Episode 6 : The ObGyn visit

Dr. Sophia:
Hello everyone. It's me, Dr. Sophia, and welcome to the Dr. Sophia Podcast, episode number 6, the ObGyn visit. I'm here with my good friend, Touseef Mirza

Touseef Mirza:
Hi everybody. It's good to be back. And today we wanted to talk something a little bit more, I guess, general, about the ObGyn visit, and just sort of talk about like general questions, of what you can expect or what do people think they have to do before they go. So these are all different questions, that we know that's on your mind that we wanted to addressed with the Dr. Sophia. So let's begin. So let's start with, how often does a woman need to go see an ObGyn?

Dr. Sophia:
Woman should come to see an ObGyn once a year if she just needs a checkup. What we would consider as the annual visit or routine visit is once a year. Typically at that visit, we are going to, you know, dive into your medical history. We want to know if there are any changes, if you're considering a pregnancy, if you need birth control, if, there are any changes happening with your period. So these are just some of the things that are happening at your annual visit.

Touseef Mirza:
So that's more like conversational in terms of what you spoke about, like just to get to know the patient in terms of where they're at in terms of the actual tests, what actually occurs, what are the tests that usually happen on a, on an annual?

Dr. Sophia:
So an annual also encompasses a full exam. And for myself that includes a breast exam. I touch and feel your abdomen. I will do a pelvic exam. And a pelvic exam means, the vaginal exam or the exam perhaps with a speculum. It's the little device that we use in order to look inside of the vagina. And the test that we typically would be doing is something called the pap smear or the pap test, or the Papanicolaou.

Touseef Mirza:
That's the real name.

Dr. Sophia:
That's the real name's.

Touseef Mirza:
That's fun to say. Papanicolaou

Dr. Sophia:
Papanicolaou. So actually named after the scientist who developed the test. And, that test is very specific actually. It's a test that's looking to see your risk of developing cervical cancer in the future. And used to be actually that, that was a part of the annual exam meeting every year. And so most women think, okay, I'm going to the gynecologist because I need my pap smear. In recent years, we recognize that the pap smear or the pap test is not necessary at every exam. And as I said, it's a very specific test. It's looking to see your risk of developing cervical cancer. so that test is done at an interval of every three to five years, depending on your age. And if the test includes both looking at the cells of your cervix as well as a virus that is very common called HPV or the human papillomavirus. So that's all encompassing, in terms of the PAP testing. And outside of that, we also do STD testing or STI testing, meaning sexually transmitted infections such as chlamydia, gonorrhea, HIV. The biggest part of doing your ObGyn visit is really having the conversation. It's having the conversation so that we can figure out what your needs are and what are your goals in terms of your health.


Touseef Mirza:
So when you talked about, that you do the pelvic exam and the pap smear, is that happening at the same time?

Dr. Sophia:
That's a great question. So on your annual visit, if it's the time when you'll get your pap smear, it is when we would look in through the vagina in order to see the cervix and we use the speculum in order to perform the exam.

Touseef Mirza:
And the speculum is that metal looking thing.

Dr. Sophia:
I know everybody thinks about the metal clamps

Touseef Mirza:
Because that's what we feel <laugh> It's the clamps. That's the clamps <laugh>. Okay. All right.

Dr. Sophia:
And yes, it, it can be metal. I prefer the plastic ones. Hmm. They may or may not feel more comfortable, but I personally prefer the plastic.

Touseef Mirza:
But it's basically used to open up.

Dr. Sophia:
The point of it is used so that we can see inside of the vagina. And when we look inside of the vagina, what we're looking for or what we see is the walls of the vagina. Your secretions, your cervix, and that's all that we see. I say that to say that some people think that when we do that, we can see all the way into the womb, into the uterus, into the uterus that is, and the, the reality is that no, we can't. It stops at the cervix. It stops at the cervix.

However, when we do what's called the pelvic exam, so that's when we take the speculum out and we then use our hands in order to feel both the cervix as well as with our top hand, we feel for where we can touch your uterus as well as your ovaries. That is what is called the pelvic exam. And in all honesty, it can be both. Usually it's kind of done in, in concert. So we would do both the speculum exam as well as a pelvic exam or what we call the digital exam. And with the digital exam, that is when we can feel more of what's happening, let's say with your uterus. So for example, when we do a pelvic exam, sometimes we are able to feel if you have something like a fibroid.

Touseef Mirza:
So this is what your hand, when you mean when you mean digitally. We're not talking about tech, we're talking about digits.

Dr. Sophia:
Like your fingers.

Touseef Mirza:
Like your fingers. Okay. Just want to be clear. <laugh>. Okay. So this is when you're using your fingers to act and you can go all the way up to my uterus and pass through the cervix.


Dr. Sophia:
We don't pass through the cervix. We don't, no. Okay. What we are doing is we can feel the level at the level of the cervix. And with our top hand, because the cervix and the uterus are kind of all one organ in the sense that they're connected, we can assess the uterus by touching, using both of our hands, both the hand that's in the vagina, as well as the hand that's on top on the abdomen.

In order to understand the size of the uterus, the contours of the uterus, we can feel the ovaries, we can assess if whether or not you have what we call tenderness or pain that's associated with touching those areas. When we do your pelvic exam, you should feel some pressure, but you should not feel pain. It should not feel tender. And if it does, that may signify that there may be an issue. It may be that perhaps you're very close to your menstrual cycle and everything kind of feels a little bit more tender or inflamed, but it does give us a lot of information.

Touseef Mirza:
So we talked a lot about the tests. At what age should the women start having these tests at the ObGyn?

Dr. Sophia:
Well, we usually say that a woman should come to visit an ObGyn for the first time at the age of 21. With all things being considered, if everything has been normal, then 21 is the appropriate time to first visit your gynecologist. Usually we consider that a woman may have, you know, already had sexual debut, meaning her, she's lost her virginity and, and may need sexually transmitted infection testing, or she may need birth control, or she may be having an issuer or problems with her period that we can address.

And so this is a time that I would say I would consider a good time to have your first gynecological exam. Now, there are certain gynecologists that have special training in what we call adolescent gynecology. And there are times when teenagers need to see a gynecologist because of issues with their periods that they're not able to get addressed, let's say, with their pediatricians. But overall, I would say that no need to come and see me before the age of 21.

Touseef Mirza:
Okay. After that, we can come and see you as many times as we want. We talked about when a woman comes and sees you the first time. And is there, once we start to then come and see you more on an annual basis, more or less, am I seeing you for the rest of my life or is there a certain point that I can scale it back or more? How does that work?

Dr. Sophia:
Most women actually start to come and see me more during times of pregnancy. So when a woman gets pregnant, we are the people who handle pregnancy. You would come to your gynecologist or your obstetrician gynecologist, your ObGyn during the time of pregnancy, and, and you would see us a lot more during that time, while we're managing your pregnancy and helping you get through. What's typically a very beautiful journey. What I love about being an ObGyn, and it's really the reason why I decided to go into women's health in the first place, is because we get to see women through all aspects of their life. So, you know, like I said, you'd start at 21 and a typical 21-year-old is coming not just for an annual, but you know, to talk about birth control. And then perhaps when she's 26 or 27, she's pregnant with her first child.

And so now we're seeing her for her pregnancy. And then at 35 we're seeing her because she's experiencing certain changes that's happening, with her hormones or her periods have changed, or she's, you know, recognized that she has a fibroid and, and we need to address that as an issue. And then we see her throughout the menopausal changes or perimenopause and, and managing those symptoms. And then we see women after menopause, in terms of just keeping them healthy. So making sure that they've had their mammograms, but making sure that they've had their colonoscopies, bone density exams. So a gynecologist is really the kind of like the everything doctor for the woman. On average, I would say most women could stop seeing us or kind of scale back after the age, perhaps of 65, 70 or so. We, we typically say that a woman does not need a pap smear any longer after the age of 65.

If her pap smears in her life have always been normal. She's had no scares of, you know, in terms of a abnormal pap smear or any, increased risk of for cervical cancer. So typically we say that about the age of 65, but we see women all throughout, well into their seventies, and mostly because it's for management of postmenopausal symptoms, whether that includes some vaginal dryness or some pelvic pain or sexual discomfort or problems. And, and these are things that can happen, you know, throughout their women's life. And so, you know, I like the fact that we are able to see women for the gamut throughout their lives.

Touseef Mirza:
It's interesting because there's certain tests that are more sort of rudimentary over the course of the woman's life. You know, like for example, the, the pelvic exam start at the beginning and goes all the way to 65. And then there's other types of visits that are more specific being age appropriate, like when you're pregnant or when you're younger or, or so forth. So I guess as an ObGyn, you really get to see the whole lives of your patients when they're like, if you, if you know, if you get them at the beginning and then they're staying with you.

Dr. Sophia;
Yes. I think it's one of the beauties of being an ObGyn is the fact that you get to grow with your patient, you get to experience life with your patient, and it's a very intimate relationship, quite frankly, even though I didn't take you to dinner <laugh>.

Touseef Mirza:
Yeah. It's much more intimate than dinner <laugh>, like scaling it back and really making it more like concrete. Some of the questions were like, do I need to prepare myself before I go to see the ObGyn? One other question was, do I need to shave down there before I come and see you?

Dr. Sophia:
Oh my God, I love this question. The patients always think that they need to shave or have a wax or, you know, do some extra thing because they're coming to see the gynecologist. And the answer to that is absolutely not. We think of the vagina the same way we think of the nose. There's nothing special or extra that you need to do prior to coming to your ObGyn visit, except I would say just feel clean.

Touseef Mirza:
Just like on a normal day.

Dr. Sophia:
Just like on a normal day, what you would do to clean yourself is all that really needs to happen. And if you have to come and see your ObGyn at the end of the day because you went to work, that's okay too.

Touseef Mirza:
So no problem with hair.

Dr. Sophia:
Absolutely.

Touseef Mirza:
Pubic hair is all in.

Dr. Sophia:
Is all in, is all in, no problems with pubic hair.

Touseef Mirza:
Another question, is it okay if I'm having my period to come and see the ObGyn, is that a problem?

Dr. Sophia:
Actually, that's another question that I get pretty often. Can I still see my ObGyn if I'm on my period? And it really depends on what's the purpose of your visit. If you are coming to the ObGyn to have your annual exam and you happen to be on the lightest day of your period, then by all means still go and see the ObGyn, because it really, it's not going to affect anything, that we have to do in the sense that if you need a, your pap smear, we typically can still do your pap smear if you're on a lighter day of your period. I would say though, that if it's a very heavy period or it's a heavy day of your period, or you're having a lot of discomfort or pain or cramps with your period that maybe that's not the best day to come in for an annual exam, something that's pretty routine, then you can schedule out a time when, you may have less discomfort.

Because when you're on your period and you need to be examined, everything just feels so icky. But understand it's not from our perspective for us, we are able to clear away the blood that is in the vagina. And like I said, as long as it's not very heavy, we are able to clear it away and still do the things that we need to do, such as your pap smear. But for the most part, what I would say is it's more so for the patient's comfort and for most women, they feel very uncomfortable during the time of their period to be examined or to have someone touch them and see them. And, especially just the concept of the bleeding itself. So I would say if it's your light day, yeah, you could come in. If it's a heavier day, you may want to reconsider and reschedule. And if you're fine with it, then understand that we're fine with it.

Touseef Mirza:
So even if it's a heavier day that doesn't skew any of the, the testing or anything like that, that's not an issue.

Dr. Sophia;
A heavier period can affect the test in terms of a pap smear, for example, because what the pathologist or the cytologist will see, the person who's reading the pap smear may only see the blood cells. It kind of will block the other cells that we're looking for. But overall, we are able to kind of clear the blood out of the way for the moments of that test. And so if that's your only opportunity to get to the gynecologist, you, you've taken the day off from work, you made your appointment like three months ago and it's problematic because of your work schedule or just life in general, and it's the only time you're going to be able to go, I would say take the chance and go.

Touseef Mirza:
I think for some women when they go see the ObGyn, it's something that's become more routine and they feel quite comfortable. and I think that for other women it's still very uncomfortable. It's very vulnerable to go to an ObGyn visit. So for those women who feel uncomfortable, what would you recommend them to say or to feel like? Do you have any suggestions to help them go through that visit?

Dr Sophia:
I love this question. It's very important in my opinion, that the doctor patient relationship be one that is a comfortable one. I think that's what's going to help the patient provide as much information as possible, and it's going to allow us to be able to really examine you, diagnose you if we need to, and go through the visit a lot more seamlessly. And so that doctor patient relationship is so, so important. Some of the ways that I think a patient can help with that is by advocating for themselves saying exactly what they're feeling at the time, whether that's anxiety, whether that's, a fear of pain, whether it's, just if you are having discomfort and pain at the time, let us know so that way we can be a lot more gentle through the process or figure out a way in which to make you more comfortable. And if we know that, because you've expressed to us that coming to the gynecologist is, very, anxiety provoking, sometimes that's a clue to us that we need to dig a little deeper. Is it because there's a history of trauma? Is it because there's some other situation or life situation that may be happening.

Touseef Mirza:
Or sometimes it's cultural as well.

Dr. Sophia:
And certainly it can be cultural. And so I think the best thing you can always do is simply say how you're feeling, certainly before you're examined. And, quite frankly, for any doctor, we should always ask to touch you, to examine you and to know that it's okay. And, and if that's not happening, that you should certainly speak up and, and see how you're feeling.

Touseef Mirza:
And in the same vein, if we don't feel comfortable about having a male gynecologist, can we request to have a female gynecologist? Does that happen? And how would we go about it?

Dr. Sophia;
In this day and age, many gynecologists are parts of, you know, large groups, large hospital systems. And in that, there's definitely the chance or the likelihood that you may encounter a male gynecologist. I think it's important to do your research for where you're going to know perhaps what's the male to female ratio in terms of the doctors that are available to see you. And I think that that should be a request that's made at the time of making the visit, so that way the office staff has an opportunity to accommodate you. Sometimes with things such as pregnancy, certainly labor and delivery, that is not always possible because oftentimes it's the person who's on call and if that person on call happens to be a male

Touseef Mirza:
On call, meaning that's just the person that's there,

Dr. Sophia:
That's the person who's there, who's going to be there for that shift. And if, and if that's the time that you're coming for delivery. But otherwise, as far as an office visit, I would say that just do your due diligence in terms of doing your research on the group that you're going to see the doctors that are available to see you and certainly make that request.

Touseef Mirza:
So again, it goes back to advocating for yourself.

Dr. Sophia;
100%

Touseef Mirza:
Really listening to yourself.

Dr. Sophia;
Understand what are your own comfort zones and being able to identify what you feel in your body. You know, like I said, this is a very intimate exam. This is a, you know, a routine, it is as it may seem and be for someone like me as a gynecologist, I also am a woman. And I recognize that that is not the easiest doctor's visit. Even for me as a gynecologist. I admit to my patients all the time that when it's time for my pap smear, I am like up the bed. The doctor's kind of constantly, okay, you can come down, you can relax <laugh>. So I get it.

Touseef Mirza:
Well that's comforting to hear coming from an ObGyn because when you're having a pap smear, from my experience, it is very hard to relax when that is happening because it's such a different experience that the whole body's like, what is going on down there? <laugh>.

Dr. Sophia:
Right, exactly.

Touseef Mirza:
Yeah. And so that's normal.

Dr. Sophia:
That is very normal. I mean, I think it's good. That's why it's, it's great when you're able to see the same person kind of year after year. And I get it, that's exactly why most people who, once they find their person, they stick to them. You know, they'll follow you to the end of the earth. And, and it's because it's a relationship, it's something that's developed over time. And so it becomes a lot less, you know, anxiety provoking. You can kind of like take a deep breath and be like okay, you know, Dr. Lubin is going to be there and she knows me. That's very important to develop those type of relationships. And part of developing that relationship is truly in the advocacy for yourself. Developing that relationship is knowing yourself, understanding you know, what your boundaries are and bringing all of that to the table.

Touseef Mirza:
So as we close this episode, what would you say then, are the three top areas? Why people come and, and see you as an ObGyn?

Dr. Sophia:
Top three reasons? Yes. Okay. Birth control, pregnancy, menopause.

Touseef Mirza:
Okay. So pap smear, that's pretty close there up too?

Dr. Sophia:
Of course, I'm sorry I left out the pap smear, which is definitely very routine. But I think when a woman is coming to see me, yes, of course she's thinking, oh, I have to go get my pap smear. Or some other doctor, her primary care doctor or whoever has said, oh, it's time for your pap smear. But oftentimes they have other things on their minds. And so those to me is the other part of it.

As we close, I'd like to share one of my favorite Maya Angelou quotes I learned a long time ago: “The wisest thing I can do is be on my own side, be an advocate for myself and others like me.”

Thank you for listening to the Dr. Sophia podcast. See you next time.