We’d love to see you, but I won’t lie. Sometimes patients come in and want me to look at a mole on their leg, or want advice on back pain, or congestion. While it’s flattering that patients think I know everything, gynecology is a true specialty and has its scope. Those health issues listed above? Not gynecology! Your orthopedic surgeon isn’t going to help you solve your PMS symptoms and I, fortunately, am not going to troubleshoot your broken ankle.
So what are common issues people visit a gynecologist? So, so many. But here are some common ones:
Routine health maintenance is an important part of health care. It helps you reconnect with your doctor and talk about staying healthy. When a health issue arises, doctor visits are focused primarily on that health issue. A routine visit allows time for everything else.
TIP: if you have a specific concern you want to talk to your gynecologist about, tell the office staff when scheduling your appointment. They may schedule you for a longer appointment to address both the annual exam AND the concern at hand! They may also advise you to schedule 2 appointments – an annual and a problem visit. Either way, the goal is to get all your concerns addressed without feeling rushed.
~2~ Irregular periods
It can be normal to have one or two irregular periods a year, especially in times of stress or big life changes. It is also normal to have slight fluctuations in cycle length every month – for example, to expect a period every 28 to 31 days (up to 7 days difference is usually considered normal). However, consistently irregular periods or no periods for long lengths of time should be evaluated. Likewise, extra bleeding between periods or after sex should be noted. The evaluation might include blood work (like hormone levels), vaginal swabs, and sometimes an ultrasound. A common underlying cause of irregular periods is Polycystic Ovarian Syndrome, which is associated with other health issues as well. The underlying cause of irregular periods is super important to uncover! That’s the first step – before recommendations or treatments are recommended!
~3~ Heavy and painful periods
Heavy periods can be painful and are a major contributor to anemia. They can affect normal life, like work and exercise and keep you housebound. Periods should not be like that! Some reasons for abnormally heavy bleeding include fibroids or polyps, clotting or bleeding disorders, infections, medications, or, rarely, cancer. The underlying cause of the heavy bleeding and the severity of it should be investigated to know how best to help treat the problem!
People can have painful periods for a variety of reasons too, and a discussion of possible endometriosis is often at the top of a person’s list to discuss with their doctor at office visits for this. Evaluation and treatment options often depend on the severity of pain and how much it impacts a woman’s life. Sometimes painful periods are easily helped with medications and lifestyle changes. Sometimes painful periods are debilitating and medication after medication have failed. There is such a wide range here. The bottom line is if you are bothered by the pain with a period, see your gynecologist.
Urinary tract infection (UTI) symptoms include burning, pain, and feeling the urge to urinate even when the bladder is empty. UTIs are often simply treated with a course of antibiotics. Recurrent UTIs (typically defined as 4 or more per year) may require a bit more to help prevent and treat.
When females have had a UTI in the past and the symptoms are exactly the same, a gynecologist visit may not be necessary. I usually just prescribe antibiotics without an office visit so there is no delay in treatment! However, if the symptoms aren’t clear and the person is unsure what may be causing the symptoms, an evaluation is a good idea.
~5~ Abnormal vaginal discharge
Abnormal vaginal discharge should absolutely be evaluated by a gynecologist. It may be an indication of a vaginal microbiome imbalance, a sexually transmitted infection, or a variety of other issues. Abnormal vaginal discharge can be hard to self-diagnose, so an exam is often indicated.
Females can also become concerned about abnormal vaginal discharge when it is simply a change in the vaginal discharge during different parts of the menstrual cycle. These fluctuations and changes can be better explained and reassurance provided if the exam is normal. Remember, it’s important to see a gynecologist when the symptoms are present. A description of what the symptoms were is not as helpful!
~6~ Vaginal odor
Vaginal odor is a common concern – don’t be embarrassed (trust us, we’ve seen worse!). It is often the result of a bacterial infection called bacterial vaginosis (BV). However, odor can be from other causes too – such as an STI, something stuck inside the vagina like a forgotten tampon, or body odor. To be able to help figure it out, an exam and some swabs or tests may be helpful.
~7~ Lumps in the breast
A clinical breast exam is a normal part of a gynecologic annual exam. Women often see the gynecologist for lumps or pain in the breasts too. These lumps can sometimes be normal, especially with dense breast tissue called fibrocystic breast tissue. Other times, a noticeable rubbery ball -like mass may be noticed. These lumps are often benign growths called fibroadenomas. Breast lumps and bumps are usually evaluated with a breast exam in the office and some sort of imaging, like a mammogram or ultrasound.
~8~ Preconception and fertility
This visit is super common and absolutely recommended! It’s one of my favorite discussions.
Planning on trying to get pregnant in the next 3-6 months? Come see us! We talk about getting off the current form of contraception and what to expect. Will there be a delay to fertility? Maybe and maybe not. We talk about optimizing natural fertility. We discuss prenatal vitamins and other supplements that may be helpful. And finally we run some tests to look at your health status – like checking blood type, anemia, vitamin D, and STIs.
Not ready to get pregnant? Let’s talk about contraception. There are lots of different options, but none of them are perfect. Hormones versus no hormones, STI protection needed or not, long acting versus short acting – we can talk about all these! There’s often a trial and error period as well (with the error hopefully NOT being a pregnancy, but a “I’m not super happy with this method” type of error). Bedsider.org is a great resource to get you started
~10~ STI testing
You honestly don’t NEED a gynecologist for testing alone – this can be done with a primary care doctor. But complications or longer term follow up of STIs, like herpes or HPV, needs a gynecologist’s expertise
~SO~ many more!
Here’s a list of common other issues we address with patients! We never want you to feel embarrassed to bring up something – if we aren’t sure what to do with the symptoms, we’ll tell you!
- vulvar or vaginal itching and irritation
- painful sex
- low libido (low sex drive)
- ovarian cysts
- low abdominal or pelvic pain
- a palpable mass or heaviness in the pelvis
- perimenopause and menopause symptoms
~Last~ few words of advice:
- It is helpful to gather information before the visit. For example, if you are having irregular periods, a calendar of the last 6-12 months of bleeding can help evaluate the problem far better than simply saying “my periods are irregular but I don’t know how irregular”.
- Gynecologists don’t care if you shave your legs, or wax your pubic hair, or paint your toenails! Come as you are.
- When you visit a gynecologist, a pelvic exam is not mandatory! Some concerns do require an exam to complete the evaluation, but many don’t! If you’ve never had an exam before, let your doctor know. I usually explain the process a bit more and that may make you feel more comfortable.
- As with any doctor- patient relationship, establishing rapport and trust is key. If you aren’t happy with your doctor for whatever reason, it is very reasonable to switch or seek a second opinion. Doctors also do not have their “feelings hurt” if you seek a second opinion. It can sometimes confirm their opinion, or it may provide the patient with a different approach or perspective. Either way, if you as a patient feel you would benefit from another doctor, I encourage it!
I am a board certified OBGYN at Cedars Sinai in Los Angeles.
I am co-founder of Female Health Education, a platform offering digital courses, striving to empower females through health education.
My passion is promoting and demystifying health information to the public. My blog, Dr. Sara Twogood’s LadyParts Blog, provides comprehensive information about fertility, pregnancy, and gynecology topics. I am on the medical board for the period tracker app Flo; contribute as a medical expert for pregnancy app and website The Bump; and serve on the Byrdie Beauty and Wellness Review Board (Byrdie.com). I have been featured as an expert for the podcasts The Dream and Her body, Her Story and quoted in numerous online and print publications.
I am honored to be named “Top Doctor” in Los Angeles magazine for years.