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Lasso of truth

6 warning signs you’re seeing the wrong gyno

As a doctor, I appreciate that I am at an advantage when I seek medical care. Knowing terminology and basic medical principles helps a lot. In addition, when you’ve been practicing medicine for a while you get a feeling from how a doctor discusses options if the care seems valid or if a second opinion is in order. Other things I look for are board certification and a doctor who explains their treatment plan in the context of recommended guidelines.

Summarizing everything that combines to make good medical care is very hard. However, from time to time I take unfortunate histories from patients or hear stories of medical misadventures from friends and I just cringe. Actually, they make me want to shout, “Your doctor did/said what!?!?!!” These are red flags, because not only are these recommendations potentially harmful, but if your doctor recommends one thing that is so flagrantly bad, well, uh, um, how can you trust the rest of their care?

So, these are six red flags that would make me stop and not pass go. They would make me get up, get dressed, and say, “Thanks but no thanks,” and walk out the door looking for a second opinion:

1) A prescription for estrogen containing birth control (pills, patch, or ring) with no inquiry about migraines. Why? Migraines with aura are an absolute contraindication to estrogen containing birth control (do to an increased risk of stroke) and if your doctor were up to date on the WHO/CDC guidelines he/she would know that. I want my doctor to be up to date on guidelines, you know?

2) Blaming pelvic pain on pelvic organ prolapse. Prolapse is not a cause of pelvic pain. It causes a bulge, it causes a feeling that something is coming out of the vagina, but it does not cause pain. Any doctor who thinks that the two are related knows nothing about prolapse and even less about pain. And if they want to operate on your prolapse to fix your pain don’t walk out of the office, run.

3) Getting booked for incontinence surgery without a bladder diary (basically measuring everything that goes in and out for 48 hours) and a post void residual (a test to make sure you are emptying your bladder correctly). This simple diary and test can distinguish people who can (and can’t be helped by surgery) as well as indicate some people who could even be worse after surgery.

4) Having concerns about pain with sex dismissed. Painful sex, called dyspareunia, is not normal. Let me repeat that: sex should not hurt. If your doctor doesn’t know that or doesn’t care, move on until you find someone who will listen to your history and do an appropriate exam. There are a multitude of medical conditions that cause painful intercourse and not one of them is, “It’s all in your head.”

5) Getting a prescription for fluconazole (Diflucan) but you also take a statin drug for high cholesterol. These two medications can interact in a fatal manner (rhabdomyolysis) and should not be given together. Especially for a routine yeast infection. In the RARE circumstances where I have a patient with yeast who can only be treated with fluconazole (it’s pretty rare, because there are other options for a yeast infection) I stop the statin, but I really prefer to use something else.

6) Being told your pelvic pain is due to pressure from fibroids. FIbroids are benign tumors of the uterine muscle and they do not cause chronic pain (sometimes when they outgrow their blood supply, they degenerate and that condition is acutely painful, but you can usually pick that up with imaging studies and it’s not chronic pain). Fibroids can cause irregular and or heavy bleeding, but they don’t cause pain. A large fibroid uterus would be 1 lb (most are much smaller, although they can certainly be bigger). If a one pound uterus caused severe daily pain how could pregnancy ever be endured? Think about it.



9 thoughts on “6 warning signs you’re seeing the wrong gyno

  1. I saw 12 medical providers for my personal gynocological disaster. I was suspected of having chronic yeast infections. I was told I’d have to live with literally no skin on my vulva. That there was nothing to do. I was passed back and forth until I got a nurse practitioner that prescribed estrogen cream on the “feeling” that I had low estrogen levels, without ever checking my estrogen levels. For six months I saw this woman once or twice a month while she never once cultured me to see if I did have a yeast infection or not. She put me on boric acid tablets, the one day OTC yeast creams (used weekly despite the fact that they ripped my skin off.) This was all at the same time, too. She put me on BCPs despite my being surgically sterile, because that should help my “estrogen problem”.

    Through it all she said gems like, “You know, women that have sex and orgasms don’t have this problem.” How are you supposed to have sex and orgasms without skin on your vulva?!

    It wasn’t until I got to a specialist at the University of Washington, that I got a real diagnosis. He took me off all the crap. Turns out I have no estrogen shortages. Boric acid tablets made my problem worse. I had a massive yeast infection on top of lichenification, and so many open lesions they were horrified in the office. In six months time, I was back on my feet and returning to normal.

    It wasn’t easy to find doctors that gave me the time of day. I got treated like I was some hysterical woman for complaining. I got told I had to live with it. I spent thousands of dollars going from doctor to doctor to doctor. I was lucky, I am a nurse. I knew what was happening to me was not normal. I knew my way around the medical system. If I hadn’t, I don’t know what I would have done.

    Posted by Ethical Cannibal (@ethicalcannibal) | July 14, 2012, 4:31 pm
  2. I was already pretty sure I loved my gyno. Thanks to this article I’m even more convinced that he’s awesome.

    Posted by Kristi G | July 14, 2012, 5:02 pm
  3. Can I add one?

    If. when recounting your horrific and debilitating periods, your gyno responds with something like:

    You think yours are bad? Ha! Mine are so awful that…


    It took finally getting a male gyno to find out I had endometriomas in my lungs and gut, and on my kidneys, bladder, ovaries and around the base of my uterus.

    14 years of screaming agony, ugh?

    Posted by boostick | July 15, 2012, 2:24 am
  4. These are useful, but limited suggestions. First, limited to only a few specific gynecological conditions, and second too narrow in their scope. I have a close family member whose primary care doctor routinely directs her to take supplements typically only found in “health stores,” or as I like to call them, quackporia (singular: quackporium). This to me is a gigantic, billowing, iridescent red flag, but she cannot be persuaded to fire him. I once had a doctor order an MRI for what seemed to me like a classic torn muscle. (My primary care doctor assured me that this was, as I suspected, unnecessary.)

    My examples illustrate a point: It seemed like there should be more signs, which fall into the category of more-general-yet-less-obvious which would be useful and informative to a broader audience. A doctor who routinely “prescribes” supplements, orders unnecessary, costly procedures, misdiagnoses repeatedly, and badly (I once had a doctor diagnose eczema as scabies).

    Posted by TGAP Dad | July 15, 2012, 11:24 am
  5. I miss my OB/GYN practice in the city I lived in when I got my IUD. All the doctors were fantastic, listened to me (“Yes, a 16-day cycle is not normal with your history, we can get you in tomorrow”), were compassionate and understanding about my pain issues, started with simple measures before recommending stronger treatments, and trusted my judgment about getting the Mirena IUD at 23. The one downside was having to fight their horrific hellbitch of an office manager to get my own medical records. But hey! They got my insurance to cover the IUD!

    Posted by gop360 | July 16, 2012, 11:34 am
  6. Very nice post. I just stumbled upon your blog and wished to say that I’ve really enjoyed surfing around your blog posts.

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