Ask Me A Question. Please.

Rebecca Levy-Gantt

Looking through any social media, it seems obvious that it is a common method of seeking information to “crowd-source” in various on line groups, looking for answers to medical questions from random internet strangers. I often wonder why these curious information-seekers do not ask their health care providers for the answers to their medical questions, yet instead trust the word of complete (often ill-informed) readers to tell them what to do.

“How do I know I’m not pregnant?”

“Have any of YOU had this same thing happen to you?”

“What should I take for my (headache/dizziness/chest pain/bleeding problem)?”

I have come to realize that it is possible that many people either do not have a trusted medical professional (like in the “olden days” where your family’s doctor was familiar, available, and close-by) to ask their questions to, or they may be too embarrassed or too anxious to approach a medical professional with the questions they really want to ask. I often hear that the business of medicine now seems so impersonal, so automated, and so rushed, that it is difficult to feel connected to a doctor, let alone feel that he or she has the time or the inclination to do more than just your (barely) basic medical care.

So I have decided here, to answer, pre-emptively some of the questions that I see posed multiple times in social media groups — -some of the same questions that many patients come in and ask ME, which I DO have the time to answer — to explain — We have a consultation, we discuss — -I draw pictures, and I send people home with written pamphlets and information, so I can be sure they leave with the understanding and the knowledge to participate in their own health care. Here are a few of the most commonly asked questions:

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How do I know I can get pregnant? Actually, you don’t. IF you are of reproductive age- roughly between 14 and 48 — and having a menstrual cycle that comes with exact regularity, (meaning from Day 1 of one period, to Day 1 of the next one, there is a regular interval of 28 days — or 26, or 30 — but always the SAME interval) then it’s a good assumption that you are fertile. No guarantee, but a regular cycle is a sign of regular ovulation. Ovulation generally takes place 14 days before the start of the next period, so if you are looking to become pregnant (or, to avoid pregnancy) the likely time that you want to focus on is then — a three day window of fertility monthly— so count backwards from the next expected period, and there you have it. Even using an ovulation predictor kit is not a guarantee that you are fertile. It measures a hormone that is supposed to surge 24 to 48 hours prior to ovulation — so if you get a positive test, it means you are likely going to ovulate 24 to 48 hours after the positive…..but you may not.

— -What is the best way to prevent pregnancy? Besides the absolute obvious answer of abstinence, birth control, used correctly and regularly, is the best way to prevent an unwanted pregnancy. Although no method other than abstinence is 100% effective, the effectiveness of various contraceptive methods are directly correlated with how little one has to do to be sure that the method is working. Long-acting methods — IUD’s (which are inserted into the uterus) and Nexplanon (a one rod implant that gets inserted under the skin of the arm) are some of the most effective methods out there — for the simple reason that once they are IN, they do not rely whatsoever on you — to do anything — to be sure they will work. On the other hand, a birth control pill or a patch — or a condom, for that matter — rely 100% on the ability of the person seeking the contraception to use it properly for it to work as an effective contraceptive method. Correct and proper use leads to a more effective contraceptive. Improper or irregular use leads to less effective contraception, and therefore more unplanned pregnancies — -not from failure of the contraceptive, but from failure on the part of the user. Know yourself — if you are not the type of person to take a pill daily at the same time every day, the Pill is not for you.

— -Why are you not doing my Pap smear every year anymore? Pap smears are screening tests for cervical cancer. We do Pap smears with some regularity on all women between the ages of 21 and 65, and often also do a test for the HPV (Human Papilloma) virus, which is the virus that causes almost ALL cases of cervical cancer. Although guidelines are changing, currently we do Pap smears based on individual and personal guidelines. IF you have always had normal Pap smears, and have never had HPV, and are currently in a monogamous relationship (meaning there is no new partner to give you HPV, which is sexually transmitted) then you do not need a Pap smear every year. We may do it only every three years or even less frequently, depending on your individual circumstances. How often you have a Pap smear depends on your individual circumstances, based on relationship history, bleeding history, infectious history, Pap smear history, and whether your immune system is healthy. Make sure your health care provider has all of this information about you — -even if they don’t ask — — so you will get your Pap smears done at the appropriate interval. Just doing it every year “because it was always that way in the past” does not make sense.

— -What is the best way to stay healthy for the long term? The studies all show it — the evidence shows it — -the BEST way we know of to live longer and healthier is to EXERCISE. Get moving. I don’t mean “I walk my dog” moving. I mean follow the guidelines of the Department of Health and Human Services, to do at least 150 minutes (yes, that is 2 hours and 30 minutes) of cardiovascular exercise per week(running, speed walking, dancing, swimming, biking, etc) that is moderate in intensity along with at least 2 days a week of strength training, working all major muscle groups. Period. No excuses. Evidence even shows that if you start exercising before age 60, even if you never did before, there will still be great benefits to your heart and your general health for the rest of your life. Other things that go along with this to stay healthy for the long term are to cut down on alcohol (did you know that more than 3 five-ounce glasses of alcohol per week increases your risk for breast cancer by 16%?), and aim for higher protein, lower sugar and lower processed food in your diet. I don’t believe in severe restriction diets, nor cutting out entire food groups — but aiming for an overall healthy diet (think Mediterranean) along with regular exercise is a great way to start off the new year!

— -I want to have an all- “natural” labor and delivery — isn’t that better? Better for who? If you believe that feeling every contraction and labor pain, and feeling every moment of the baby emerging from your body is somehow better for the baby — -you are wrong. There is no medical evidence that says that a mother getting an epidural for pain relief is somehow risking the baby’s health or well being. If the pain of active labor contractions is somehow something that you have decided that you want to feel, I am not here to stop you……but please don’t think that there is some benefit that the baby will get by you suffering. In my (25+years) of experience taking care of mothers and delivering babies, it has always been clear to me that the happiest mothers — the ones who actively participate in, enjoy, and fondly remember their deliveries (instead of just praying for it to be over) were the mothers who did not have endless hours of suffering along with painful hours of pushing, and then the discomfort of a tear that had to be repaired while trying to get just the right amount of local anesthesia injected into a very sensitive area. Some women have quick labors and push three times and the baby is out — — but if that is NOT in the cards for you, please make your decision on whether to be comfortable based on what YOU want your experience to be, not on some false notion that you are doing your baby harm by your decision to choose comfort over pain.

— -I can’t get Herpes from a partner who does not have a current herpes lesion, right? No — — wrong. If someone has herpes (and yes — -there are even people who are unaware that they have it), they usually have periodic (from every week- to every few months — or years) outbreaks where there is a very definite pattern of events. They feel a “burn” or a tingle or an itch in the area, and then some blisters form in the area, which are usually quite painful. The blisters eventually burst and then scab over, and then go away. If there is any sexual or skin-to-skin contact from the time of the “tingle” to the time all the blisters have scabbed over, that is the most likely time to transmit the herpes virus to a sexual partner. However, studies have shown that even if there is NO tingle, NO blister and NO sign of a herpes outbreak, 50% of people can still be shedding virus in the area, and can transmit Herpes to someone else, especially if there is a break in the skin. This is how people get the virus, have symptoms (btw, the most classic symptom is having a “sore spot” on the genital area, which burns when urine passes over it) and end up in my office wondering HOW THIS COULD HAVE HAPPENED, since they are either sure they did not see any sign of the virus, or their partner swore that they did not have it. It happens. Safe. Sex. Always.

— -What is that thing/growth/skin tag/extra skin/hard spot that I am feeling down there? I don’t know. But I will remove or biopsy anything that is in the genital area that does not belong there. If there is something new that was not there before, or something that was lighter but then got darker or changed colors, or something that is suddenly bothering you or painful — -by all means, show it to someone who can advise you. Vulvar cancers are rare — but I have removed many growths/moles/skin tags from this area, and even when they look like the most benign of birth marks, they have sometimes been a pre-cancer or something frankly cancerous. It is not an area that can easily be self-evaluated, and it’s usually not a sun-exposed area, so you cannot write off a new growth to a “sunspot” or a birthmark. There are all kinds of variations in the normal texture and architecture of the genital area — but someone who knows what they are looking at and what to look for can best advise you what the next steps should be — and biopsying anything questionable should be a part of the plan.

— -Why does it hurt when I have sex? There are so SO many reasons for this. It can be anything from an uncomfortable position, to an infection, to an injury or an anatomical problem in the area, to lack of lubrication, to lack of Estrogen, to a bladder problem, endometriosis, and at least 3 or 4 other things I can think of. The important thing is not to treat one thing if it’s really something else — so see someone, have an exam, give an accurate history of the problem, and have a health care provider treat whatever is causing the pain. Some problems require only a quick fix, like the right lubricant (My favorite is actually UberLube — try it!!) and other things require much more investigating and a longer-term solution. But this is too important a problem to let it go without some expert help to solve it.

When I see women on social media outlets asking earnestly for advice, my first inclination is to answer them — because, after all, I am likely to know the answer to their question, or at least I may be able to direct them to some resources to get answers. But I quickly understand that no matter how well-intentioned, answering one question leads to many many more questions — requiring more detail, more explanation, and creating more worry and doubt, as I have no trusting relationship with these women. Why should they believe what I have to say?

I’ll save my answers for my patients — — and the readers of my articles…..and, one day — — for my book.

Rebecca Levy-Gantt

Written by

An Ob Gyn physician in Napa California, who has been practicing for 20 years. Also a writer (blogger, memoirist, advisor, humorist).

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