If a stranger came up to you and asked you how heavy your menstrual flow was and whether you ever had anal sex, you could justifiably respond, “That’s none of your !&$% business!” For gynecologists, though, these personal and seemingly inappropriate questions are our business—literally. And while they may seem random, there’s always a specific reason we’re asking. My patients’ answers will change my approach, influencing what I will examine, what tests I’ll do, or what I’ll ultimately recommend. Here, five questions your gynecologist may ask you, and why:
“When was your last period?”
Yes, this is to determine whether you could be pregnant, but the timing of your periods indicates much more. If they’re irregular or MIA, could you be perimenopausal or hypothyroid, or have a hormonal imbalance such as PCOS that’s throwing things off? Beyond that, the results of many tests are interpreted based on where you are in your cycle. And when we test your urine, one thing we’re looking for is the presence of blood—but if you have your period, it’s normal for there to be some blood there. So we need to know.
“How many pads do you use?”
I have learned over the years that one woman’s spotting is another woman’s hemorrhaging. I had a patient who, when I asked about her periods, simply said they were normal, but I asked how often she needed to change her pad or tampon and she said that for the first two days she changed a super tampon and a pad every hour. That might have been her “normal,” but it was not normal. It turned out that she was very anemic and her heavy bleeding was due to a large fibroid in her uterine wall.
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“Are you sexually active?”
While this is a common question, I personally never ask it. What is meant by “being sexually active”? Does oral sex count? Masturbation? Maybe you aren’t having intercourse because sex is painful, but you would like to. Maybe you’re between partners but generally you’re very sexually active. The truth is, it’s not clear why some doctors ask this question. Do they want to know if you need contraception? Are they trying to determine whether you would like to be screened for sexually acquired infections? Do they want to know whether you have any sexual concerns? I ask, “Do you need contraception?”; “Would you like an STI screening?”; and “Are you satisfied with your sexual function?” Next time you’re asked, “Are you sexually active?” you can legitimately respond, “Why are you asking?”—or, even better, consider it an opportunity to say, “Yes, I need contraception/an STI screening/some advice.” Or, “I am so glad you asked. I’d like to have sex, but intercourse really hurts.”
“Do you have anal sex?”
Anal intercourse is part of many couples’ sexual repertoires. But because the rectum is meant to be a one-way passage, I discuss several health considerations with women who are having anal sex. First, the anal sphincter can become weakened, which may result in fecal incontinence. And since the anus lacks the vagina’s natural lubrication, penetration can cause tearing inside, allowing bacteria and viruses to enter easily. So in addition to the swabbing of the cervix to screen for STIs, women who have anal sex need a separate swabbing of the rectum and should have a Pap test of the anal canal because of increased risk of anal cancer.
“Are you using cannabis?”
Doctors don’t always ask this question and when they do, many patients do not respond honestly. Cannabinoids have the potential to interact with certain medicines, such as blood thinners and antiseizure drugs. In some cases, they can potentially make other medications less effective. Cannabis, while generally felt to be safe, can have side effects such as brain fog, dry mouth, unsteady gait, diarrhea, and drowsiness, and high doses are associated with an increase in paranoia and anxiety. Cannabis users need up to twice the sedation for medical procedures. If someone is smoking or vaping cannabis, THC increases the risk of pulmonary and cardiovascular complication. A recent study found the use of medical cannabis for chronic pain is associated with an 83% increased risk for arrhythmias, even in people with no prior history of them. If you’re using cannabis, please tell your doctor, even if he or she doesn’t ask.
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