On this episode of the Take Good Care podcast, we’re discussing sexual health awareness. We talk about the importance of visits to the gynecologist as a young woman for reputable information on sexual health.
Sexual Health Awareness Transcription
Dr. Mironda Williams:
Welcome to Take Good Care podcast.
Dr. Deanna Guthrie:
An endeavor that grew out of our love for obstetrics and gynecology. Our aim and mission is to serve as a source of vital information for women of all races, ages, and walks in life.
Dr. Mironda Williams:
I am Dr. Mironda Williams.
Dr. Deanna Guthrie:
I am Dr. Deanna Guthrie.
Dr. Karen Greene:
And I’m Dr. Karen Greene.
Dr. Deanna Guthrie:
Welcome to our show.
Dr. Mironda Williams:
Welcome to our show.
Dr. Karen Greene:
Welcome to our show.
Dr. Mironda Williams:
Welcome to another episode of Take Good Care podcast. I’m Dr. Mironda Williams.
Dr. Deanna Guthrie:
I’m Dr. Deanna Guthrie.
Dr. Karen Greene:
And I am Dr. Karen Greene.
Dr. Mironda Williams:
The month of September has been designated as Sexual Health Awareness Month, and on our previous podcast episodes as well as on our website, we’ve always talked about important reasons to come and talk with your provider, whether you’re a menopausal or at any stage during your reproductive life, to have real conversations with us about any number of things, sexual health being one of those. And also today we’ve done conversations about menopause when you’re on that end of the spectrum, on that part of the journey. And we also like to give good information and encouragement for our audience to get the teen ladies in. And so we wanted to go back and revisit some of that today. So once again, I’m Mironda Williams.
Dr. Deanna Guthrie:
I’m Dr. Deanna Guthrie.
Dr. Karen Greene:
And I am Dr. Karen Greene.
Dr. Mironda Williams:
And a little bit ago, Dr. Greene did a couple of talks and gave some information about why even bring a teenager to the doctor to see the gynecologist. Can you get us started with the conversation?
Dr. Karen Greene:
Yes, Dr. Williams. We’ve been in practice a long time, so our patients often will come in and say, “My daughter is such and such age, and when is the time you need to start seeing the gynecologist?” And so that’s usually where the conversation starts because recommendations have definitely changed. And so of course, as we like to stay up on the latest recommendations of when to come to the gynecologist and why to come to the gynecologist, and most of the time when the woman asks, we’ve actually probably delivered that child and realizing that we’re going to see the baby that used to be a baby. So we want them to come in at the appropriate time. So the recommended age per ACOG is anywhere between 13 and 50. A lot of women will realize-
Dr. Mironda Williams:
13 and what now?
Dr. Deanna Guthrie:
15.
Dr. Karen Greene:
13 and 15 years old.
Dr. Deanna Guthrie:
Sounded like you said 50. That’s a wide-
Dr. Karen Greene:
13 and 15 years old. And so most of our patients will suddenly realize that that’s the time that they’re no longer seeing the pediatrician. And they probably need to see a gynecologist, but do I want my child to see a gynecologist? And they’re getting ready to potentially graduate in a couple of years and well, they probably do need to see a gynecologist, but unlike when we came along where the recommendation was, as soon as you start having sex, you go to the gynecologist. So recommendations aren’t like that anymore. And therefore I think that the gynecology visit isn’t as scary or at least we try not to make it as scary. We try not to make it scary.
Dr. Mironda Williams:
It should be because it wasn’t just go see the gynecologist, you were going to start your pap smears.
Dr. Karen Greene:
Exactly. And so that part of it has changed that you had to go to the gynecologist and have a pap smear. Now understand, a pap smear is a screening test for cervical cancer. And back then we did pap smears on everybody that had been exposed to anybody that could give them anything that could cause cervical cancer, and that included sex. So you had sex, you went to the gynecologist, you did a pap smear. That however, can be a very traumatic experience for a lot of younger women. And so they talk to their friends, they talk about how horrible it is, and they don’t want any part of going to a gynecologist and having a pelvic exam. So when recommendations change that you no longer had to have a pap until you were age 21. But the more important thing was actually screening them for sexually transmitted diseases. A lot of women, their moms would start thinking, well, they still need to come and talk. I had an exam. And so we explained to the parents that they do need to come in between ages 13 and 15. But no, it is a conversation.
That’s how we started. We want it to be a conversation. And so the questions from the mom is, “Okay, well what are you going to talk about?” And so explaining to the parents that we’re going to talk about the same sorts of things that we talk about with you, but we want to be in a setting that’s comfortable for them. So at the outset of the visit, we let them know, this visit is your visit. This is your time to establish care with someone that you probably will see on a regular basis for the rest of your life. And so you want to actually be able to ask those questions that you have, get information that’s actually reputable and not information from your friends and from TikTok. And you can even ask the silly questions and things that your friends have been talking about. Do I have to? Does it do this? All those questions that they really want to ask that they might actually be a little uncomfortable with asking their parents about.
My children went through the school system at a time where I don’t think they got as much of good sexual education. And so a lot of kids do have questions that they think they’re getting the answer from because they can Google everything. But they really don’t quite understand their anatomy. They don’t understand how things work. They may not even understand how they get certain things and certain things being sexually transmitted diseases even though they had a health class in school. And so having them come in for that visit and explaining why it is important to have good sexual health, is important to ask those questions. And then if things like birth control and prevention of pregnancy is indicated, then we have that discussion as well. And we try to have that discussion away from mom so they can be free to ask all the questions and all the things they want to ask about.
Dr. Deanna Guthrie:
Because that setting, like I said, sets the tone for that young woman’s, for the rest of her life as far as gynecology visits are concerned. There are a lot of women who just don’t come because it was such a bad experience that one time. And it takes then to even further that misconception, she now has to wait until only things are bad.
Dr. Mironda Williams:
Exactly.
Dr. Deanna Guthrie:
An infection when you’re already hurting, you’re uncomfortable, and then you have to have an exam during this uncomfortable time which further sets that up. So bringing your teen in early just to talk to get information in a relaxed setting where nothing is wrong, nothing is going on, kind of lets them know that coming to the gynecology does not mean something bad or something uncomfortable or something painful. So that’s so key as far as that’s concerned. And it’s not… And talking about sex doesn’t mean that you’re going to have sex. A lot of parents have that fear-
Dr. Mironda Williams:
We just won’t talk about it. If we don’t talk about it, they won’t do it.
Dr. Deanna Guthrie:
If you don’t talk about it, it is not there. No.
Dr. Mironda Williams:
Not so much.
Dr. Deanna Guthrie:
Studies are showing that, no… But the thing about kids nowadays, you said they have so much information. When we came up, you’d have to go searching for books and-
Dr. Mironda Williams:
Go to the library to the back and see-
Dr. Deanna Guthrie:
You got to sneak to the library and then, what you did at the library?
Dr. Mironda Williams:
Oh, nothing.
Dr. Deanna Guthrie:
Oh, nothing.
Dr. Karen Greene:
Research. Got a paper.
Dr. Deanna Guthrie:
And it’s almost like you said, it’s another pendulum. Now, they almost have too much information that they can’t process correctly or appropriately as Dr. Greene said, what does this mean to me or for me? And so again, just getting reputable information from a trusted source is very, very key.
Dr. Mironda Williams:
Right. And again, this goes along with our whole philosophy and I think where a lot of healthcare is trying to go, which is to Dr. Guthrie’s point, well care. Going to see your gynecologist as a young woman and into your older years is just a part of your well care. You don’t want to set up the expectation and the anticipation that I only go see a doctor if there’s a problem or I don’t want to go see the doctor because they’re going to find a problem. No, this is a part of your well care. And I think that’s the thing that the ACOG, American College of Obstetrics and Gynecology really emphasizes about why it is important to get your young girl, woman, lady to come see a gynecologist before turning age 21. 21 is just when we start doing those screenings for pap smears. And again, pap smears is the test that we do to help screen for any changes that are early changes that could lead to cancer.
But the reason for doing the pap smear is to prevent the cancer so that we can determine if there’s something that needs to be treated at that time. But there’s so much more that goes into establishing a relationship with your gynecologist. It’s not just to come to get your pap smear because you’re afraid you may have cancer. It’s about learning healthy lifestyles, how to feel good about yourself. I think Dr. Greene has now two men that she’s raised, and so she has very personal and real experience with the challenges that these young folk have these days because they have so much input. Gender identity issues. Am I “normal?” Is this “normal?” Well, normal may mean a number of different things. And the way these algorithms work, if you click on one thing, it’s going to send you down a whole rabbit hole that’s going to reinforce something that may not be true.
So that’s really any relationship with a physician or any provider is for that. We’re trying to establish a safe space, a space that is trusted where you can have these conversations and get information as these young people are learning who they are, what do they like? You don’t know. You just got here. You’re just starting to experience these things. Don’t put yourself in a box. Don’t make a decision now because you’re experiencing the input that you’ve gotten. You’re still gathering that. You’re still experiencing these things. And so we want the young person to come to see the gynecologist because you want to learn how to establish these healthy lifestyles and how to feel good about yourself. In another episode of our podcast, we talked about having good body image and why having a healthy body image is so important because that can sometimes lead you down all kinds of roads.
Dr. Deanna Guthrie:
I had a patient, young girl who wanted, she was 13 or 14, I know she wasn’t over 15, who wanted some sort of vaginal plastic surgery because she felt she didn’t look normal down there like her other friends. And just to have them get the reassurance that this is… You are not abnormal. You may not look like your friend, but you are not abnormal. Or even sex, like I said, the studies are showing that kids are watching porn in elementary school. So their whole concept of what sex is can be completely skewed if they’re not able to discuss it and know what is normal or healthy. I hate to use the word normal, but what is healthy. That’s the word to use. So there’s so many issues, but that body image is so key for women, like I said-
Dr. Mironda Williams:
At really all ages, but definitely trying-
Dr. Deanna Guthrie:
Definitely in the teen years.
Dr. Mironda Williams:
Teen years.
Dr. Deanna Guthrie:
Or breast implants so early when their breasts haven’t developed yet, that sort of thing.
Dr. Mironda Williams:
My boobs came in late. People, I’m just here saying. I’m a late bloomer. But anyway-
Dr. Karen Greene:
But you didn’t have social media to compare. You just could look at people. But with social media, you get it-
Dr. Mironda Williams:
In your face.
Dr. Karen Greene:
In your face all the time. And you speak of the algorithms, and so that really does play a part in… If they look at someone that looks like a certain way, every single video that person’s going to look that way. And then they’re going to look in the mirror and say-
Dr. Mironda Williams:
I don’t look like that.
Dr. Karen Greene:
I don’t look like that.
Dr. Deanna Guthrie:
But even to that point is that those are doctored. There’s so many filters.
Dr. Mironda Williams:
Right. You don’t even know if it’s real.
Dr. Deanna Guthrie:
You don’t know what’s real or not.
Dr. Mironda Williams:
AI, could be AI breasts. You don’t [inaudible 00:12:29].
Dr. Deanna Guthrie:
AI breasts.
Dr. Mironda Williams:
Or body part, some other body part could be altered.
Dr. Deanna Guthrie:
So there’s so many things hitting our teens from all different directions, that is so important for them to have a place to go to talk about it.
Dr. Karen Greene:
And it’s actually nice to be able to sit in a room with a teenager and explain stuff and show them pictures and let them ask questions and say, “Okay, this is just an example. You might not look like this. And that’s okay. This is what the labia looks like.”
Dr. Mironda Williams:
We see possibly 20 vagina a day.
Dr. Karen Greene:
Right.
Dr. Mironda Williams:
They all different.
Dr. Karen Greene:
They all different.
Dr. Mironda Williams:
Nobody look the same.
Dr. Karen Greene:
They all different. Just like everybody’s face looks different. It’s just another part of your body that’s going to look different. Your breasts are going to look different. Your breasts might not be the same size.
Dr. Deanna Guthrie:
Doesn’t mean it’s abnormal. Exactly.
Dr. Karen Greene:
But you get that it can make a woman self-conscious. But to have that safe space and say, “It’s okay to be self-conscious, but this is actually normal for you and we want you to be healthy.” I think that’s the key. We want the kids to be healthy. We want them to be able to ask the question, even if they are not really sure what they’re asking, just ask the question. Just ask the question. Have that communication. And to our listeners, if you are not near us, find a provider that you can talk to and communicate with. Because as Dr. Williams said, we sometimes feel like maybe we are the exception in terms of the education portion of it. But I think education is so key because you can get so much information that’s not always correct information and you can’t process it. And we like to help you process that. And not to add to your fears about coming to a doctor’s office.
Dr. Mironda Williams:
So talk a little bit in specifics in terms of what happens. Let’s say I’m bringing my 16-year-old, 17-year-old daughter to see you Dr. Guthrie. She’s going to her senior year of high school, Dr. Guthrie. So can you just talk to her? Dr. Guthrie, can you talk to her please?
Dr. Deanna Guthrie:
Sure. I’d be more than happy too.
Dr. Mironda Williams:
Dr. Guthrie, do I have to be in the room?
Dr. Deanna Guthrie:
No. If she wants you in there, you are more than welcome to be in the room. And I asked the patient, and as Dr. Greene had mentioned earlier, it is her visit. I do let them know there’s… And it depends on which state you’re in, there are laws as to the confidentiality of your discussion with the patient. And I let my teens know that whatever you tell me, you guide what I tell your parents. I don’t go behind your back and say, “Let me tell you what she told me today.” That won’t happen. But I do encourage my teens, but do talk to your parents. This is not… If you wanted something private, yes, you can have it, but I say, “But your parents are there for you. Believe it or not, they have been through what you’ve been through. You may not believe it.”
I had one patient who when I walked in the room and I asked her, I said, “Are you having sex?” She goes, “Maybe.” I said, “That’s probably a yes.” And I said, “You know your mom brought you in because she wanted me to talk to you about birth control.” “She doesn’t know I’m having sex.” Yes, she does.
Dr. Karen Greene:
Yes, she does. They know.
Dr. Deanna Guthrie:
You’re not fooling her. And so it’s just so cute how some teens come in. But like I said, I do encourage them to talk and talk with their parents. And of course, if mom wants to be in the room, and sometimes I have teens who say, “No, she can go wait in the waiting room or no, mom, I want you to be here to hold my hand.”
Dr. Mironda Williams:
And are you going to have to do a pelvic exam on her, Dr. Guthrie?
Dr. Deanna Guthrie:
No, not necessarily for the first visit, no, not at all. Like I said, if we’re just coming in to talk about your periods, if you’ve not been sexually active, there’s no reason to do… Even if you’re getting started on birth control, you still don’t have to have an exam just to get started on birth control. So it depends on the nature of the problem. Now, if you’re complaining about a particular complaint that I do need to evaluate you, then yes, you may have to have a pelvic exam. But believe it or not, we have different size speculums.
And so there are ways to even do the exam that may not be as uncomfortable for you as you think it may be. And it’s not the one size fits all that may be… If you go to a primary care doctor’s office, they’re not going to have the different size-
Dr. Mironda Williams:
Or urgent care.
Dr. Deanna Guthrie:
Or urgent care, yes. Do not wait just to have problems.
Dr. Karen Greene:
Then you got to get urgent care.
Dr. Deanna Guthrie:
You’re going to go to the urgent care. They’re going to have one size speculum-
Dr. Mironda Williams:
One size spectrum.
Dr. Deanna Guthrie:
And a doctor who does not do pelvic exams-
Dr. Mironda Williams:
Every day.
Dr. Deanna Guthrie:
Every day routinely. And so that can be a source of anxiety and discomfort. And what’s it called? Trauma.
Dr. Karen Greene:
PTSD.
Dr. Deanna Guthrie:
[inaudible 00:17:17] for women to have PTSD. And so no. So a pelvic exam is not necessary at a first visit.
Dr. Mironda Williams:
For any visit for a teen and depending on what’s going on.
Dr. Deanna Guthrie:
Depending on what’s going on.
Dr. Karen Greene:
And actually if they’re not having a problem, but they are sexually active, you don’t actually have to do an exam to screen them for those things. They can actually… You can explain to them how to self-collect so that they at least will screen for it.
Dr. Mironda Williams:
Be specific, Dr. Greene. What does self-collect mean, Dr. Greene?
Dr. Karen Greene:
So the reason we screen for sexually transmitted diseases in all teens or anyone below the age of 26 is to protect them. We don’t want them to have a disease. It could potentially affect their fertility when they actually do want to have children later on. And so normally we do a swab in their vagina to screen for specifically gonorrhea and chlamydia, which are the most common things that can cause those type of problems of infertility if not treated. But we don’t-
Dr. Mironda Williams:
How big is that swab, Dr. Greene? What’s a swab?
Dr. Karen Greene:
It’s a Q-tip. It’s just a very long Q-tip. So if they are sexually active, we give them a swab and we give them a container and we tell them, open up the container, take the swab, put it in your vagina, put the swab into the container, break it off at the little black mark, put the cover back on it and leave it in the bathroom. And so they can do it in the bathroom or they can do it in the exam room. And we don’t have to see anything. As long as they are checked to make sure they don’t have anything they’re not aware of. Because a lot of women can have sexually transmitted diseases they’re not aware of. And so they want to be treated for those so that they don’t have problems later on.
Dr. Mironda Williams:
What are sexually transmitted diseases? What are you talking about?
Dr. Karen Greene:
Sexually transmitted diseases like gonorrhea, like chlamydia, like trichomoniasis, like syphilis, like hepatitis, like HIV. So all of those are considered sexually transmitted diseases. But the most common ones we screen for are gonorrhea and chlamydia.
Dr. Deanna Guthrie:
And going back to your self-collect, that is certainly an option. But also to reassure patients that if you’re able to use tampons, this exam will not be extremely uncomfortable for you. And I think that’s the fear they just don’t know. And if you have been sexually active, it’s not going to be uncomfortable for you because the speculums are typically smaller than a penis.
Dr. Mironda Williams:
Let’s hope.
Dr. Karen Greene:
Yes.
Dr. Mironda Williams:
We hope so. But I digress.
Dr. Deanna Guthrie:
I was going to say.
Dr. Mironda Williams:
That’s another topic.
Dr. Deanna Guthrie:
That’s a whole nother topic.
Dr. Mironda Williams:
That’s a whole nother topic. So thank you for bringing those points out. Y’all are reading my mind because that’s exactly what we’re trying to communicate with our young patients, our teens, as well as our moms. That’s why going to a gynecologist is so important. We’ve got the experience. This is what we do all day, every day. So we know how to evaluate a patient’s anatomy so that we can determine what is the appropriate size speculum. And we have all sizes-
Dr. Karen Greene:
All sizes.
Dr. Mironda Williams:
Of speculum. Some are small as your pinky finger and some are bigger because everyone’s anatomy is different. And so we have in our office the ability and we have the equipment and we have the experience to be able to determine what is the most appropriate kind of examination that you need, physical examination, if you need a physical examination, as well as a pelvic examination. Because the last thing we want to do, because we cannot tell you how many times we’ve seen women in their 20s, 30s, 40s who have not been to see a gynecologist in years. Because when they went to see a gynecologist in their teenage, they were traumatized. They were traumatized.
Dr. Karen Greene:
And they never went back.
Dr. Mironda Williams:
And they never went back.
Dr. Deanna Guthrie:
Or women who still come in but it is a true struggle for them when they come in, when they have that exam and it ends up being more painful than it should be for somebody.
Dr. Mironda Williams:
And so again, that’s the importance of bringing your teens in to establish relationship with a gynecologist. This is what we do. If we don’t do anything else-
Dr. Karen Greene:
This is our bread and butter.
Dr. Mironda Williams:
This is what we do. We can do pelvic examinations in a way that are not traumatic, that allow you to feel seen and heard and valued, that you’re not a piece of meat, that we’re not evaluating you in any other way other than as a clinical person that’s trying to make sure that you live your best and healthiest life. And again, it’s the relationship building. And one of the things I wanted to talk about is I think this was something that we ended up doing as a result of COVID. COVID was a lot of things, but it actually I think helped to accelerate our adoption of virtual options, digital options of connecting, communicating with patients, podcasts. All this came out of COVID.
And so again, one of the reasons I stress with moms as well as young girls, young ladies, as they’re getting ready to leave the home, graduate from high school, go off to where they’re going to go off to. Once you’ve established a relationship with us here in this office, yes, you can come into the office physically and be seen, but if you have a question, if you have a concern, you can send us messages through the patient portal. It’s confidential, it’s safe. We can do video visits. There are so many things that we’re doing now that five years ago we weren’t doing.
And so we have the ability to stay connected with you as you travel, as you go off to college and do all the wonderful things that we want you to do. But if you have a question that you don’t feel comfortable talking with your mom or your mom may not know, or your father or whoever your guardian is, you can reach out to your gynecologist and say, “Hey, I have a question.” And you can upload those pictures if you must, of the different things. I’m better. I’m getting better. I’m getting better at the digital communication because these young people take pictures.
Dr. Karen Greene:
Of everything. I personally would like them to describe it, but I have [inaudible 00:23:08] the fact that they’d rather take a picture.
Dr. Mironda Williams:
They take a picture.
Dr. Karen Greene:
They take a picture.
Dr. Mironda Williams:
Upload it securely to the portal-
Dr. Karen Greene:
But then we can talk about it.
Dr. Deanna Guthrie:
You won’t see it on Instagram.
Dr. Mironda Williams:
You won’t see it on Instagram.
Dr. Deanna Guthrie:
I promise you won’t see that on Instagram.
Dr. Mironda Williams:
So anything else, ladies? I think we’ve given the audience a good general view. It’s important. And it’s not just about the pelvic examination, that’s the biggest thing. It’s about the relationship.
Dr. Karen Greene:
Yeah, it is.
Dr. Mironda Williams:
It’s about the relationship that should be lifelong with your gynecologist as you go through all the different phases and journeys of life as a woman and dealing with everything that we deal with.
So once again, please, we’d love to see you here at Rosa Gynecology. We have the three physicians. We also have two wonderful nurse practitioners who are very knowledgeable and accessible, especially to our younger ladies. They do wonderful jobs with them in terms of educating them and giving the information that they need. So feel free to look us up at rosagynecology.com. If you have questions or concerns or things that you may want us to talk about in another episode, you can send us an email at [email protected].
[email protected]. We’ll try to read those emails. You can also check out our website, rosagynecology.com. Continue to share us with your friends and your family and let them know about this podcast and all other kind of podcasts that we have, our website where there’s a wealth of information. So continue to follow us on all of your social media platforms. And until we meet again, we’re on YouTube and we’re on a website and we are-
Dr. Karen Greene:
Live.
Dr. Mironda Williams:
Live and on the air.
Dr. Deanna Guthrie:
She just has to do it.
Dr. Mironda Williams:
Even though we’re closing this podcast, we’re still live.
Dr. Karen Greene:
We’re still live, very live.
Dr. Mironda Williams:
And on the air. So until we see you again, I am Dr. Mironda Williams.
Dr. Deanna Guthrie:
I’m Dr. Deanna Guthrie.
Dr. Karen Greene:
And I am Dr. Karen Greene. Take good care.
Dr. Mironda Williams:
I looked at their light-
Dr. Deanna Guthrie:
I know.
Dr. Mironda Williams:
The light ain’t on. Let me turn the light on.
Produced by Just Eldredge Media