From the Frontlines of the Tia Clinic:
A medical mystery solved: IUD edition
For most people, healthcare is a black box — something misunderstood, feared and to be avoided (until you have to use it). Yet, when we asked our community what they wanted to know about healthcare at Tia, 97% of people told us they were eager to hear real patient stories, and dive into the weeds of what really happens in our exam rooms.
As a care provider who believes that transparency is the foundation for any fruitful patient <> provider relationship, I am excited to introduce “From the Frontlines” — a new series to give you a peek behind the curtain into what it’s actually like to be a patient and provider at Tia.
Through the lens of real patient stories, we’ll dive into the clinical research that supports our “whole women’s health” model, the types of diagnoses we make and treatments we recommend, and how our team of gynecologists, nurse practitioners, naturopaths and acupuncturists actually work together in practice.
A special thanks to our brave Tia patients for their willingness to share their stories in service of education. Names have been changed to protect their privacy.
Meet Sam, 29
Sam came to the Tia Clinic for her annual Well-Woman Exam with a complaint of vaginal burning.
Sam reported that a few months back, another gynecologist treated her for a yeast infection, but the burning continued.
Part I: Health Record Review
In reviewing Sam’s health record ahead of her visit, a few pieces of information stuck out to me as particularly relevant in context of her complaint:
Part II: Physical Exam
Per standard guidelines, I did a Pap smear, which appeared to cause extreme & atypical discomfort. Concerned, I asked Sam about it, who suddenly noted that Paps had been extremely uncomfortable for her the past few years, that she frequently experienced pain during sex, and sometimes, bleeding after sex too — a telltale sign that something was definitely wrong.
Part III: Pap Test Results
Despite the HPV vaccine, Sam’s Pap test results came back with HPV detected — a reminder that while the HPV vaccine protects women from the most dangerous strains of the virus, it is not a silver bullet that protects women 100% of the time, which is why routine Paps are so important! The HPV diagnosis did not explain the “burning,” however…
Part IV: Follow Up Colposcopy
To take a closer look at Sam’s cervix, I followed up with a diagnostic procedure called a colposcopy (or as we call it, a “colpo”)! Not only was her cervix irritated and inflamed, I could see the tip of her IUD, which was NOT sitting in her uterus (where it’s supposed to be), but partially expelled! It became clear to me that Sam’s IUD was too big for her altogether, likely causing the discomfort and burning.
Part V: A Collaborative Care Plan
In collaboration with Sam, we designed a Care Plan to get to the root cause of her complaint:
#1: IUD Removal
Clearly out of place, I removed her IUD immediately. I recommended Sam take a break from birth control altogether to both give her uterus and cervix a rest from chronic irritation, and to see how her body reacts without the progestin. Because she is sexually active, I recommended using the sponge paired with condoms in the interim.
#2: Reassess Birth Control Method
In three months, I recommend Sam comes back for a follow up visit and to discuss longer-term birth control options then — potentially a smaller IUD like the Skyla or Kyleena.
Lastly, I recommended a biopsy to check her cervix for any precancerous changes.Good news — it came back as inflammation without precancerous changes. We’ll do another Pap smear in one year as standard follow up.
This story is a reminder to all women that when something feels wrong, it probably is wrong! At Tia, we look to our patients to raise these concerns to their providers, and to our providers to listen deeply and follow the breadcrumbs — however unusual and ostensibly disconnected they may be — until the root mystery is solved. This, we believe, is the future of collaborative care.
Thank you to Sam for sharing her story!
The Tia Clinic is a modern gynecology and wellness practice in NYC. To learn more, visit www.asktia.com