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Let me explain to you why I know about more than just the vagina.
Tag: vagina
Please, just leave the pelvises to me.
Hey there folks. Dr, Katz here. I have been an Obgyn for the last 28 years. I have delivered thousands of babies. I have performed thousands of surgeries. I have done thousands of paps. All of these things are essential parts of the specialty that I was specifically trained for. I was also fortunate enough to have gone through residency at a time where Obgyn was temporarily reclassified as primary care so I also have training in internal medicine, er, icu, pediatrics, and family medicine. As a result, I know how to diagnose things outside the scope of regular Obgyn practice, but, at the same time, I realize that I am not the expert in those areas so I know when to refer when necessary.
Sometimes, I feel like the same does not apply to obgyn care. There are a lot of family physicians and internists out there that still do the occasional pap when they have to or if the patient does not want to visit an actual obgyn.
Most of the time you get lucky and the pap would have been normal regardless so no harm done. But, then there are those other times when the patient has been getting “normal” paps for years by their family doctor and then they come and see me and actually have an invasive cancer that could have been caught earlier. Thank goodness these times are rare, but they happen nonetheless and are preventable.
To me, this says don’t dabble. You are potentially putting someone’s life at risk, even if unintentionally. I know that a lot of people think that doing a pap is a no brainer and that is the complete story as far as Obyn. I tell ya. It’s not true. There is an art to it from the performing of the procedure without harming the patient and actually knowing what you are looking at and being able to pick up on the subtlest of cues that something is off. Obgyn stuff is that sneaky. You usually don’t get any symptoms until something is already bad. Then, it can be too late. However, if you just stop into the Obgyn once a year, a lot of that is both preventable and/or treatable.
I know how to treat blood pressures and treat a multitude of various diseases, but I know I am not the expert so I refer appropriately. I think that every patient needs a primary care physician and an Obgyn because they both care for different necessary aspects of health. I think that both are necessary to achieve total health and well-being. I think we are different specialties for a reason. All I’m asking is, please leave the vaginas and the pelvises to me. I promise I won’t let you down.
Dr.Katz
“I don’t mean to overshare, but”…..the words every Obgyn loves to hear.
What does it mean to overshare? To overshare is to reveal an inappropriate amount of detail about one’s personal life. I think it is somewhat subjective to determine just what is inappropriate. I think it’s different for everybody and even somewhat situational. In my profession, it is just a way of life.
I just heard these words the other day. “I don’t mean to overshare..but”. I am never sure what the point is of leading with that statement. Does the patient expect me to be shocked? Ask them to refrain from saying what they were going to say? Heck no! My usual reaction is to just buckle up and lean in closer. I can’t wait to hear what they have to say. Usually it is something pretty juicy and intimate….my orgasm was mind blowing from that treatment you did, I had the best sex ever after I started that medicine, a very personal description of a vaginal sensation, etc, stuff like that.
Why worry about saying stuff like that? If you can’t tell the gynecologist stuff like that, who the heck can you tell? My very profession is all about oversharing. It’s not like you can just blurt out stuff about your pelvis just anywhere. But you can here! The best way for me to help you with any of your concerns is to know everything!…every…last….detail. There is nothing embarrassing about it. If you tell me everything, we can either celebrate it or get to the bottom of the problem together. It is a win win. So, c’mon. Let’s start sharing.
Dr. Katz
It really isn’t supposed to smell like flowers, cake or pie down there.( To douche or not to douche)
Say it with me…feminine…hygiene…products. Whenever I hear a patient say,” Eww. It smells like vagina down there,” I find myself wondering well what the heck is it supposed to smell like for chrissake? It SUPPOSED to smell like vagina….BECAUSE IT IS A VAGINA! C’mon people. Let’s get real here. I would just like to know who first started the trend of convincing women that it shouldn’t.
Let’s go over a few vaginal facts and a few feminine hygiene product facts. Spoiler alert! They are not actually good for you! I am going to attempt to rationally explain why so bare with me please. What you choose to do with this information is completely up to you, but don’t say I never tried to save your hinterlands from ruin.
OK. Here we go. We all know that feminine hygiene products have been around for what seems like forever. I am talking decades at least. There are wipes, washes, deodorants, douches, creams, sprays, etc. You name it. We’ve got it. Everyone of them is geared toward reducing odor, using after intercourse, or cleaning up vaginal discharge. Did you know that there was a study in 2006 that reported that most women start using douches or feminine washes in their teen years, usually between 15 and 19 but some start as early as 10 years old! Whoah. There are mixed results demographically regarding whether Black and African American women tend to douche more than White and Hispanic women. Some studies say yes. Some say no.
You can see how the advertising gets you. Who hasn’t seen a commercial or a ad about getting rid of period funk or that not so fresh feeling? This kind of marketing can easily make some women ashamed of their own natural odor and set up an unrealistic expectation of some flowery fresh scent that is supposed to be down there. It is just one more way that we are potentially messing with a healthy self image. I am not on board with that. I think I have even found some of that stuff in my daughters’ bathroom!
Let’s talk next about what the biological environment of the vagina and vulva are supposed to be like. Vaginal ph changes throughout the lifetime of a woman. Usually during reproductive years, the pH ranges from 3.8 to 4.4. This range is essential because it allows the normal bacteria of the vagina to flourish. Bacteria called Lactobacillus are supposed to be there to protect it. Well, the pH balance in feminine hygiene products, regardless of what they tell you, is widely variable and usually contain ingredients that make the vagina way too acidic. We have studies that show that these products start wiping out the Lactobacilli within 2 hours and can even eliminate them all together by 24 hours! When this happens, an inflammatory reaction occurs because a substance called interleukin-8 starts increasing because the normal healthy bacteria are not there to stop it. This potentially leads to a much more wide varied growth of different bacteria, which in turn leads to bacterial vaginosis, yeast infections, urinary tract infections, generalized itching and discomfort and even a greater risk of sexually transmitted diseases. A lot can happen when we get rid of the vagina’s natural defense system. On top of killing all the normal bacteria, the chemical in some of the products actually breaks down the vaginal wall. Here’s a kicker on top of that. Once women start having itching or discomfort from the products, they think they need more product to stop the itching! It really is a vicious cycle.
This is the last thing that I would like you to think about. Once you have damaged the vaginal environment, it can be very tough to impossible to restore it. Most research indicates that it will require at least two weeks after the last time a woman used an irritant to get any relief. Let me tell you, that is a rough two weeks without out much recourse available. Those are my patients that end up coming in chronically miserable and there is not a lot we can do but wait for all of the product to leave their system.
Listen, I am not about to call out any products by name but I am telling you that I am not a fan of anything out on the market right now. You never know, new items may come out in the future that are more conscientious of the natural vaginal flora. But, in the meantime, I advise you to just say no!.
Dr. Katz
Man! It’s hard to feel sexy when you have cancer.
Picture the scene: Your partner gives you the let’s get frisky look. They start petting you in the way you are normally into. The sexy dance has started. The lights are dimmed aaaaaaand……nothing. You are laying there all bald and post chemo( well it has been a few days but you get the idea), fresh off your latest chemo hot flash, tired, bloated and not the least bit sexy….in your mind. You just aren’t up for it. It’s not you. It definitely isn’t your partner. It’s the freakin absence of sexiness that sometimes comes with cancer and chemo. I tell ya, the changes in appearance alone are a real confidence killer at times. My husband is the most amazing partner and best friend on the planet and regular me can’t get enough of him. But, cancer me is another story.
Cancer and cancer treatment can have a very significant impact on a woman’s sexuality in many ways. Disfiguring surgery may be required that can significantly affect your self esteem and confidence. Treatments can sometimes put you into premature menopause with hot flashes, vaginal dryness, pain with intercourse and decreased libido. Certain pelvic cancers require such extensive surgery, radiation, etc that a woman is left without proper function of her sexual organs permanently.
I get it, this sounds all doom and gloomy. The good news is that not all women are left with permanent sexual dysfunction after cancer. Sometimes the effects are temporary and things go back to normal when treatment is over. I am seriously hoping that I fall into this category.
Fortunately the data shows that if a woman was able to have satisfactory sexual experiences before cancer, she will be able to again. The American Cancer Society has a whole section of helpful tips and information for women who are having sexual issues resulting from cancer treatment. Some of these are in fact very helpful. The bottom line of all of them is that sometimes you have to get creative and you have to reinvest in your own self-love and confidence. Sometimes the same techniques for sexual satisfaction that you used before will not be successful anymore. You might not even have the same parts anymore. You may have to use more lubricant when you didn’t have to before. You may have to explore different things that excite you. You may require a vibrator for extra stimulation. You may need to try different positions. You may need to employ more fantasies into your sexual relationships. You may need dilator therapy to re-stretch the vaginal canal. These are just a couple of examples.
There is an interesting set of exercises recommended by the American Cancer Society for patients feeling anxious about sex and the way that their appearance has changed and adjusting to those changes. They suggest looking in the mirror, dressed at first, and noting the changes in your appearance: your surgical scars, ostomies, missing parts, etc. Then notice what you try to avoid looking at. Then while dressed, try to find three things that you like about your appearance. Once you are comfortable looking at yourself as a stranger might see you, then change the exercise and repeat it with you being dressed “sexy” for your partner. Finally, repeat the exercise nude with the same steps until you are able to look at yourself and adjust to the changes and feel comfortable. Don’t stop until you can give yourself 3 compliments like you did in phase one of the exercises.
The last thing to address regarding the impact of cancer on sexuality is the anxiety that goes along with it. It takes time to realize even when treatment is over that you are actually better and that life can go on, including sex. Clear communication is the absolutely paramount here. Talk openly with your partner about your fears and issues. Don’t leave them in the dark and just reject them. They can’t possibly understand what is going on in your head unless you tell them. Get therapy if you need to. Talk openly with your doctors. You be the one to bring it up. I can tell you right now that most physicians are not comfortable enough to make sure to address sexual issues at any time, much less with their cancer patients. This will be something that you really need to take charge of and advocate for if you want things to change and improve. As much as we try to deny it at time, our sexuality and sexual health are key components to our relationships and overall health. Sex is just as important for cancer patients as it is for every day folks. So, do what you can to preserve it. It’s for your health!
Dr. Katz
What do you look for in an obgyn?
This question actually has multiple answers and is a more complicated process than selecting a primary care physician. The usual selection criteria apply of course: 1) Is the doctor in your network? 2) Are they local and easy to get to? 3) Does their availability(office hours) fit your availability? 4) Do they have good reviews? 5) Do you know anyone personally in your family or friend group that already sees them so that you can get firsthand feedback?
These are good to go by when attempting to select any physician, bearing in mind that reviews on google can be written by anyone anywhere, even if they have never been in the office in question. Having family feedback is good as well, provided that you know the whole story surrounding their comments. ( i.e Grandma Martha hates Dr. X, but also has multiple no show appointments and owes the office a lot of money that they are rightfully trying to collect) You see what I mean? Even the seemingly best source of information does not compare to your own personal experience.
Having clarified all that, I feel that selecting an obgyn adds yet an additional level in selection complexity. Finding the right obgyn means finding someone with a communication style and listening skills that make you feel comfortable enough to discuss some of your most personal and potentially embarrassing issues. I mean, you can’t go discussing your vagina and hormones with just anybody. Hopefully you are able to find somebody that listens and “gets you” at the same time.
This is the kind of thing I strive for the most….the listening part I mean. It is so so important. Many of the women that I see are frustrated because they have spent years dealing with unresolved issues because they either did not feel comfortable mentioning them to their previous physicians or they were dismissed. This should never happen. Every single patient deserves to be listened to and, in my opinion, if they have an issue that you are not prepared to deal with, they should be referred onward to someone that can. The patient should never have to suffer due to your lack of comfort or familiarity with their particular problem.
I received a compliment once from a patient that I did not understand at first, but now I consider it one of the best compliments I have ever gotten. She said that coming to my office was like coming to a girlfriend’s house. At first I thought, what the heck does she do at her girlfriend’s house? My face must have registered my confusion for a minute because she went on to explain what she meant. She meant that I was able to make her so comfortable at my office that she was able to disclose and discuss anything and everything that she wanted to. That is my job, my sacred mission, and what it’s all about. Have a great night everybody!
Dr. Katz
I received this amazing video from two of my patients.
I received this amazing video from two very special patients. I just had to share it with you.