Wellness

What's Not Normal (And What Is) When You Go To The Gynecologist

Some occurrences at your doctor's office aren't just "weird" -- they're wrong.
07/09/2018 12:42pm ET
jenjen42 via Getty Images

Dr. George Tyndall, a full-time gynecologist on staff at University of Southern California’s student health clinic, repeatedly engaged in sexual misconduct while treating patients, according to a Los Angeles Times report published in May. Administrators were fired for mishandling the complaints against Tyndall, but significant damage had already been done: More than 25 former patients relayed their stories to the Times, and over 400 more called a USC hotline to report wrongdoing after the initial article came out.

Many of the young women who accused Tyndall of misconduct had something in common: They didn’t know what was (and was not) supposed to happen during a gynecologist visit.

Former USC student Chelsea Wu told the Times that Tyndall asked probing sexual questions and made uncomfortable comments about her body while his fingers were inside her.

“I thought it was normal,” she said. “Being so young, I didn’t have a framework for what was acceptable.”

Having such a framework, and walking into your OB-GYN’s office knowing what to expect, can help prepare you in case you encounter something unexpected ― and wrong.

How Your Doctor Should Address You

A visit to the gynecologist should be thorough and methodical. Like a visit to your primary care doctor, a nurse will likely check your height, weight and blood pressure. Then the OB-GYN will start the exam by asking some general questions, said Dr. Sigal Klipstein, a former chair of American College of Obstetricians and Gynecologists’ Committee on Ethics.

“The physician should ask the patient if there have been any changes to her health since they last met,” she said. “They should also ask the patient about her general health, ask about any concerns she has, inquire about any recent potential exposures to sexually transmitted infections and ask about any problems with bleeding.”

“Listen to yourself, and ask any questions you may want to ask. If your doctor shuts you down or dismisses you at any point, that’s not the doctor for you.”

- Dr. Mary Rosser, assistant professor of obstetrics and gynecology at Columbia University Medical Center

Once you and your doctor develop a rapport, he or she will probably ask a little more about other concerns that might affect your care, including whether you have reproductive concerns or want to talk about birth control.

“Once we’re in conversation, I may inquire about substance use in a nonaccusatory manner,” Klipstein said. “Deeper into the conversation, I may inquire about any depression, anxiety or mood-related issues.”

Your doctor should then explain the rest of the appointment to you, and maybe even show you the speculum if it’s your first time having an exam. He or she should also ask if you have any questions, Klipstein said.

The interview is typically done while you’re fully covered, said Dr. Mary Rosser, an assistant professor of obstetrics and gynecology at Columbia University Medical Center.

“Listen to yourself, and ask any questions you may want to ask,” she said. “If your doctor shuts you down or dismisses you at any point, that’s not the doctor for you.”

fstop123 via Getty Images

The Proper Routine

Your doctor should take your needs and background into account.

For example, Rosser said she is pretty thorough in her check-ups because she’s often the sole physician for female patients on college campuses.

“I’ll check their lung and hearts, ask about the bladder health,” she said. Like many doctors, she may also do a breast exam and teach her patients how to do a monthly self-check if they’re unfamiliar with the routine.

You may only have the external genital exam at your first appointment. “In this exam, the doctor looks at the vulva,” Klipstein said. “They may give you a mirror so that you can look at the vulva, as well. This exam is a good way to learn about your body and the names for each part.”

Your OB-GYN will then move onto the pelvic exam ― which involves checking the vagina and cervix with a speculum ― if you need one. (You won’t need a pelvic exam on your first visit if you’re under age 21, unless you have issues like abnormal bleeding or pain.)

“When you have a Pap test, your doctor will take a sample of cells from your cervix with a small brush,” Klipstein said.

Lastly, your doctor will check the health of internal organs with a gloved hand.

“The doctor will place one or two gloved, lubricated fingers into the vagina and up to the cervix,” Klipstein said. “The other hand will press on the abdomen from the outside.”

The whole thing should take five to seven minutes, Rosser estimated.

“If you’ve had a difficult time with some aspect of the exam in the past, this should be conveyed to the physician at the start of the visit. It’s important that women feel comfortable and supported.”

- Dr. Sigal Klipstein, former chair of American College of Obstetricians and Gynecologists’ Committee on Ethics.

Most doctors will walk you through the exam verbally as it’s happening. He or she should also ask you if you’d like a chaperone, nurse or medical student in the room during the exam, Rosser said.

The exams can be a little unpleasant, for obvious reasons, but don’t be afraid to ask for what you want.

“I use a narrow speculum on almost all my patients,” Rosser said. “You can also ask for the smaller one if you’re concerned, or that gel be used before insertion.”

She also recommended taking deep breaths while you’re on the table. You can request your doctor be more vocal about what he or she is doing, too.

If you’re seeing a new doctor and you’ve had a pelvic exam before, bring up any concerns before the exam starts.

“In particular, if you’ve had a difficult time with some aspect of the exam in the past, this should be conveyed to the physician at the start of the visit,” Klipstein said. “It’s important that women feel comfortable and supported.”

OKrasyuk via Getty Images

What’s Not Acceptable

The majority of physicians take your health, comfort and safety very seriously. However, it’s vital to know what’s not normal.

First off, know how much touching to expect.

“Examinations should be performed with only the necessary amount of physical contact required to obtain data for diagnosis and treatment,” Klipstein said. This means the doctor should follow appropriate procedure, like that laid out above, and explain what he or she is doing.

Klipstein said you should “feel empowered” to stop the appointment at any time, especially if you’re denied a chaperone or have other concerns about how the exam is being conducted.

“I always say that you are the best advocate for yourself, so you have to listen to your own internal voice. If you’re not sure that something’s right, then it probably isn’t.”

- Rosser

Rosser said photos of your genitals should never be taken during an exam, unless, in very rare circumstances, you’ve been notified well in advance and signed proper documentation.

After your exam, if you feel like something was off, speak out.

“Talk to your friends,” she said. “Sometimes, speaking to your girlfriends can give you the best idea of what’s healthy and what’s not.”

Above all, don’t doubt yourself. If you’re in school, Rosser said you can talk to a counselor or trusted adviser; you can also report complaints to hospital administrators.

“I always say that you are the best advocate for yourself, so you have to listen to your own internal voice,” Rosser said. “If you’re not sure that something’s right, then it probably isn’t.”

100 Ways To De-Stress