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Shy about talking to your gynecologist? Here are some answers to difficult questions

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A visit to the gynecologist isn't just an essential part of your health routine. It's an opportunity for anyone who has a cervix, vagina or ovaries to ask questions about their reproductive health, from painful periods to a decreased libido.

If talking to your provider about this kind of stuff makes you feel shy or squeamish, you're not alone, says Dr. Rachel Bervell. She's a physician with training in obstetrics and gynecology and the co-founder of The Black OBGYN Project.

"I come from a strict immigrant household," she says. "I never had the birds and the bees talk. I never had any of those types of conversations."

Today, Bervell is much more outspoken about this topic — in fact, there'sa viral video on Instagram of her talking about what happens during a pap smear ... at her family's Thanksgiving dinner.

You shouldn't be afraid to speak up, either — especially when your health is on the line, says Bervell. To give you an idea of what kinds of questions you can ask your provider, Bervell answers queries from our listeners. Whether you're a woman, trans or non-binary, this story is for you. This interview has been edited for length and clarity.

I have terrible anxiety surrounding pap smears. Are there any changes I can make during a routine exam that gynecologists would be willing to accommodate?

Sometimes anxiety is because of a bad experience, whether that's conditions like vaginismus [an involuntary tensing of the vagina] or other pain, or because of prior [sexual] assault.

There are things you can do to make the pap smear easier for you. Think of your provider as a partner in your care. If you feel like there will be a concern with pain or discomfort, ask the provider to use a smaller speculum. Ask them to use more lubrication. And [get them to help you] understand why you're doing this exam. At the end of the day, it's to prevent cancer. But it can be done in a way that prioritizes your needs and comfort.

I have intense period pain. How do I know when my pain isn't normal?

Excessive pain during or outside your cycle can be noteworthy because it can indicate an underlying health issue — something isn't "quite right" and is contributing to the subsequent pain/discomfort. In that case, it's important to seek medical attention to identify the source of that issue, diagnose the underlying cause and receive treatment. The last thing we want to do is wait for worsening conditions or complications.

Conditions like endometriosis, when [endometrial-like] tissue that's supposed to be within the womb [grows] outside the womb, can cause debilitating pain and discomfort for patients.

If you're having intense period pain andyou can't get relief from an over-the-counter medication like Tylenol or ibuprofen, consider talking to your physician or your provider about other ways to ease that pain.

I'm a post-menopausal woman with both ovaries removed and I am not taking any hormone replacement therapy. How do I get my libido back?

When we stop our ovarian function, which is really what menopause is all about, you are no longer releasing eggs. You're no longer able to have those eggs fertilized. And there will be a decrease in estrogen. Estrogen is needed to maintain the lubrication, elasticity and blood flow in the vagina. When estrogen drops, vaginal dryness occurs.

I recommend an open honest conversation with your health provider. They might suggest hormone replacement therapy, vaginal estrogen, lubricants and moisturizers or meds to address sexual dysfunction. They may ensure you are maintaining positive health habits and assessing stress/psychological factors overall. Enjoying sex and having a libido is not just biological, it's also lifestyle and behavioral.

I deal with multiple sclerosis, which causes severe spasticity. In order for me to get a simple gynecological exam, two people must support my knees and keep them open. But most doctors' offices have said they cannot accommodate me. As a result, I do not see a gynecologist as often as I should, simply because it's uncomfortable and embarrassing when my foot kicks the doctor without my control. What should you do if you're struggling to find a gynecologist who can meet your needs?

This isn't the best answer, because it's telling the patient they have to do the work for themselves. But No. 1 is, you know what you need. And you know providers are supposed to take care of your needs as a patient that has a disability [it is also the law].

Making sure the clinic is accessible to you should be your priority, and the clinic should be able to respect that and respond accordingly, because that's our duty. So speak up, send a message ahead of time.

If your provider cannot accommodate you, find someone else who will respect how you are coming to the provider and ensure you are getting the care that is necessary.

How should I talk to a gynecologist about birth control?

The first question is to figure out what your goals are. Is it because you don't want to get pregnant and you're not ready to start a family at the moment? Are you concerned that your periods are not regular and you want some consistency? Or is it to help with other health conditions like acne or heavy bleeding [during your period]?

Once you figure that out, your provider can talk to you about the full scope of options. One of the organizations I always refer to is Bedsider.org. They've done a wonderful job of listing all the birth control types with their effectiveness and what it does, what's included, what it looks like, where it goes.

The digital story was edited by Margaret Cirino and Meghan Keane. The visual editor is Beck Harlan. We'd love to hear from you. Leave us a voicemail at 202-216-9823, or email us at LifeKit@npr.org.

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Copyright 2024 NPR

Emily Kwong (she/her) is the reporter for NPR's daily science podcast, Short Wave. The podcast explores new discoveries, everyday mysteries and the science behind the headlines — all in about 10 minutes, Monday through Friday.
Malaka Gharib is the deputy editor and digital strategist on NPR's global health and development team. She covers topics such as the refugee crisis, gender equality and women's health. Her work as part of NPR's reporting teams has been recognized with two Gracie Awards: in 2019 for How To Raise A Human, a series on global parenting, and in 2015 for #15Girls, a series that profiled teen girls around the world.