Chapter 1 The Big Picture
Tina is new to the area and hasn't found a gynecologist that she likes. Judy doesn't know why she needs to get a mammogram every year. Helen doesn't understand how she could suddenly develop a midriff bulge after menopause. Ask Your Gynecologist begins by addressing questions surrounding a challenge that every woman faces at one time or another, selecting a gynecologist and working efficiently with his or her office staff. The chapter then proceeds to address questions women have about Pap smears and mammography, two screening tests that are recommended for every woman at some stage in their life. Finally, the chapter looks at questions surrounding weight loss and pain, two of the more frequent areas that women battle.
· Why should I go to a gynecologist?
· How should I choose a gynecologist?
· What can I do if I'm too anxious and embarrassed to see a gynecologist?
· Why do I have such a hard time getting an appointment?
· When is the best time to schedule an appointment?
· Why do I have to wait so long in the doctor’s waiting room?
· How often do I need to see a gynecologist?
· When should my daughter first see a gynecologist?
· My daughter has a problem and refuses to see a gynecologist. What should I do?
· Can my family doctor do the pelvic exam?
· Is douching a good idea?
· What do all those fancy words mean?
· What is the doctor doing down there during the examination?
· What is a Pap smear?
· How reliable are Pap smears?
· What is a mammogram?
· Are mammograms painful?
· Aren’t mammograms dangerous?
· How reliable are mammograms?
· Why do I have to get a breast ultrasound?
· If breast MRI is more sensitive than mammography, should I get that instead of a mammogram?
· How can I lose this weight?
· What medications help you lose weight?
· When is surgery indicated for obesity?
· What can I do if I have pain?
Chapter 2 The Menstrual Cycle
Haley seems to have her period all the time, but her friend Erica hardly ever gets it. What's the deal with that? Judy inhales Advil, but still has terrible cramps with her period. “It’s not fair, she exclaims! Why do I get these when my sister doesn’t?” Mary nearly rips her son Jonathan's head off when all he did was drop a towel on the floor. She thinks she has PMS but doesn't know what to do about it. These situations are the focus of chapter 2, questions surrounding the menstrual cycle and conditions related to it.
· What’s a normal cycle?
· I'm late for my period. Am I pregnant?
· I get my period two or three times during the year. Is that O.K.?
· When my period comes, I flood. Is that normal?
· What does it mean when I get clots during my period?
· Is bleeding between my periods normal?
· Why do I get pain in the middle of my cycle?
· I get terrible cramps with my period. What’s wrong?
· What can I do if I have PMS?
· I always get a headache at the beginning of my period. Why?
· My daughter is 15 and still hasn’t gotten her period. Should I be worried?
· Are tampons safe?
Chapter 3 Family Planning
"I can't believe Shelley got pregnant. How did she manage to do that?"
"I don't know, maybe she thought she couldn't get pregnant the first time. I remember when a guy tried that line on me."
"I thought she was using birth control pills."
"Yeah, when she remembered them."
"Well that’s not happening to me. I'm getting an IUD."
"Aren't those things dangerous?"
"I don't know. All I know is I don't want to get pregnant."
Family planning is one of the most important functions that gynecologists provide for patients. However, much of what young women think they know about contraception is inaccurate. Chapter 3 focuses on providing accurate answers to the questions surrounding family planning including contraception, abortion, and tubal sterilization.
· Is it possible to get pregnant the first time I have sex?
· What is natural family planning?
· What is barrier contraception?
· Is withdrawl a good method of contraception?
· How good are those over-the-counter spermacides?
· Why should I use the birth control pill?
· Birth control pills are dangerous, aren’t they?
· What about all those side effects from the pill?
· Are there any medications I can’t take with the pill?
· What should I do if I miss a pill?
· Will I have trouble getting pregnant when I stop the pill?
· Some birth control pills let you skip periods. Is there any reason not to use these?
· What is the minipill?
· What is the “morning-after” pill?
· What is that birth control device that is placed in your arm?
· I hear there are shots that prevent pregnancy. Is that true?
· Are IUD’s safe?
· How can I tell if my IUD is in place?
· How do I know which method of contraception is best for me?
· How are abortions done?
· Can I have a normal pregnancy after having an abortion?
· How is a tubal ligation done? Is it safe?
· Can my tubes be put back together?
· Why have my periods been irregular since my tubal sterilization?
· Is it better for my husband to have a vasectomy than for me to undergo a tubal sterilization?
· If I’m in menopause, can I still get pregnant?
Chapter 4 Sexual Relations
Cynthia has had painful intercourse ever since menopause, but she is too embarrassed to ask her doctor about it. Gina seems to have lost her sex drive and wants it reignited. Lynn’s boyfriend has asked her to consider anal sex. Aside from the fact that she’s worried it might hurt, she doesn't even know if it is safe. All women at some point in their life have a question regarding sex. Many are too shy or anxious to ask their doctor. Chapter 4 addresses the most common questions women have about sex.
· Why does it hurt when I have sex?
· Why don’t I have orgasms?
· Where is the “G Spot”?
· Why don’t I have any sex drive?
· Will my sexual pleasure decrease after a hysterectomy?
· Is oral sex dangerous?
· Is anal sex safe?
Chapter 5 Pelvic Infections
Down the way
Where the lovers play
Critters might roam on you someday
Things that jump
and cause nasty bumps
so you better learn your lessons
or you'll take your lumps
From the song Celibacy off the CD Gynecology Unplugged
Even though Dr. Thornton uses sexually transmitted infections (STI’s)to create a humorous song for his comedy CD, he and Dr. Schramm take STI's very seriously. Misinformation abounds and consistent use of condoms is few and far between. Chapter 5 answers all the questions women have surrounding STI’s. Non-sexually transmitted conditions such as yeast infections and bacterial vaginosis are also explored, with a particular focus on helping women who recurrently develop these conditions and are at their wits end.
· Why does my vagina itch?
· Why do I keep getting yeast infections?
· Are yeast infections dangerous?
· How are yeast infections treated?
· Will yogurt or other natural products keep me from getting yeast infections?
· I have a discharge but no itching or burning. Is that normal?
· What is PID?
· How can I tell the difference between a bladder infection and other pelvic infections?
· Do people still get syphillis?
· I have bumps that feel like warts. What are they?
· What is that painful sore down there?
· Can women get AIDS?
· Can you get hepatitis through sex?
· If I get a sexually transmitted infection, should I be tested for others?
· Why can’t the gynecologist cure my infection?
· What can I do to avoid getting a sexually transmitted infection?
· How do I cope emotionally when I discover that I have a sexually transmitted infection?
Chapter 6 Why Can’t I Get Pregnant?
Sandy’s been on an emotional roller coaster. First she thinks she's pregnant and then she's not. She's getting hormone shots she thinks are driving her crazy and her husband Scott is inclined to agree. It's not fair. She submitted to an interminable array of unpleasant tests when all he had to do was masturbate for a semen specimen. Truly, there is no justice in the world.
Chapter 6 addresses one of the most frustrating challenges a woman can confront, infertility. It never seems fair. Joann’s neighbor Sally, who didn't even want to get pregnant, did so effortlessly while Joann isn't successful, no matter how hard she tries. In this chapter, the authors help guide women through the demanding ordeal of infertility.
· I’ve been trying to get pregnant for six months. Does this mean I have a problem?
· When’s the best time in my cycle for conception?
· Do I need to see an infertility specialist?
· What is a BBT chart?
· How can the gynecologist tell if I have a problem?
· What about my husband? Should he be checked?
· Why does the doctor want to perform a laparoscopy?
· What is artificial insemination?
· When am I too old to get pregnant?
· Are there more natural approaches to infertility?
· I hear that infertility drugs cause ovarian cancer. Is that true?
· Why do I feel as if I'm riding an emotional roller coaster?
Chapter 7 When Something Goes Wrong: Complications of Early Pregnancy
Stephanie was ecstatic! She found her soul mate in Robbie. They had a storybook wedding in Antigua, and after trying for two years, she finally conceived. The whole world just had to know! She was so excited that she posted it on Facebook. But her joy wasn’t destined to last, at least not this time. Three months into the pregnancy she began bleeding. Her doctors reassured her that this was not uncommon, but it didn't stop and she miscarried.
Perhaps the only thing worse than not being able to get pregnant, is conceiving, only to lose your pregnancy. Stephanie was left with a thousand questions. What did I do wrong? What is wrong with me? Why did this happen? Am I ever going to have a successful pregnancy? Chapter 7 addresses Stephanie's questions and others that arise when there are complications early in a pregnancy.
· I missed my period and have a positive pregnancy test. Now I’m bleeding. Am I having a miscarriage?
· What needs to be done if I’m having a miscarriage?
· Why did I have a miscarriage?
· How long should I wait after a miscarriage before trying again?
· I had two miscarriages. Is there something wrong with me?
· What is a tubal pregnancy?
· I am pregnant and have pain. Do I have a tubal pregnancy?
· Is surgery always necessary to treat a tubal pregnancy?
· Can I get pregnant again after a tubal pregnancy?
Chapter 8 Endometriosis: The Great Masquerader
At first, Joan just had a few cramps with her periods. She didn't make too much out of that because most of her friends had similar symptoms. However, in the last few years it seems like her cramping has gotten out of control, even starting several days before her period. Dr. Seaver told her to take Motrin and placed her on birth control pills, but she still gets the pain. What's going on here?
In all likelihood, Joan has endometriosis, a condition in which tissue lining the inside of the uterus is located outside the uterus. Affecting 10% of all women, endometriosis can present with a vast array of symptoms, including infertility. Chapter 8 addresses all of the questions that women have surrounding this disconcerting condition.
· I was told I have endometriosis. What is that?
· If I have painful periods, does that mean that I have endometriosis?
· What other symptoms characterize endometriosis?
· How is endometriosis diagnosed and treated?
· If I have endometriosis, does that mean I can’t get pregnant?
· Will endometriosis come back?
· My doctor said I’ll eventually need a hysterectomy because of my endometriosis. Is that necessary?
· What happens to my endometriosis after menopause?
Chapter 9 Disorders of the Uterus
Kathy was told she has fibroids. They're not really causing any pain. “Why do they have to come out? Should I get another opinion?”
Debbie was just called by the doctor and told that her Pap smear is abnormal and that she tested positive for a virus called HPV. “What does that mean? Does this mean I have cervical cancer? What is the doctor going to do to me?”
Martha is two years out from menopause and now she's bleeding. “This must be cancer. Right?” She knows she should see the doctor but is scared of what she might find.
Here we see three women, all with different problems, yet all related to the uterus. In this chapter, Drs. Thornton and Schramm answer the questions women ask about the numerous problems associated with the uterus. A third or more of women will have problems in one of these areas during the course of their life.
· What are fibroids?
· Will my fibroids turn into cancer?
· What problems do fibroids cause?
· When do fibroids need treatment?
· Can fibroids be treated with medications?
· What type of surgery is used to remove fibroids?
· Are there any other non-surgical treatments for fibroids?
· How can I determine which treatment for fibroids is best for me?
· Can fibroids grow back?
· Where do polyps come from?
· Can polyps turn into cancer?
· How are polyps removed?
· My doctor said my heavy bleeding is from adenomyosis. Is that the same as endometriosis?
· How can the gynecologist tell if I have adenomyosis?
· How is adenomyosis treated?
· I’m sixty years old, and now I’m bleeding. Does that mean I have cancer?
· What is endometrial cancer?
· How did I get endometrial cancer?
· How is endometrial cancer diagnosed?
· Why didn’t this show up on my Pap smear?
· Do I need a hysterectomy to treat endometrial cancer?
· I’m scared. What will happen if I don’t do anything?
· I had a hysterectomy for endometrial cancer, and now my doctor says I need radiation. Is that really necessary?
· Can I use hormone replacement after treatment for endometrial cancer?
· How often should I see the doctor after my treatment for endometrial cancer?
· My Pap smear is abnormal. Does that mean I have cancer?
· If my Pap smear is abnormal, why did the doctor tell me to come back in six months?
· What cervical conditions are precancerous?
· How do you diagnose LSIL and HSIL?
· How do you treat LSIL and HSIL?
· Why is my doctor treating my SIL differently than someone I know who has the same thing?
· Will SIL come back again after treatment?
· If the SIL can recur, why don't you just do a hysterectomy?
· What’s the difference between SIL and cervical cancer?
· How will I know if I have cervical cancer?
· How do you diagnose and treat cervical cancer?
· What are my chances of surviving cervical cancer?
Chapter 10 Disorders of the Ovary
Gladys is devastated. Dr. Simpson just informed her that she has an ovarian tumor the size of a grapefruit. How can this be? She was faithful in her visits to the gynecologist every year and always got her Pap smears? She hasn't noticed any pain. In fact, she hasn't noticed any unusual symptoms. Does this tumor have to be cancer? Should she go to a hospital that specializes in cancer?
There is nothing scarier than having an ovarian abnormality. People don't know much about ovarian cysts and tumors, but they know enough to be scared of ovarian cancer, or even the possibility of ovarian cancer. In chapter 10, the authors answer all of Gladys's questions and more.
· I was told I have a cyst. What is that?
· Why do I have pain from my ovarian cyst?
· Do I need surgery if I have a cyst?
· What type of surgery is done for ovarian cysts?
· How does the doctor know that my cyst is not cancerous?
· The doctor says I have an ovarian tumor. Does that mean I have cancer?
· Does ovarian cancer run in families?
· Are there screening tests for ovarian cancer?
· What symptoms will I have if I develop ovarian cancer?
· If the tumor is on my ovary, why does the doctor want to perform a hysterectomy?
· The doctor says all of the cancer was removed. Why do I need chemotherapy?
· I know people who had chemotherapy and died anyway, so why should I take chemotherapy?
· Will I get sick from chemotherapy?
· How long will I get chemotherapy?
· Can I be cured or will my cancer come back?
Chapter 11 Problems of the Vagina and Vulva
While waiting for their Starbucks order, Susie glances over to her friend Heidi who appears to be scratching her crotch.
"What in the world are you doing? Quit that. You're embarrassing me."
"I can't help it. It feels like my vagina is on fire."
"Well go see a doctor for goodness sake!"
"I have. He keeps telling me that I have yeast infections, but nothing he gives me seems to work.”
Welcome to the world of vulvar disorders. Of all the places in the body you might have to scratch, the vulva is possibly the most embarrassing. There is no way of doing that discreetly. Your average woman, and many general practitioners, attribute every vulvar symptom to yeast. In chapter 11, Drs. Thornton and Schramm address the myriad of abnormalities found in the vulvar and vaginal region.
· What is that lump by my vagina?
· Why do I keep getting boils?
· I constantly have burning in my vulva. What can I do?
· The doctor wants to do a biopsy of the skin on my vulva. Does that mean I have cancer?
· How is vulvar cancer treated?
· Can you get vaginal cancer?
Chapter 12 Problems of the Breast
Jeannie feels a breast lump. She reflects on the possibilities, "OK, don't panic! You know that all breast lumps are not cancerous." She tries to remain calm but is still overcome with anxiety. Her heart is racing with palpitations. Her mind is racing with questions. She knows her mother had breast cancer. Does this mean that she has breast cancer? The lump feels a little tender. Is that a good sign or a bad sign? She knows she should see the doctor. Should she see her family doctor, gynecologist, or a breast specialist? What studies will be ordered? Does she need a biopsy?
Jeannie is not alone. Most women are very anxious when it comes to breast abnormalities. Breast cancer is very common and pretty much every woman knows someone who has had breast cancer. National and local fund raising events are promoted nonstop. Breast cancer awareness campaigns appear everywhere. We see the public service ads on TV, receive pamphlets in the mail, and see ads posted at bus stops and on billboards. There is so much awareness surrounding breast cancer that one begins to assume it is inevitable.
Chapter 12 addresses all the questions women have regarding benign and cancerous conditions of the breast. This includes cutting-edge breast cancer treatments such as partial breast radiation.
· Why do my breasts hurt?
· Are breast implants dangerous?
· Can anything be done if my breasts are too large?
· I have a tender area in my breast. Does that mean I have cancer?
· Why does the doctor want to draw fluid out of the lump in my breast?
· What does it mean if I have discharge from my nipple?
· Is there anything I can do to prevent breast cancer?
· Is my risk of breast cancer increased if my mother had breast cancer? When should I get genetic testing?
· How can I tell if I have breast cancer?
· When is a breast biopsy necessary?
· Do I need to have my entire breast removed if there is cancer?
· I hear they can reconstruct your breast. Is that true?
· Why do I need radiation after a lumpectomy?
· When is chemotherapy necessary?
· What is hormonal therapy?
· I was told I have CIS is that the same as breast cancer?
· How do you treat breast cancer that has spread to other parts of the body?
Chapter 13 Menopause and Hormone replacement: The Great Debate
Do you take them? I don’t know.
Do you put up with the flushes and the flashes and the sweats?
Dryness and the burning and the wretched painful sex?
Urgency, frequency, incontinence you know.
Hair on your faces, sagging in some places.
Wrinkles pop up here and there, some begin to show.
Mother nature’s awfully mean, man she’s really low.
Will I be a new person? Side effects might worsen.
Lovely like a dream, or just some big doctor’s scheme.
Estrogen, progesterone, androgens I’m using.
Do I really need these, all just too confusing.
Patches, shots, and pills, all have their own niches.
Are they really good for me? Someone’s getting riches.
Bones breaking, heart’s aching, can’t end up like that.
But cancer’s in the family. Will hormones make me fat?
Hormones, do you take them I don't know.
Something else might help me, saw it on a show.
Beans, roots, and sprouts, woman screams and shouts.
Buy them in the store, add vitamins for more.
Are they really safer, can we be sure
Never have been tested. What’s this hype for?
Hormones, so upset I might weep.
Going back to bed now, going back to sleep.
Hormones, a rap by Dr. Thornton from his CD Gynecology Unplugged
This rap song from Dr. Thornton clearly represents the frustration that women have surrounding menopause and the confusion they have in trying to understand the benefits and risks of hormone replacement therapy (and the alternatives). As the director of New Horizons Menopause Center and a member of the North American Menopause Society, Dr. Thornton has a renowned level of expertise in menopause. He combines 30 years of experience with his knowledge of the latest advancements in the treatment of menopausal disorders to answer their questions.
· When will I reach menopause?
· Why do I have trouble sleeping?
· What is a hot flash?
· Why is sex painful since I stopped getting periods?
· I don’t seem to have any sex drive. Is that because of menopause?
· I feel depressed. Does menopause cause that?
· What is the latest update on hormone replacement therapy?
· What type of hormones should I take? How are they given?
· What about bioidentical hormones?
· Do I have to wait until I stop getting periods to begin hormone replacement therapy?
· Is there an age at which it is too late to start hormone replacement therapy?
· Should I avoid hormones because they cause cancer?
· What side effects will I get from hormone replacement?
· Are there women who can’t take hormones?
· What else can I take for my symptoms other than hormones?
· What are those new drugs that are supposed to replace estrogen, and are they safer?
· How can I tell if I have osteoporosis and what can I do to prevent it?
· What medications are used to treat osteoporosis?
Chapter 14 Where’s the Nearest Bathroom?
Jimmy is convinced that his mother, Rita, could write a book entitled Bathrooms Across America. He's not kidding. Rita knows where every bathroom is within a 100 mile radius. At the supermarket, it's between the butcher section and the produce section, make a left and it's the first door on the right. At Macy's, it's on the third floor between home furnishings and women's petite. It only has one stall, so don't wait too long. She has every rest stop on the New Jersey Turnpike timed to the nearest minute and the nearest 10th of a mile.
OK, not all women are worried about their bladder as much as Rita, but bladder urgency and urinary stress incontinence are certainly common in postmenopausal women. Vaginal deliveries, advancing age, and lack of estrogen conspire to weaken bladder function. In this chapter, Drs. Thornton and Schramm provide answers to the questions related to the prevention and treatment of bladder disorders.
· Why do I always run to the bathroom?
· Is it normal to get up at night to go to the bathroom?
· Why do I lose urine when I cough or sneeze?
· Why do I keep getting bladder infections?
· What are those tests the doctor wants me to do?
· My doctor says I have interstitial cystitis. What's that?
Chapter 15 Pelvic Prolapse: The "Dropped Bladder"
It's been a long time but Joe is feeling vigorous. He finally discovered the wonders of the magic blue pill. He eagerly climbs into bed with Angie. They start to snuggle and just when he's getting excited, something horrible appears. "There’s something coming out of your vagina!” he exclaims. "What are you talking about?" asks Angie. She's totally baffled. Joe continues, "There's something bulging out of your vagina. It looks like you're giving birth to an alien or something. I’m not getting near you till that thing gets checked out." "Well I don't feel anything abnormal," says Angie, "but I'll get it checked out. Now you've got me worried."
No, Angie’s not giving birth to an alien, but she does have a "dropped bladder" or what doctors call a cystocoele. Many women later in life develop pelvic prolapse with descent of the uterus, bladder, or rectum down the vagina. Most women don't have much in the way of symptoms from this until something starts protruding from the opening of the vagina. In this chapter, the authors answer the questions that arise when pelvic prolapse is discovered.
· What is that bulge down there?
· How did this happen?
· What symptoms will I have from prolapse?
· I lose my urine. Is that because of my dropped bladder?
· Is pelvic prolapse dangerous?
· What can I do to keep my prolapse from getting worse?
· How is prolapse corrected?
· I hear that surgery doesn’t always work. Why?
Chapter 16 When You Need Surgery
Dorothy has just been told that she needs a hysterectomy. Nothing conservative has helped her horrendous bleeding problems. She should have seen this coming as one treatment after another failed, but she remained in denial, hoping that hysterectomy wouldn’t be necessary. Now that she's consigned to surgery, one question after another pops up. “So what's next? Do I need a complete hysterectomy? Is this going to put me into menopause? How long will I be in the hospital? What complications will I get? How long will I be out of work?”
Yes, when it comes to surgery, a thousand questions arise. We’ll take a pill with very little compunction, but when it comes to surgery, most people put on the brakes. Dorothy remembers Aunt Tilly who went in for a hysterectomy and came out with a colostomy bag. What if that happens to her? In chapter 16 Drs. Thornton and Schramm answer the questions women ask about surgery, and in doing so help allay their fears.
· What are the complications of surgery?
· How long will I be in the hospital?
· Will I be "knocked out" during surgery, or can I have a local anesthetic?
· Why do I need a catheter in my bladder?
· What can I get to relieve pain after the surgery?
· Will I feel nauseous after the surgery?
· When can I return to work?
· What restrictions will I have after surgery?
· What’s the difference between a complete hysterectomy and a partial hysterectomy?
· When I have a hysterectomy, should my ovaries also be removed?
· How will the doctor perform a hysterectomy?
· Will a hysterectomy put me into menopause?
· Why do I have to be examined if I had a hysterectomy?
· If I have an ovarian tumor, does the whole ovary need to be removed?
· Will I need to take hormones after the surgery?
· Why do I need a catheter for so long after bladder surgery?
· Why am I losing urine after my bladder surgery?
· Why do I have pain in my shoulder after laparoscopic surgery?
· Why do I have so many incisions on my abdomen?
· Is laparoscopic surgery safer than regular surgery?
· Can I have laparoscopic surgery as an outpatient?
· How much pain will I have after laparoscopic surgery?
· Can hysteroscopy be done in the office?
· How much pain and bleeding will I have after hysteroscopy?