What ISN’T okay behaviour from a health professional
Guest contributor Dr Madeleine breaks down what to expect from your health professional when you have sexual and reproductive health questions - and what ISN'T okay behaviour!
Health professionals are very accustomed to discussing health topics regarding periods, sex, pregnancy, sexually-transmitted infections, and any other concerns you may have about the more private parts of your body. Whilst it is just a part of another day for GPs and many other medical specialists, it’s not an everyday occurrence for patients, and it can feel exposing and uncomfortable. We recognise these things can make you feel vulnerable, but you should never feel embarrassed or unsafe when you ask for help. Read on for what you should and generally should not expect when you see a doctor for these common complaints.
Period problems
What you can expect: questions about the character of your period, how many days they last for, and how many days in between. It is a good idea to remember the first day of your last period for the doctor’s reference. If your periods are painful, you may be asked about symptoms with sex to help point to certain diagnoses, but this discussion will be limited.
What you shouldn’t expect: Unless you are trying to get pregnant, your sex life does not weigh in heavily. Discussion of different contraceptives is common to help control periods; you do not have to be having sex to take these medications. An invasive examination is usually not warranted, but your doctor may wish for you to have an ultrasound scan. This can be done with a vaginal probe for more accurate images, but you can always say no to this and have your ultrasound done over the abdomen only.
Other kinds of bleeding in women
What you can expect: questions will focus on the symptoms you’re having. You may be asked to perform a urine or blood test to rule out pregnancy, as this helps with possible diagnoses and dictates what medicine we can give. A speculum exam is usually performed in this case (a medical tool which looks like a duck bill, which is inserted into the vagina closed, and then opened). This helps to visualise the cervix (the entrance to the uterus), the walls of the vagina, and any bleeding that may be occurring.
What you shouldn’t expect: Speculum exams are frequently uncomfortable but shouldn’t be painful, and can be stopped at any time. Your doctor should use a well-lubricated speculum and insert it slowly and gently. Focus on deep breathing and relaxing your legs and buttocks to make this process less uncomfortable!
Painful sex (if you have a vagina)
What you can expect: questions will address the specific types of pain you experience and the type of intimacy that brings this on. Physical examination is done more routinely with this complaint; for women, your doctor may examine the outside anatomy for any scar tissue or features of infection, and may perform a vaginal exam (by inserting one or two gloved and lubricated fingers into your vagina) to assess your muscle tone, to feel for any areas of tenderness, or for any lumps. You should be in a private room with the door closed, and a curtain will be closed around you for added privacy. If you wish to have a chaperone with you (especially if your practitioner is of another gender to you), feel free to ask – usually a nurse can assist.
What you shouldn’t expect: Questions will centre around the problems you’re facing and in which circumstances. Other circumstances don’t need to be explored in detail. You are not expected to sit through significant pain during examination; if you ask to stop, the medical practitioner should do so immediately.
Abdominal pain
What you can expect: you will likely be asked about risk factors for STIs and pregnancy. These include your recent sexual partners, if you’ve been having unprotected sex, sometimes the types of sex, and if you’ve been tested recently for STIs. If you have had altered vaginal discharge or think you could be pregnant, please tell your doctor. A urine or blood test for pregnancy and STIs is usually done, and a speculum exam may be done to look for infection or bleeding. In some cases, a bimanual examination may also be done – this is when a doctor inserts two gloved, lubricated fingers into the vagina and uses the other gloved hand to press down on your lower belly from the outside. This can help identify problems with the ovaries or fallopian tubes.
What you shouldn’t expect: if you are uncomfortable with any parts of the questions or the exam, you do not have to proceed. You can ask for more pain relief before these exams.
Painful / swollen testicles
What you can expect: questions about your sexual history, including number of partners and use of barrier contraception like condoms, are pertinent, as is an examination of the scrotum and the testes. This is conducted systematically, by examining each testis first, and then along the shaft of the penis. If you have any discharge, the doctor may swab this. They will also ask for a urine sample and some blood tests.
What you shouldn’t expect: if the pain is isolated to the testes, a per rectum exam is usually not necessary (this is when a doctor inserts one gloved, lubricated finger through the anus to feel the prostate). However, if you’re having trouble passing urine or the pain is into the groin or back also, this is a very reasonable exam.
Breast lump
What you can expect: questions will address how long you’ve had the lump and any other symptoms, like tenderness or skin changes. Your doctor will examine both breasts, one at a time, in a systematic manner (usually a spiral or zig-zag fashion) and will feel under the arms too. You may have an ultrasound scan as well, and possibly an X-ray or tissue sample taken.
What you shouldn’t expect: An uncoordinated exam that does not appear to be comparing sides one at a time.
