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Making the Most of Your Annual OB-GYN Appointment

Monday, April 21st, 2014

Too often, women have a list of questions or concerns in their heads in the days leading up to an appointment with their doctors, only to forget most or all of them once in the exam room. Or, they leave the doctor’s office without feeling they received all of the information they needed. You don’t get a lot of time with your gynecologist, so it’s a good idea to be aware of some strategies for making sure you get as much as you can out of the visit. Here are some tips for making sure you and your doctor communicate well and that you get what you need out of your visit.

1. Know when your last period was. Mark it on a calendar and know the date – your gynecologist needs to know this. If you are experiencing irregular bleeding, a calendar tracking your periods as far back as possible is preferable.

2. For a couple of days before your visit, do not douche (which you should not be doing anyway) or have sex. Both of these things can interfere with the results of your pap test.

3. Bring a written list of all medications you are taking, including herbal supplements and vitamins. Know the doses and names of all of them.

4. Bring a list that you have prepared ahead of time of all questions you want to ask or concerns you want to bring up. Even if there are only a few items on the list, write them down – it’s too easy to forget them during the visit.

5. Ask for clarification. If the doctor says something you don’t fully understand, speak up. If you aren’t sure, repeat it back to the doctor in your own words to make sure you get it. Also ask if he or she can recommend any books or other resources for information on any condition you may have.

6. Be completely honest. Never lie about drug or alcohol use, your sexual history, or any other issues your doctor asks about, no matter how embarrassing the conversation may feel. Not being truthful can lead to a wrong diagnosis or the wrong advice.

7. If you need to discuss a specific problem you are having, take some time to make some notes before your appointment and know the answers to questions such as: When did the problem begin? What have you tried to improve your symptoms? What worked and what didn’t? Has any other doctor seen you for the condition; have any tests been done? What were the results? What makes the problem worse and what alleviates it? Include any information you can think of that might be relevant.

Most women don’t look forward to their annual gynecologic checkup, but it is one of the most important things you will do all year. Following these tips for making the most of your visit can ensure you get the highest quality care possible.

– Yvonne S. Thornton, M. D., M. P. H

Choosing the Right Gynecologist

Thursday, September 19th, 2013

There are many reasons why you might be looking for a gynecologist. Maybe you are looking for a doctor to see for the first time, or maybe things just aren’t working out with your current doctor. Maybe you have moved to a new place and must find a local gynecologist. In any case, this is a decision that should be taken seriously. Friends and family members can be valuable sources of recommendations, but realize that their recommendations are likely to be based on things like whether the doctor is personable and how long they have to wait for appointments, rather than whether the doctor is board-certified or how long they have been in practice.

Board certification is extremely important and a topic that I cover extensively in Inside Information for Women. Terms like “board eligible” or “board active” mean that the practitioner is not board certified. So, the first thing you should check for is current board certification to ensure that you are seeing a qualified gynecologist (or other specialist).

You may also need to check with your insurance provider to make sure that the doctor you are considering will be approved by them. Once you have narrowed your options down to a few conveniently located, board certified gynecologists, see if you can set up a meeting with each one. Your insurance company will probably not cover this meeting, so be prepared to pay out of pocket. If you choose not to set up a preliminary meeting, you can still get some useful information from a receptionist or secretary.

Things You Should Know Before Selecting a Gynecologist

Questions you should ask include how long it takes to schedule appointments if you have a non-routine concern and whether there are times when the doctor can be reached by phone. As this report shows, doctors are busier than ever, so ensuring that the doctor you choose will be available when you need him or her is important. You may want to know where the doctor attended school and completed his or her training. Also, ask which hospitals he or she is affiliated with; this may be especially important if you are planning to become pregnant. Finally, you may also want to know how long the doctor has been in practice. Again, if you can’t meet with the doctor before scheduling an appointment, an administrative person can answer any of these questions.

While the answers to these questions might tell you whether the doctor is competent, they will not tell you anything about your chemistry with the doctor or whether you will like him or her. Keep in mind that a competent doctor is much more valuable than a personable doctor – but if you can get both, all the better. If you really have poor chemistry with your gynecologist, it’s best to make a change – but be sure your new doctor is board certified and otherwise competent and available, not just someone who is located closer-by or smiles more.

– Yvonne S. Thornton, M. D., M. P. H.

Why you MUST get a gynecological exam every year. Period.

Monday, November 23rd, 2009

You may have heard that the American Congress of Obstetricians and Gynecologists (ACOG) has just come out with new guidelines for how often women should get Pap smears. Rather than discussing the details of the guidelines, I want to stress one essential fact:

A Pap smear is not an annual pelvic exam. It’s just one small segment. If you’re over 21, you must still get a pelvic examination each year, every year, for as long as you live. Some years the Pap test will be part of the examination and some years, it may not be. Whether you get a Pap has nothing to do with whether you need to be examined.

You do. Here’s why.

During your annual pelvic exam, your physician evaluates you for many diseases and disorders that have nothing to do with Pap smears or cervical cancer. Among the most critical that your doctor checks for are ovarian cancer, uterine cancer, and vulvar cancer.

If caught early, such cancers are highly treatable. If left undetected for years, as I fear might happen should women skip pelvic exams in years when they don’t get Pap tests, such cancers can be killers.

So, no matter what you’ve heard about the change in the guidelines for Pap smears, the take-away is that this change should not affect your behavior in any way; it’s merely guidance for your doctor.

Get your annual pelvic exam as you have in the past. Let your doctor decide whether the Pap should be part of it every two years or three years or if that particular test is necessary after age 70.

Remember that you’re not going to the doctor for just one test that detects just one type of cancer. You’re going to ensure that you’re in good gynecological health, and to get treated promptly if your doctor finds anything wrong.

– Yvonne S. Thornton, MD, MPH

Why getting the HPV vaccine (Gardasil®) makes sense

Friday, October 30th, 2009

Too often, the Internet is filled with rumors about the dangers of vaccines. And those rumors are typically based on misinformation, disinformation and fear.

That’s been the case with Gardasil® (Quadrivalent Human Papillomavirus  (Types 6, 11, 16, 18) Recombinant Vaccine), the vaccine that protects girls and young women from the human papilloma virus (HPV).  Many people who have HPV may not show any signs or symptoms.  This means that they can pass on the virus to others and not know it. A male or female of any age who takes part in any kind of sexual activity that involves genital contact is at risk.

While all medicines carry some risk, the benefits of being vaccinated against HPV far outweigh the small potential dangers.

A large part of the backlash against this vaccine may be due to an effort by the drug’s manufacturer to make vaccination mandatory.

Do I believe that young girls and women should be forced to get the vaccine? Absolutely not. Coercion would be a mistake. And that attempt by the drug maker appeared, in this physician’s opinion, to place profits above the right to make a personal choice.

But, getting past the bad decisions of pharmaceutical companies, let’s look at the benefits for our daughters and ourselves. We know for a fact that HPV is connected to cervical cancer. And we know for a fact that cervical cancer is a horrible disease.

So, if you can get a vaccine that will largely protect you against HPV, then getting vaccinated is an absolute no-brainer. Gardasil® protects against four types of HPV: two types (Types 16, 18) that cause about 70 percent of cervical cancer cases, and two more types (Types 6, 11) that cause about 90 percent of genital warts.

The HPV vaccine is typically offered to girls and women between the ages of 9 and 26.  Given in a series of three injections (initial vaccine, another in two months and the last in six months).   For adolescents and younger, I would recommend discussing the vaccine with your gynecologist when your daughter comes in for her first gynecologic visit, which should be between 11 and 12 years of age. That first visit is only for an introduction to a gynecologist and a pelvic examination is not performed. It is a “get acquainted” visit and it is then that the benefits of the vaccine should be discussed.  Gardasil® is most effective if you can vaccinate before a woman risks being exposed to HPV … in other words, before she becomes sexually active.

As a woman gets older, her body isn’t as susceptible to the damage of HPV, so vaccinating isn’t recommended.

– Yvonne S. Thornton, MD, MPH

Why it’s essential to offer kids comprehensive sex education

Monday, August 31st, 2009

In a recent study, about half of teens surveyed admitted to sexual activity. It’s a fact of life that adults have to face squarely.

And adults probably would be naïve to assume that the only ones having sex are the ones who are willing to admit to it.

But there’s another factor to consider: kids without access to comprehensive sex education may not know enough to call the sex that they’re having “real” sex.

Consider this finding from another survey, this one of ninth graders, that appeared in the journal Pediatrics in April 2005:

Adolescents evaluated oral sex as significantly less risky than vaginal sex on health, social, and emotional consequences.

That study found that, because of their assumptions about it being less risky, considerably more ninth-graders were having oral sex than were having vaginal sex.

Clearly, we’re failing our children if they believe that oral sex is less dangerous to their health. Oral sex can expose teens to the same sexually transmitted diseases — herpes, Chlamydia, gonorrhea, and HIV — as “real” sex. The only risk they’re avoiding by having oral-genital or anal-genital intercourse instead of genital-to-genital contact is pregnancy.

So why don’t kids know the risks?

Because we adults are not providing them with frank, comprehensive sex education.

We all want to keep children safe and preserve their innocence. But think for a minute — would you hand over the car keys to a child who’s never had a driving lesson? Teens are exposed to a more powerful drive than the one to get behind the wheel. Those raging hormones of adolescence are a biological imperative. We ignore that irrepressible drive at our children’s peril.

As an Ob-Gyn, I see the consequences of inadequate sex education. After years of decline, STDs are on the rise among adolescents. So is pregnancy.

We need to be honest with our children about sex, not because we expect them to be sexually active any more than when we expect them to crash the car when we tell them to buckle up. We must do it to protect them. We would be negligent not to. And, we need to discuss sexual intercourse and all the attendant risks along with the responsibilities before they are teenagers.

Age-appropriate sex education must be available to all youngsters. It must be comprehensive, and include detailed information about homosexuality, heterosexuality, anal-genital intercourse, oral-genital intercourse, and sexually transmitted diseases, as well as abstinence. We must tell our youth the entire story, without flinching or sugar-coating. A child’s future fertility, even his or her life and quality of life can be at stake. If that doesn’t merit giving them the truth, I can’t imagine what does.

– Yvonne Thornton, MD, MPH

Why your Ob-Gyn should be board-certified

Wednesday, July 22nd, 2009

It’s almost impossible to judge a professional’s skills if you’re not a member of that profession. Only a radiologist can say whether another radiologist accurately read a CT scan. Only a dentist can attest to the quality of the crown another dentist fits over a molar.

So how do you, a layperson, judge the qualifications of your doctor? If they drive fancy cars, wear designer clothes, and charge the highest fees in the community, you can be sure they’re successful. But does that mean they’re qualified? You can ask your girlfriends or your sister or mother to recommend someone. You can determine whether you have rapport with a physician. But that won’t tell you about qualifications, either.

If you want to know whether the kind, caring person you select has the minimum qualifications, there’s one way to determine that. Go here to see whether your doctor is board-certified.

Board certification isn’t mandatory. Once a doctor gets a medical degree and a state license to practice medicine and surgery, he or she can practice any specialty. No law requires a doctor to complete a four-year residency in a specialty, such as ob-gyn, in order to be called a specialist. Nothing prevents a doctor from giving him or herself the title of obstetrician or fertility expert or perinatal specialist or really, almost anything.

But only board certification assures you that the doctor has earned that title.

A board certified doctor has gone a giant step further than a physician who hasn’t passed her boards. After completing a residency program, passing a written test in the specialty, and practicing for a year or two, she’s gathered up all her cases and submitted them to an august body known as the American Board of Obstetrics and Gynecology. Before these distinguished university professors and chairs of departments, she’s been extensively questioned about real and hypothetical situations and asked about diagnoses, patient management and treatment.

As an oral examiner for the American Board of Ob-Gyn since 1997, I’ve certified hundreds of new ob-gyn candidates who have proven their capabilities under difficult circumstances. And there were some who did not pass because they didn’t meet those high standards.

So I speak from experience when I say that board certification is the minimum you should expect from your doctor.

Yvonne S. Thornton, MD, MPH

Danish study links hormone replacement therapy to ovarian cancer. Should you worry?

Tuesday, July 14th, 2009

In the news today is a Danish study, published in the Journal of the American Medical Association (JAMA), that indicates there may be an increased risk of ovarian cancer among users of hormone replacement therapy.

While this may sound like scary new information, it’s not actually news. Thirteen years ago, for my masters degree in public health, I wrote my final epidemiology paper on the link between hormone therapy and ovarian cancer.

Other studies link hormone replacement therapy, especially estrogen alone rather than estrogen plus progesterone, to breast cancer and endometrial cancer.

After reviewing the available information, you and your doctor may still decide that estrogen’s benefits outweigh any risk. Or you may want to try a different tactic to alleviate menopausal symptoms. As I mentioned in a previous blog post, other treatment options, including SSRIs and blood pressure medications, may work as well and cause fewer concerns.

– Yvonne S. Thornton, MD, MPH

More media attention for the study

Friday, June 5th, 2009

Forbes reports on my study, showing that obese pregnant women should limit weight gain as does Medline.

Other media outlets giving the study prominent coverage are United Press International, Yahoo News, The Baltimore Sun, US News and World Report, and even the Times of India.

– Yvonne S. Thornton

My study on obesity and pregnancy in the news

Wednesday, June 3rd, 2009

I’m pleased to see that the media is getting the word out: obese pregnant women should be eating healthier diets and limiting their weight gain.

In the past few days, I’ve been interviewed by a number of news organizations about the study. You can see some of the reports at the following links:


The Atlanta Journal-Constitution

Science Daily

The Los Angeles Times

and Health Day

– Yvonne S. Thornton, MD, MPH

When are irregular periods or spotting cause for concern?

Friday, May 29th, 2009

Are your periods coming at different intervals than in the past? And, if so, should you worry?

That depends.

Some women have regular periods every two months. Others have regular periods every 21 days. So, if your periods aren’t on a 28-day schedule, it may not be a problem at all, as long as it’s regular for you. And your cycle’s schedule may change over time. In your 20s, you may menstruate every 30 days, then every 33 days in your 30s. In  your 40s, the intervals could change again. There’s no one-size-fits-all cycle.

If you’re used to getting your period every 28 days and it’s now 45 days without a sign of menstruation, the first thing you should do is to see your gynecologist.  A blood test (not urine testing) for pregnancy would probably be ordered.

But what if you haven’t been sexually active? Ask yourself, what else in your life has changed? Have you been on a starvation diet? Undergone some very stressful event? If so, mention these changes when you discuss your menstrual cycle with your doctor.  The menstrual irregularity may be the first sign of thyroid dysfunction, or other metabolic or endocrine disorders.

The “take home” message here is that you should always be sure to keep an accurate menstrual calendar every month so you can tell your doctor when your period started, when it ended, when you had intercourse, and when you have spotting.

Speaking of spotting between periods, sometimes it’s a sign of a problem but often it’s not. Certain women will spot right in the middle of their cycles, when they ovulate. This sort of spotting can be perfectly normal. There’s even a German name for it: mittelschmerz,  But, if it continues, even in the middle of your cycle or if you’re spotting at odd intervals, like three days after your period ends, it’s time to make a gynecologist’s appointment.

– Yvonne Thornton, MD, MPH