with 473 patients, found a difference of less than 1 lb after six months. There was also no difference between groups in discontinuation of the contraceptives because of weight gain. Furthermore, most of the studies comparing two contraceptive regimens did not show differences in weight gain.
The bottom line is, that women in both groups gained some weight, but not more frequently in those that took birth control versus those that didn't. So although some women on the pill might gain some weight, the pill itself does not cause weight gain.
