Dr. Margit Lister with Wasatch OBGYN shares five questions your gynecologist hopes you will ask.
1. Am I overweight?
The easiest way to determine this is to figure out your percentage of body fat. There are several ways to calculate your percentage of body fat, but the easiest way is determining your Body Mass Index or BMI. If your BMI is >25 you are over weight, if it is >30 you are obese, and if it is >35, your percentage of body fat is negatively affecting your health. Another good evaluation is measuring your waist circumference. For women, if you waist circumference is >35 inches, your fat is likely putting you at risk for heart disease. For men, your waist circumference should be less than 40 inches.
Be prepared to get some information that you may not like! This is a difficult subject to discuss with women but a very important health risk.
2. Is there a treatment for urinary incontinence?
Urinary incontinence (or the loss of urine involuntarily) is common in most women’s life at some time. It becomes more common with a urinary tract infection, pregnancy, vaginal delivery, age, increasing weight, drugs, and even a chronic cough. Incontinence that is triggered by urgency symptoms ( you pull into the garage, feel the urge to use the bathroom and you can’t get your pants down fast enough before you are leaking) are usually treated by medications and behavior modifications. Incontinence that is triggered by stress (coughing, laughing, sneezing, jumping) is usually fixed with physical therapy and surgery.
The simplest thing to help with incontinence is strengthening your pelvic floor with Kegel exercises. Up to 40-75% of women can improve their control of leaking with increasing their muscle strength with kegels. The good news, most will improve. The Bad news, if you stop exercising, you loose the benefit.
3. How do I do a breast self exam?
Self breast exams should be done a few days after your menstrual cycle, to ensure that your breasts are less lumpy or tender. If you are no longer having cycles, then perform your breast exam at the same time every month.
There are two parts to the SBE (self breast exam), the first part of the exam is looking at your breasts in the mirror. Place your arms at your sides and look for dimpling, puckering, or redness of the breast skin, discharge from the nipples, or changes in breast size or shape. Your breasts should be symmetrical, if you have a lump on one side you should see it on the other. It is normal to have one breast be slightly larger than the other. Next look for the same signs with your hands pressed tightly on your hips and then with your arms raised above your head.
The next portion of the Self breast exam is the feeling for lumps. Start with feeling your breast with your dominate hand keeping your fingers flat and together, gently feel your breast without pressing too hard in a linear or circular manner. See diagram below. For most women, this is where it becomes difficult to determine good or normal lumps from bad lumps. In general if you are concerned, see your doctor but this is what I teach women.
Feel your eye beneath your eyelid, this is typically what normal breast ‘lumps’ feel like. You feel a lump but the skin skips over the lump and things move easily. Now feel the tip of your nose, here there is a lump but when you feel the lump, it pulls the surrounding tissue and skin. This is what is typical of a worrisome lump. Another good rule of thumb, is recheck the lump in a week, if it is gone, it was normal breast tissue that changed with your cycle.
The next time your doctor does your breast exam, ask him or her, what does my normal breast tissue feel like? By knowing your normal breast tissue, you may save yourself some future anxiety.
4. Why does sex hurt?
Let’s start with sex should NEVER hurt. If it hurts then there is likely a problem. That being said, do you need to run to the doctor even time you have painful intercourse? Not necessarily. Let’s take a few common causes of painful intercourse.
First, a yeast infection can be a common cause of painful or irritating intercourse. This is easily treated with over-the-counter medication and will resolve in 48 hours. Post pregnancy pain is also extremely common. This is caused by the low estrogen levels post delivery (especially with breast feeding), the birth trauma, and slow healing of the vagina. Estrogen supplementation can quickly fix some of this pain, but it will decrease the amount of breast milk that mom produces. So time and patience, is the best treatment for breastfeeding moms. Rest assured, most post delivery pain will completely resolve in 6 months postpartum with no treatment.
Menopause is another example of a low estrogen state where women have vaginal dryness. This can be easily fixed with topical estrogen. You also can buy water-soluble lubricants that help moisten the vagina.
Another common cause of vaginal dryness is not enough foreplay prior to sex. Make sure that your partner knows what sexually excites you. ( Make sure YOU know what sexually excites you!) Sexual lubricants can also help with vaginal dryness during intercourse. For my menopausal patients with vaginal dryness, I encourage an oil base lubricant (olive oil), a little bit goes a long way. If you are using condoms, DO NOT USE oil based lubricants. It will DISSOLVE the condom. You need to ensure that your lubricant is water-based, like Astroglide.
These examples are pain that is at or near the opening of the vagina, you can also have pain deep inside. The most common cause of deep pain is call ‘bumper dysparunia’ or pain as the penis bumps into the cervix, causing the uterus to move. This movement is often painful. This is normal. Just like if you tapped his testicles, he would flinch. There is nothing wrong with his testicles, they just don’t appreciate being ‘tapped’. With deep penetration, the uterus doesn’t appreciate the bump, there is nothing wrong with the uterus, it just doesn’t want to be pushed around. Simple tricks that can alleviate this issue is changing positions; ensure that you are on top to control depth of penetration, tilt your pelvis forward or back, or try a position that does not allow for deep penetration (spooning).
5. Are birth controls that shorten the length of my periods, safe?
Yes! The history behind why birth control pills make you have a cycle every month is two fold. First when they manufactured pills, they wanted to replicate a women’s natural cycle. They did this because women were very skeptical when birth control pills came onto the market. They didn’t believe that they could take a pill every day and this would prevent pregnancy. So, having your cycle every month ensured that you currently were not pregnant. There is no medical reason to have a cycle every month, unless you are worried that you are pregnant.
The benefits of using birth control pills for most healthy, non-smoking, normal weight women far outweighs any health risks. Benefits of Birth control pills include; lighter, shorter cycles, the ability to manipulate or stop your cycles (spotting is common), decrease pain and production of ovarian cysts, decrease in bone loss, anemia, and pelvic infections, it also protects you from ovarian, endometrial and colon cancer, just to name a few. You should not be taking birth control pills if you are 35 yrs old and smoking, have had a personal history of blood clots/stroke, uncontrolled high blood pressure, or unexplained vaginal bleeding.
Dr. Margit Lister is an OBGYN with Intermountain Health Care. If you would like to schedule an appointment, visit: www.intermountainclinics.org.