Tag Archive for: STI

Gynecologist, obstetrician (OBGYN), or primary care physician — which doctor should you see and when?

To know which type of physician you should visit, it’s important to understand the difference between them and what they specialize in.

What is a primary care provider?

A primary care provider is focused on the whole patient, specializing in family medicine, internal medicine or pediatrics. They are often at the center of your health journey and will refer you to other specialists as needed.

What is a gynecologist?

A gynecologist is a primary care physician who specializes in women’s health needs, reproductive health, and women’s health after menopause. Gynecologists also perform minimally invasive surgeries including hysterectomies, removal of ovaries or ovarian cysts, tubal ligation, removal of polyps and fibroids from the uterus, treatments for precancerous changes of the cervix such as LEEP, and other surgical procedures.

What is an obstetrician (OBGYN)?

An obstetrician (OBGYN) is a physician who has received specialized training in the care of women who are pregnant. They care for women throughout their pregnancy, delivery, and into their post-partum period. While they are primarily focused on women’s health and reproductive health, they can also help women manage other health issues.

Which One Should I See?

Many women choose an OBGYN to be their primary care provider so that all their care is through the same person. This is a common choice, especially with younger women who have uncomplicated medical needs. However, older women and women with complex medical problems should continue to have both a Primary Care Provider and a separate OBGYN or gynecologist.

Most of the physicians at Madison Women’s Health are OBGYNs. If you are already a patient at Madison Women’s Health and wonder if you should see an OBGYN or your Primary Care Provider, send us a message through MyChart. We’ll be able to tell you who would be the most appropriate physician for your unique situation.

Reasons You Should See Your OBGYN or Gynecologist

There are many reasons to visit your OBGYN or gynecologist. Below are the typical reasons someone would come in for an appointment at Madison Women’s Health.

• • Birth control: Discuss the many different contraceptive options that are available to you, how they work, how often you need to take birth control, and what kind of birth control would be best for your lifestyle and needs. Read more about birth control options.
  • Pre-pregnancy planning: Learn how to have a healthy lifestyle that will support a healthy pregnancy and delivery. Read more about preparing for pregnancy.
  • Pregnancy: Call us as soon as you find out you’re pregnant, which is usually around 8 weeks pregnant (or 3-4 weeks past your missed period). At your first prenatal visit, we’ll do an ultrasound to establish a due date and confirm viability of the pregnancy. You’ll meet with a nurse to learn about what to expect over the next 30 weeks. Read more about our pregnancy services.
  • Changes in your menstrual period: If your period is different than it was before — heavier, lighter, more prolonged, more irregular — then it’s a good idea to see your gynecologist or OBGYN. Changes in your period could be caused by a variety of factors, such as hormonal imbalances, stress, weight loss or weight gain, infections, abnormal cervical changes, presence of an ovarian cyst, and development of fibroids or polyps in the uterus.
  • Unusual vaginal discharge or odors: It’s important to know what is causing pain, irritation, discharge and odor so you can treat it. These things could be caused by a yeast infection, vaginitis, or STI. Read more about our well woman care services.

• Screening for Sexually Transmitted Infections (STI)

• • Pain while going to the bathroom (urinary tract infection)
  • Age-related screenings for breast cancer, colon cancer, osteoporosis, and bone health.

• Pap smear and pelvic exam

• HPV screening beginning at age 25

If you have other health symptoms or concerns, such as questions about skin issues, painful joints and aching muscles, anxiety and depression, postpartum depression, it is perfectly fine to ask your OBGYN about them. As a primary care provider, your OBGYN can give you care and write prescriptions. They will also refer you to other specialists as needed.

How Often You Should Receive an HPV Screening/Pap smear and Pelvic Exam

Several years ago, women received annual pelvic exams and Pap smears to screen for cervical cancer. We’ve since learned that the presence of certain types of HPV (human papillomavirus) is what increases your risk of developing cervical cancer. The changes to the cervical cells that lead to cancer take a number of years to develop. We know that HPV causes the cells to become abnormal.  For that reason, HPV screening is routine alone, or in conjunction with a pap smear for women 25 and older.  If you test negative for HPV, the pelvic exam may not be needed as often as previously recommended.

Pelvic exams are done along with HPV screening and pap smears,  typically about every 3-5 years unless you have had an abnormal pap smear or positive HPV test, or if you have concerning pelvic symptoms. A pelvic exam is one way your gynecologist can screen you for infectious diseases, cancers to the reproductive system, or other conditions like endometriosis and pelvic floor dysfunctions.

During a pelvic exam, your gynecologist will look at your vulva, vagina, and cervix. They do this by gently inserting a speculum, which widens the vagina so they can see the vagina and cervix. They will also check for any changes in your other organs, the uterus, fallopian tubes, ovaries, and bladder. Samples needed for HPV screening or a Pap smear are taken during the pelvic exam while the speculum is inserted. Your gynecologist will use what looks like a long popsicle stick and brush shaped like a mascara brush to swab the cervix, collecting a sample of cells which will be used for testing.

Most women ages 21-65, regardless of sexual history, should receive HPV screening and or a pap smear every 3-5 years to test for the presence of abnormal cells that could lead to cervical cancer. Some women may be more at risk of developing cervical cancer, such as women with HIV, those with a weakened immune system, or those who have had treatments for pre-cancer or cancer. These women would be screened more frequently, on an individual basis.

HPV screening detects whether the HPV virus is present. If HPV is detected in the sample, then the remaining cells from that sample are sent in for cytology (Pap smear) to see if they are pre-cancerous or cancerous. If the test for HPV is negative, you won’t need another screen for 3-5 years.

How to Prepare for Your Exam with a Gynecologist

It’s important that you feel comfortable and listened to at your gynecological exam. The best way to have a good exam is to relax and remember that your doctor is on your side. We want to help you be the very best version of yourself!

You might be surprised to hear this, but as OBGYNs, we’re really not worried about whether you shaved your legs or waxed your bikini line. You don’t need to do anything special ahead of time. We’re here to take care of you just as you are!

We generally don’t recommend douching because it throws off your vaginal pH, which can cause bacterial imbalances which can lead to or predispose to infection.

Questions to Ask at Your Next Gynecologist Exam

Never be afraid to ask your doctor anything! We care about you as a whole person, so we’ll ask you a lot of questions that cover many aspects of your life. If we haven’t covered something in our conversation with you, please feel free to ask us.

Here are the most common questions we’re asked. If it helps, write a list ahead of time of questions you’d like your doctor to answer (or screenshot ours).

• Do I need birth control? How does it work?
• Is my period normal?
• Do I have to be in so much pain every month?
• Do I have to have my period every month? Is it too heavy? Too light?
• How often should I consider sexually transmitted infection (STI) screening?
• What should I expect about perimenopause and menopause?
• How can I reduce perimenopause and menopause symptoms?
• How can I reduce mood changes associated with my menstrual cycle?
• I have a family history of chronic illnesses, like diabetes, heart disease, and thyroid disorders. How can I reduce my risk of living with these disorders?

Preparing Your Daughter for Her First Gynecological Exam

Moms, we strongly encourage you to openly discuss reproductive and sexual health with your daughters. We’re here to help you with that discussion and process! We have pamphlets at our office that you can use to talk to your daughters about what to expect.

A common question we’re asked is, “When should I bring my daughter in for her gynecological exam?” You may be surprised to hear the answer because many of the recommendations may have changed since you were a teenager.

If your daughter doesn’t have a particular concern regarding her period, risk for sexually transmitted infection,  or need for birth control, she may not need a pelvic exam and HPV screening until she is 21.  If she is using birth control for contraception or periods, she should have a visit at the doctor’s office, but she may not need a pelvic  exam until age 21. Urine tests for STIs can be done without the need for a pelvic exam. If she does need a pelvic exam, reassure her that even though it is awkward, it’s not painful. The exams are very brief, and if it gets uncomfortable, we always stop and readjust.

What To Expect at a Well Woman Exam

Even though you do not need a Pap test or HPV test every year, it’s important that you continue scheduling your annual Well Woman Exam. Your Well Woman Exam is an essential part of your ongoing health maintenance, and is usually covered 100% by your insurance.

At your Well Woman Exam, your doctor will screen you for chronic, preventable diseases such as cardiovascular (heart) disease and diabetes by checking your blood pressure, weight, cholesterol, and glucose levels. You’ll be able to talk to your doctor about other symptoms you may have, such as allergies, migraines, low libido, depression / anxiety, and more. You’ll also discuss whether you need refills for specific medications, or whether you should be seen by a specialist. Your doctor will also make sure you feel safe in your home environment.

Because a Well Woman Exam is more for preventative care and routine health maintenance, the assumption is that you do not have a specific medical problem or condition. If you have specific concerns, you may need to make an additional, separate appointment to talk about your symptoms in more detail with your doctor.

Depending on your age and health history, you may also receive a pelvic exam, mammogram, Pap smear, HPV screening, STI testing or other tests.

Beginning at age 40, you should have mammograms every few years. If you have a history of breast cancer in your family, you may be screened more regularly.

For women 50+, a colon cancer screening is recommended. This is done with either a colonoscopy or an at-home Cologuard test.

As women get older, they’ll also be screened for osteoporosis and bone health.

What to Expect at Your Pre-Natal Appointments

At Madison Women’s Health, much of what our OBGYNs do involves pregnancy care and delivering babies. If you become pregnant, we’ll be seeing a lot more of each other!

Set up your very first prenatal visit as soon as you find out you’re pregnant. For most women, this happens around week 8, when they’re about 3-4 weeks past their missed period.

First Appointment: 8 Weeks Gestation

At your first visit, we’ll do a transabdominal and transvaginal ultrasound. This will help us establish a due date and check for a heart beat. You’ll meet with a nurse to go through your medical history. You’ll learn all about exercise, diet, and ways to manage morning sickness. We’ll cover any changes you may need to make to your medication as well. After you’ve had some basic lab work done (blood and urine tests), your OBGYN provider will meet with you to answer any questions you may have.

12 Weeks – 32 Weeks Gestation: Appointments every 4 weeks

Some women choose to have genetic screening done at about 12 weeks. As part of the genetic screening, you will have another ultrasound and you’ll be able to see all the growth and changes that have happened in just 4 weeks. At 20 weeks, you’ll be able to find out the sex of your baby if you desire to do so.

You’ll continue to come in at 4 week intervals until you reach 32 weeks (about 7 months). If your pregnancy is higher risk, you may see your OBGYN more frequently.

33 – 36 Weeks Gestation: Appointments every 2 weeks

Once you reach 7 months, or 33 weeks, you’ll see your OBGYN every two weeks. Your weight and blood pressure will be monitored. And you may receive testing for gestational diabetes.

37 Weeks until Birth: Appointments every 1 week

In the final weeks leading up to your baby’s birth, you’ll come in for an appointment every week. Your blood pressure will be monitored, and your OBGYN will check the positioning of your baby.

Our Gynecologists and OBGYN Providers Are Here for You

At Madison Women’s Health, we’re committed to treating you as the WHOLE person you are. We want to help you be the happiest, healthiest version of you that you can be! Don’t hesitate to reach out if you have any questions about how we can help you.

Dr. Dickmeyer has been providing healthcare for women in the Madison area since 1998 and is a founding member of Madison Women’s Health. Her specialties include minimally invasive surgical techniques, high and low risk obstetrics, pelvic floor disorders and postmenopausal medicine.