A visit to the gynecologist is always an exciting experience, and it’s no secret that the young ladies always gather the courage to carry out this event, of course, if nothing itches, does not hurt or does not flow – then to the doctor run for salvation and deliverance from suffering.
In addition to the embarrassment and just excitement of going to a medical institution, many are worried about how to avoid the “doctor imposed game”, that is, not to get into a situation where there is no clarity in the actions of the doctor. I decided to describe some tricks that will allow you to pass this “quest” easily and simply, and most importantly, save money and nerves.
To visit the gynecologist it is necessary not less often than once a year.
First things first. It is necessary to remember when you started your last menstruation, how the period went recently (it is best to bring a calendar), and of course, do not do any douching, so that the doctor could assess your discharge. That is, it is necessary to prepare not as a date with a loved one, but it is enough to carry out simple hygienic measures.
Before a visit to the gynecologist enough to wash. Don’t do any douching!
Prepare a detailed story about the problem that concerns you and the questions that need to be solved. Often patients come to the reception as a massage, waiting for the doctor to do everything for them, the main thing-the fact of the visit. It is this passive approach that leads to the fact that you are completely dependent on the doctor, and then he will be able to impose his “game” on you, and this is not always correct in the conditions of modern medicine in our country. There are two nuances: on the one hand, gynecology is quite commercialized, and you can spend a lot on unnecessary tests and treatment, on the other – there is a risk of getting to a not very competent doctor and not immediately understand it.
So, if you don’t like the selection or you want to get checked for infection, do in advance by an independent laboratory the following tests: a simple smear on flora + florians or familar-16 + PCR method (real time PCR) for chlamydia, Trichomonas, gonorrhea. Of course, you can do these tests and the doctor at the reception, but ask to be limited only to this. The marked list will allow you to fully evaluate your selections. I would not recommend: bakposev, “analysis of 12 infections”, PCR for all HPV types. Let me remind you that white discharge without the smell of any consistency in the absence of itching-most often the norm. In addition, the cycle phase also matters: few secretions – after menstruation, as egg white – to the middle of the cycle and dairy-in the second phase. When taking contraceptives, the discharge is usually the same.
Interestingly, American gynecologists offer to refrain from examining a woman on a chair, if she has no complaints about bad discharge, there is no need to be checked for infections or take a swab from the cervix. I do not quite agree with this approach, because often the discharge, which I regarded as pathological, and this was later confirmed by tests, patients were perceived as “normal”.
Condylomas in the vulva, a woman can detect independently in the form of single or multiple pointed outgrowths.
Proceed to the examination on the chair. At the very beginning, even before the introduction of the mirror, the doctor can draw your attention to the presence of warts in the vulva and immediately tell you about the “terrible” human papilloma virus, the need to urgently take an analysis of it, and in General, “I have not seen your neck, there may be cancer.” At this point, you need to calm down and try not to react to the frightening speech. As a rule, if you actually had large warts – you would find them yourself in the form of single or multiple pointed outgrowths. Most likely, the doctor found small warts that can pass on their own for 1-2 years. The presence of such warts is not dangerous, to a greater extent they create only aesthetic discomfort. Yes, and of course, the presence of warts is not associated with the risk of cervical cancer, as the growth of warts cause other types of virus. What to do? Try asking the doctor to show you them with a video microscope (often in the doctor’s office), a regular mirror, or in extreme cases taking a picture on your phone.
If it is small, 1-2 mm, condylomas in a small amount, decide for yourself, you can not touch them. If condylomas are large – they should be removed even just for aesthetic purposes. You can use a laser, radio wave method or topical treatment with aldara. Thus, small warts are more of an aesthetic problem that you can solve at will.
Small warts can be removed by laser, radio wave method or by topical treatment with aldara.
Next, the doctor introduces a mirror-a plastic device that allows you to see what is happening in your vagina. Depending on the accuracy of the doctor, this process can be completely painless or cause you pain. Alas, in advance you will not be able to know how your doctor is delicate in this matter, but you can help yourself. To do this, before the introduction of the mirror, try to completely relax the muscles of the legs, buttocks and pelvis, you can “push down”a little. In this case, the muscles at the entrance to the vagina will cease to compress the mirror and relax, and the pain will decrease.
The pain of inserting a mirror is associated with several things: you shrink your muscles from fear, and the mirror cuts into the mucosa, or you resist the actions of a doctor who tries to stretch the muscle at the entrance to the vagina; it is also possible that the doctor acts quite quickly and aggressively, and you do not have time to adapt to the expansion of the vagina. Ask the doctor to slowly insert the mirror so that you can keep up with his movements. Obviously, if you are in pain, you will clench more and more, and the pain will only increase. Alas, in this process it can be difficult to provide guaranteed comfort, so either you are lucky with the doctor, or just try to relax as much as possible.
After the mirror is installed in the vagina, often you can hear the story that you have “terrible erosion”, and in General the neck of the doctor “does not like”. There may also be some “cysts on the neck” that need to be removed. If the doctor in the office has a video microscope (microscope with a screen), you can show scary pictures of your neck under high magnification, which can cause you even more emotional experiences. We pass to “exorcism”: erosion is not a disease, but a common condition of the cervix, which in the absence of complaints about contact bloody discharge (after sexual intercourse) or abundant mucous discharge does not require treatment, as well as cysts, which are safe and do not need to be removed.
No matter how terrible the neck looks on the monitor with red spots, and then, after applying something brown, with unpainted spots-do not succumb to provocation and do not get infected with anxiety and excitement. All you have to do is exhale and wait until the examination is over, and then get the doctor’s opinion. Be sure to make sure that you took a cytological smear from the cervix (if you are more than 21 years old and you have not passed it for more than 2-3 years). This is all that is required of the doctor during the examination of your neck. In the cervical canal there are still polyps – are small outgrowths of the mucous membrane, which itself does not show or podkalivat after sexual intercourse, is a doctor should be described separately in the conclusion. Polyps are often not dangerous and quickly and painlessly removed under local anesthesia.
Cervical erosion is not a disease.
So, on the neck, the doctor can see the following changes.
- Erosion-is not a disease, passes on its own; requires cauterization, only if bleeding after intercourse or if there is abundant mucous discharge.
- Cysts-not dangerous; treatment, removal, autopsy is not required.
• Polyps – there are true and false; the true need to delete, false (fold of mucosa) – is not necessary.
- Dysplasia – the eye is not visible, it is detected when staining the neck with vinegar and then Lugol for evaluation under a special microscope (colposcope). Any painting during staining is only a preliminary conclusion, which can be confirmed or disproved by a cytological smear and biopsy. Therefore, we do not accept any value judgments only on the basis of this picture, we are waiting for the results of the analyses.
- Leukoplakia-many scares this name, in fact, nothing terrible, just on a separate area of the epithelium, which normally does not keratinize layer, this layer appears. Leukoplakia itself is not associated with the risk of bad changes in the cervix, just in leukoplakia may also be changes that will be detected by Cytology or targeted biopsy.
- Ruptures, deformities – such changes can occur after childbirth, in most cases it does not require any correction.
If you have no complaints about poor discharge, there is no indication for tests, unless you are checked for possible infection with sexually transmitted diseases of STDs. At the same time, remember that the only infection in which the discharge may not change is chlamydia, so with normal secretions, it makes sense to take an analysis only for chlamydia. Let me remind you that you can avoid a dispute with the doctor on the subject to take or not to take tests, just bringing to the reception the latest data of those tests, which I wrote above.
Chlamydia is the only infection that can not change the nature of secretions.
After removing the mirror, the next stage begins-inspection by hands. Immediately want to warn you that the results of this examination is very subjective and there are most often start fantasies “on this I have good news for you is over.” Painful sensations in any part of your abdomen are often followed by inflammation of the appendages, endometriosis, adhesions. Palpation of the uterus is often accompanied by exciting descriptions of serious “bends” and “displacements”, as well as a dramatic increase in the size of the entire uterus, possibly due to fibroids.
Of course, I do not deny the existence of all these diseases, except for the “bend of the uterus”; the problem is that there is often a very pronounced hyperdiagnosis.
Let’s understand what the examination on the chair and what information it carries.
To examine the hands on the chair you need to relax, which, of course, is quite difficult, sitting in this chair waiting for the verdict of the doctor. Therefore, the most important task of the doctor is to calm and distract the patient from the process. All movements should be gentle and gradual, so that the tissues have time to adapt to penetration, and the muscles of the vagina and abdomen were relaxed. I would like to draw your attention to the fact that if you do not empty your bowels, the feces in the rectum and sigmoid intestine will create additional pain during the examination, especially when they press on the stomach from the left. So try before inspection go to the toilet. In General, the examination on the left is always more sensitive than on the right, as the left are parts of the intestine with its anatomical features.
Inspection on the chair better to go with an emptied intestine, as the fecal mass palpation may be sensitive to respond in the left part of the abdomen.
When examined with his hands, the doctor puts his fingers behind the cervix, that is, plunges them into the deepest posterior vault of the vagina and lifts the uterus up to the anterior abdominal wall to assess its size, shape and soreness.
It’s a little unpleasant, but it shouldn’t hurt. Remember, if you are relaxed and you abruptly pulled the uterus up and I pushed – it is, of course, will be painful, even clamped, and after the whole inspection will be extremely unpleasant. If this happens, ask for a pause to relax again. After the doctor should grab the neck with his fingers and move the uterus several times to the right and left to assess the mobility and pain of the appendages. The fact is that with the displacement of the uterus in different directions, it is possible to identify local soreness in one side or another, which indirectly indicates a possible problem. For example, in the process of displacement of the uterus, you can clearly say that you have pain on the right, and there is no pain on the left. The main thing is not to confuse the doctor, saying that everything is very unpleasant and when it is over – it is important to help in assessing your condition.
At the next stage there is already a separate palpation of appendages. Appendages called what is located on the sides of the uterus – tubes and ovaries. Since they are, so to speak, located inside the broad ligament of the uterus, the whole structure is similar to the wings of a bumblebee, with the uterus will act as the body of this insect. If the patient has no excess deposition of adipose tissue on the abdomen, the appendages are quite affordable detailed palpation, so the doctor can between the two hands: the upper one through the abdomen and the lower introduced into the vagina – to palpate separately the tube and the ovary. The ovaries, like the testicles of a man, are initially painful even with a light touch, so if you press hard on them, you will certainly be hurt. In addition, in the ovary, depending on the phase of the cycle, there may be formations that make it even more sensitive. For example, the yellow body, appearing in the second phase of the cycle, in fact, is a large bruise on the ovary, so the ovary in which it is located, will be painful, and with the displacement of the uterus on this side will be more pronounced soreness.
A woman’s ovaries are as sensitive as a man’s testicles.
In other words, the pain during the examination can be both a manifestation of the disease and a consequence of indelicate examination, as well as just a physiological change in the ovary. It is clear that in the examination of hands too much depends on the experience of the doctor and his hands, but still there are a few control questions that allow you to make the results of the examination more transparent.
- Doctor, if you say I have inflammation of the appendages, what reason do you suggest? Inflammation can be caused by either chlamydia or gonococcus (IE STD), as well as opportunistic flora. If you come with ready – made tests-smears are good and there are no infections, and you have not had scraping and complicated abortions – the probability of inflammation of the appendages is close to zero.
• Doctor, are you saying that I have adhesions, but I didn’t have surgery, I couldn’t stand chlamydia and gonorrhea, while they have me there?
- Doctor, you say that I have endometriosis – but this diagnosis can only be suspected, and finally confirmed only by laparoscopy. By the way, do I have painful thorns in the back arch?
After inspection of the hands is required to conduct an ultrasound.
All this is very conditional, but at least allow in some cases to ask the doctor the right questions.
Ideally, after the inspection by hands it is necessary to perform ultrasound. Some doctors perform ultrasound immediately, as they own this method of research. I believe that only in this case the examination will be complete. The fact is that without ultrasound in gynecology, it is impossible to make most diagnoses, because examinations in mirrors and hands do not give a complete picture.
For example, without ultrasound it is impossible to assess the ovaries for cysts, you can only find that the ovary is enlarged, and then not always. Without ultrasound do not put adenomyosis, do not see small nodes of fibroids that do not deform the outer contour of the uterus and do not increase its size, and do not identify polyps in the uterine cavity. In other words, ultrasound is the most important tool in the hands of a gynecologist, and everyone should ideally own this tool.
Ultrasound is the most informative method of research in gynecology, allowing to identify ovarian cysts, adenomyosis, myoma and polyps in the uterus.
After the inspection begins the discussion of your situation, and there may be additional “pitfalls”. We are talking about tests and diagnoses.
• If you have a regular menstrual cycle-you do not need any tests for hormones.
- All identified cysts should be reviewed after the next menstruation, as well as polyps (there are exceptions, but, as a rule, it is necessary).
- All the talk about HPV and the horrors of cervical cancer is reduced to the following question: do I have signs of dysplasia in the results of Cytology? If not, exhale and listen to further reasoning quietly. Let me remind you that if colposcopy revealed signs of dysplasia (mosaic, punctuation, atypical vessels), it does not mean anything yet, we are waiting for the results of Cytology.
• When assessing the smear, please accurately diagnose bacterial vaginosis, aerobic vaginitis or thrush. The option “you have there a lot of white blood cells, inflammation strong” do not take.
• If you are offered surgery and you do not have an acute situation (bleeding, severe pain) – do not make any decisions in the doctor’s office. Just listen to his opinion, be sure to clarify the arguments for and against, find out alternative options. Further, already at home, make a decision after studying additional materials, preferably in the English part of “Google”, but it is best to get a few more competent opinions.
If the doctor suggests surgery, never make a decision in the doctor’s office. Study further all the information and get the opinion of the second specialist.
Visit to the gynecologist, objectively speaking – – not the most pleasant occupation. I often hear from patients the phrase: “Why go if nothing bothers?”- and I always try to prove argumentatively that this is a fundamentally wrong statement. The vast majority of gynecological diseases, which in the future will become a serious problem that requires complex, often expensive and often surgical treatment, in the initial stage develop completely asymptomatic. Fibroids, ovarian cysts, polyps, not to mention cervical cancer, do not manifest themselves until very advanced stages. If you follow the logic of “do not care – I will not go”, then your next visit to the doctor will take place only when the disease is already severely launched, and then you will have to go to the doctor much more often, and the problem is much more difficult and expensive to solve.
Many gynecological diseases are asymptomatic.
The female reproductive system is so arranged that it requires constant maintenance, so a visit to a gynecologist should be equated to basic needs, such as personal hygiene. To refuse a visit to a gynecologist because of fear of unpleasant sensations or fear of learning something bad is irrational. The more you do not visit the doctor, the higher your chance to hear an unpleasant diagnosis with a bad prognosis. How to overcome other potential difficulties encountered during the visit, I described above. Knowledge is power. Your awareness will be an effective insurance against unnecessary diagnoses, unnecessary examinations and unreasonable treatment.