Gynecological Health: What every woman should know and how to talk to a praciticioner about it

Most women know monitoring gynecological health requires monthly self-conducted breast examinations, yearly pelvic and breast exams, regular Pap smears (i.e., every other year for women ages 21-29, once every three years for those over 30) and yearly mammograms after age 40.

But what happens if you experience unfamiliar symptoms? When should you see a clinician? Is there anything you can do to prepare for the appointment? What questions do you ask her?

Red Flag Symptoms

Amy Ntoburi, a women’s health nurse practitioner in the Department of Obstetrics and Gynecology at Olmsted Medical Center, recommends seeing a clinician immediately if you experience any of the following:

• Vaginal bleeding after menopause
• No period/menstrual cycle for more than three months if not pregnant
• Discharge from nipples/breasts not during pregnancy or breastfeeding
• Skin dimpling, change in contour, red rash on nipple or new nipple retraction of breast
• Pelvic pain, pain during intercourse
• Pain with urination, blood in urine
• Blood in stool/bowel movement that is persistent, bright red, black/tarry
• Bleeding between periods for more than one month or bleeding after sex
• Vaginal discharge with foul odor, vulvar itching, color change to vaginal discharge–yellow or green, increase in vaginal discharge
• Hard lump or mass in breast or armpit

“Listen to your body,” encourages ovarian cancer survivor Kristen Larson. “Even when you are well, notice what that feels like, so you can be more in tune if that feeling were to change.”

Preparing for the appointment
Once the appointment is made (or before), take some time in a quiet place at home and write down everything you can remember about your symptoms: when they started (as exact a date/month as you can remember); any changes; how long symptoms usually last (i.e., minutes, hours, days); the amount, kind, location and duration of any pain; if you have any discharge or unusual bleeding: how much, when and what color it is.

Also record any self-treatments you have tried: any home or over the counter remedies you’ve used; how much and how often; did they help? Is there anything that makes the symptoms better or worse (i.e., certain foods, alcohol, caffeine)?

“Keeping a journal or diary of symptoms is always a good idea,” says Ntoburi, “details can be clearer rather than relying on memory.” It will give you a point of reference when you get to the appointment, which can help if you get nervous.

Talking with your clinician
When you get to the appointment, pull out your notes and explain all the symptoms you’re experiencing, even if they seem embarrassing or too private.

“Women need to understand everything discussed in the exam room [relating to one’s condition] is confidential; she should feel comfortable in asking personal, private questions,” says Ntoburi.

Don’t let embarrassing details keep you from giving your clinician what she needs to know to help you. For example, older women may find it difficult to talk about sexual activity or concerns over sexually transmitted infections (STIs), especially if they are newly divorced or widowed.

After a long, monogamous, trustworthy relationship, many older women may not perceive themselves as vulnerable to these infections but need to be aware that it’s possible to contract an STI from someone who seems perfectly healthy. Sometimes these infections cause no symptoms at all or can be mistaken for other conditions or normal aging-related changes.

“Don’t be afraid to speak up if something isn’t sounding right,” advises Larson, whose ovarian cancer symptoms included nausea and weight gain in the abdominal region, mocking pregnancy. “Several medical professionals had the initial guess that I was pregnant. Knowing that was not the case, I had to advocate for myself.”

Lastly, don’t let lack of money keep you from the doctor. For those in need, state assistance may be available. Planned Parenthood also provides counseling, breast and pelvic exams, STI testing, Pap smears and many other services to treat symptoms and prevent diseases, on a sliding fee scale. Patients might pay full price to nothing, depending on income.