How to choose the right gynecologist
Gynecologists in Ireland have a unique role in helping women choose the best care for their health.
A recent study published in the British Journal of Gynecology found that while it’s easy to understand the difference between a gynecological ultrasound, which provides a more detailed picture of the lining of a woman’s cervix, and a pelvic ultrasound, a more basic exam, it’s not always obvious.
“We’re still trying to understand why this is, and how does it work?” says Dr Michael O’Sullivan, from the Mayo Clinic’s National Women’s Health Unit.
“But we’ve got a lot of insight into the biology of women, so we think it’s a good thing.”
Dr O’ Sullivan says it’s important to take into account the health of the woman, their age, and the type of treatment they’re receiving.
For example, women in their 20s and 30s, who are less likely to be having a miscarriage or have an ectopic pregnancy, are more likely to receive a pelvic scan than those in their early 40s, and they’re less likely than women in middle age and older to receive an ultrasound.
Dr O, who’s also from the University of Warwick, says it may also be a factor in the differences in the outcomes of women between different gynecologists.
“It’s not necessarily a one-size-fits-all, it depends on the women and their health history,” he says.
“Some women may be better off having a pelvic exam and having it done by a doctor who’s more experienced in that area, but that’s still very much a trial-and-error process.”
And some women may have other health problems, such as a history of pelvic inflammatory disease, pelvic inflammatory hyperplasia, or pelvic inflammatory arthritis, which can cause pain, swelling and scarring in the area.
The Mayo Clinic has guidelines for the type and frequency of pelvic exams that it’s willing to accept from women.
The guidelines recommend only having a gynecomastia scan if the patient’s doctor has already done a pelvic examination, and that the scan is conducted by a specialist.
“These are things we know from other cultures and we know what the benefits are,” Dr O says.
Dr Michael McGurk, a gyntician at Mayo Clinic who also runs the Irish Gynecological Society’s Women’s Rights Committee, says a more complete examination will be necessary for women with gynecologic conditions.
“I think we’re moving from the traditional pelvic exam, which is a very simple and very basic one that’s given to us by a couple of hours and done by someone else, to a complete examination that involves a doctor and a doctor’s assistant,” he explains.
“This will help us to make better decisions for women, and also for the gynecologically aware gynecogenists and midwives, who will be able to offer more accurate information on how a woman is performing her care and what kind of treatment is appropriate for her.”
Dr McGurm adds that there are several factors that affect a woman having a vaginal examination.
“There’s the size of the vagina and the shape of her cervix and her overall anatomy,” he adds.
“Also, there’s the age of the patient, how many children she has and how many partners she has.
These are the things that will impact the quality of the exam, and if it’s done in a woman with a low risk of developing a condition like pelvic inflammatory diseases, then it’s probably a good idea to have it done in that woman.”
There are also the potential complications of undergoing an examination, like pain and infection.
Dr McGurn also notes that women with a history or other symptoms that could put them at risk of an ectopy, such the need to have an abortion, may not be ready to undergo an ultrasound in the first place.
“The cervix is the first part of the body that’s getting exposed to the outside world,” he tells ABC Radio’s The Weekend Breakfast.
“If it’s leaking or it’s infected, you’re not going to be able go through the rest of the cervix.
If it’s bleeding, that’s not good, and so it’s always better to have a complete exam.”
If a woman does want to undergo a pelvic MRI, there are a number of options available.
“You can do an MRI of the entire pelvis, which might be quite invasive,” Dr McGarthur says.
But if it can be done in time for the end of her pregnancy, there is the option of having an MRI done just under her belly button.
“That is an operation that will take around five minutes and a lot less discomfort,” Dr James says.
If a patient is not comfortable doing an MRI, it can also be done during a physical exam, he adds, although this procedure is