The Village finally plucked up the courage and decided to ask questions about the most important thing: why coitus interruptus is a so-so method, what every girl should learn about herself, and why great love is dangerous
- Sasha Sheveleva, March 20, 2015
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In various fields of knowledge, everything is now changing so quickly that even specialists cannot keep up with the changes, let alone ordinary citizens. Therefore, in the section “What’s new?” Every week we learn from scientists, doctors and other professionals about how their fields are changing and what those changes mean for mere mortals.
In this almost final issue of our medical detective story, The Village correspondent Alexandra Sheveleva met with Svetlana Yureneva, Doctor of Medical Sciences, leading researcher at the Department of Gynecological Endocrinology at the Scientific Center for Obstetrics, Gynecology and Perinatology named after V. I. Kulakov of the Ministry of Health of the Russian Federation. It may seem that this issue is only for women, but we urge all our readers to read this interview - regardless of gender, race, religious beliefs or sexual experience.
About postponing children for later
- It must be admitted that even educated adults know sadly little about contraception. Hormonal contraception in Russia is still viewed with distrust.
Before we start talking about modern contraceptives, I would like to give an understanding of what is happening to women in the modern world. Women have begun to care more about their education, their careers, they get married later and, accordingly, the issue of implementing their reproductive function is postponed until the age of 30–35 and older. But from the point of view of biology, nothing has changed in the female body (evolution does not happen so quickly) and the best age for the birth of the first child is still 20–25 years old (up to 30). Therefore, when a woman postpones a decision until later, we have to deal with the problems that the woman has accumulated throughout her life. Secondly, life expectancy has changed. Today a woman lives quite a long time, but her reproductive period has not changed. Previously, women began to give birth after they matured (at 18–20 years old) and had three to five children. This means that the number of menstruation and ovulation in women was limited: the woman was either pregnant or lactating. During pregnancy and lactation, women’s eggs do not mature; this is the time for the ovaries to “rest.” In very few women, the menstrual cycle and ovulation are restored during breastfeeding. For most, ovulation does not occur due to very high levels of the hormone prolactin, which is responsible for milk synthesis. Now look: age at menarche ( the beginning of menstruation. - Approx. edit.) - 12 years (from 11 to 14 years).
- Is it true that girls mature earlier now?
There is such a tendency. Maturation is closely related to height and weight, especially weight. Thin girls get their periods later; in those who are obese, earlier (more adipose tissue and more estrogen). So what's the problem? A woman has matured, but she does not realize her reproductive function, does not use contraceptives that block ovulation, lives an ordinary life, and can have several abortions before she decides to get pregnant (and we understand that termination of pregnancy has a very serious impact on reproductive function). This means that her ovaries are not resting at all. And such a woman has a potentially greater risk of getting many diseases of the female sphere: uterine fibroids, endometriosis (especially if she had abortions), benign diseases of the mammary glands. If she does not use condoms, with a large number of sexual partners, there is a high risk of acquiring sexually transmitted infections. All these problems accumulate with age. And when a woman decides to realize her reproductive function, it may turn out that there are problems.
- Do I understand correctly that the ovaries rest while a woman is pregnant or breastfeeding?
Yes, because the egg does not mature. At the beginning of the cycle, the follicle matures, estrogens are produced, after which the follicle ruptures, an egg is released from it, which travels into the abdominal cavity. If it meets a sperm, it enters the uterus through the tubes and there, already fertilized, attaches. In the place where the egg is released in the ovary, the corpus luteum is formed, which produces the hormone progesterone. It transforms the lining of the uterus and prepares it for pregnancy. If pregnancy does not occur, this endometrium is shed and menstruation occurs. This is a normal cycle. If a woman is pregnant, there are no conditions for the next follicle to mature; the ovaries rest and are therefore not injured. The fact is that the rupture of an egg and its release into the abdominal cavity is always an injury to the ovaries, which increases the risk of endometriosis and ovarian cancer. It's not helpful. Nature did not provide for monthly ovulation for many years (from 20 to 30 years, for example). Menstruation is not always desirable at all: due to injury to the ovary, and due to the fact that there may be reflux of menstrual blood through the tubes into the abdominal cavity and theoretically increases the risk of developing endometriosis. As a result of such work of the ovaries without “rest,” disorders can occur, for example, functional ovarian cysts, which not only cause pain, but also apoplexy, and then women with severe pain are admitted to hospitals.
We can encourage women to give birth young, but if a woman is postponing the birth of her first child, then the most correct thing is use contraception, which will turn off ovulation
- The worst thing is that this happens even to young girls.
Correct, because the process is disrupted. What is a functional cyst? When the follicle does not rupture at the right time, it begins to grow, produces a lot of estrogen, and then this cyst can rupture. Due to anatomical features, cysts in the right ovary rupture more often. This functioning of the ovaries without rest is not physiological, so the pharmaceutical industry has proposed an ingenious solution. We understand that life has changed: we can encourage women to give birth young, but if a woman is postponing the birth of her first child, then the most correct thing is to use contraception, which will turn off ovulation.
From the point of view of the physiology of the female body, this is perhaps the most correct approach. Combined oral contraceptives block the maturation of the egg and prevent the follicle from growing. And this is real prevention of functional cysts. Secondly, these contraceptives allow the ovaries to rest. This, of course, is not a chemical pregnancy, but the closest state to this situation. Therefore, the recommended duration of taking contraceptives is at least one and a half years, because pregnancy lasts nine months and lactation lasts about nine months.
About egg reserves
- At what age do you recommend starting to take hormonal contraceptives?
It depends on when a woman becomes sexually active. The hormonal form of contraception is preferable for many women. There is another important point that women who are planning to delay the birth of a child should be aware of: we are all born with different ovarian reserve (the number of eggs in the ovaries). One can afford to give birth at 35 or 40, while the other is already exhausted at 30 years old. Then there is nothing we can do.
- And I thought that they all had the same amount - about 250 thousand.
For most, this reserve is large and begins to be used up throughout life, but some women are initially born with a very low reserve. Therefore, we recommend that young people take tests for anti-Mullerian hormone, which is an indicator of this ovarian reserve. This way they will be able to understand what is going on with their reproduction and whether they can afford to postpone the birth of their first child until later. I have had cases in practice when girls at the age of 20 had such low levels of anti-Mullerian hormone that problems had already begun. We have two of the most important markers for assessing the ovarian reserve of the ovaries - anti-Mullerian hormone and counting the number of follicles according to ultrasound diagnostics. This is all absolutely accessible, but it allows us to program a woman’s life and not face the problem when at 20 we can no longer do anything. If the reserve is small, then you urgently need to get pregnant, give birth, or use new approaches: before the age of 20–25, take tissue from the ovarian cortex in order to get something from it later. We have already learned to freeze embryos and eggs, but what is even better and even more promising is to take a little ovarian cortex. True, after 25 years there is no point in doing this. It is believed that only 1% of women have low ovarian reserve, but I think there are more of them now.
- Why?
There are many factors. Firstly, genetic predisposition. For girls whose mothers stopped menstruation early, we recommend that you definitely determine your ovarian reserve. The average age of menopause is 45–55 years. If a mother’s ovaries shut down before the age of 45, her daughter definitely needs to determine her reserve. Secondly, various medications, smoking, radiation, and immune problems negatively affect the ovarian reserve.
It has been proven that infertility is more common in women who smoke and ovarian function is switched off earlier. After all, germ cells are the most sensitive to any toxic effects. Today, combined oral contraceptives, which contain both estrogen and gestagen, are the most biologically justified from the point of view of preventing many gynecological problems. In addition, the viscosity of the mucus increases, the likelihood of penetration of pathogenic agents is less, and therefore there are fewer inflammatory diseases.
In women who do not ovulate no premenstrual syndrome
“But people are still afraid of the word “hormonal.”
Hormonal contraception using combined oral contraceptives is most effective (98%). Some are afraid of hormones, others are afraid that they will gain weight, but modern contraceptives (a large number of studies have been conducted) do not cause women to gain weight. We now use other doses, today contraceptives have appeared that contain not synthetic ethinyl estradiol, but estradiol, which is identical in chemical structure to estrogen, which is synthesized in a woman’s ovaries. In order for the mucous membrane to be rejected, a certain amount of biologically active substances is produced, and some women are very sensitive to them. There are many problems beyond contraception that we can help solve. For example, painful or heavy menstruation, migraines during menstruation, acne, problem of hair loss or excessive hair growth. There is a contraceptive that can be used to treat heavy bleeding, containing the same estradiol, identical to natural.
- Yes, that's understandable. But no matter how high the degree of protection a contraceptive may have against unwanted pregnancy, it is reduced if a person simply forgets to take it according to a certain regimen.
During clinical practice, doctors realized that the largest number of errors and a decrease in the contraceptive effect occurs due to the fact that a woman on a standard regimen (takes a contraceptive for 21 days, then does not take it for 7 days) forgets to start taking a new package. Therefore, now we most often choose contraceptives of a different mode, when there are 28 tablets in a package. This is more convenient for a woman because she does not have to think about taking a break. Even if she forgets one tablet, this will not greatly interfere with the effect of the drug. There is also a myth that taking hormonal contraceptives can lead to infertility or difficulty getting pregnant. In fact, when you finish taking the last pill, the effect of the contraceptive ends. The last pill and fertility is restored. Nowadays they also use such flexible regimens for taking the drug, when a woman can take pills continuously for 120 days and take a four-day break when she wants. It is convenient and meets physiology. Everything is evolving, and so is hormonal contraception.
- How to choose a hormonal contraceptive?
I believe that it is imperative to do an ultrasound: now even young girls have problems. To select contraceptives, no strong special examinations are needed, especially for young people. We always assess the risks of possible complications when deciding on the selection of contraception, and every gynecologist knows them.
About premenstrual syndrome
- What is premenstrual syndrome, from a scientific point of view?
Premenstrual syndrome is an abnormal response of the female body to normal cyclical changes in hormone levels. If a woman has problems with premenstrual syndrome, when she swells in the second phase of the cycle, her mood changes - on the one hand, this is bad for her and her loved ones. But on the other hand, such a woman should know that everything is fine with her, because she is ovulating. Women who do not ovulate do not have premenstrual syndrome.
- It turns out that premenstrual syndrome is good.
Of course, it’s not very good, but it only happens to women who are ovulating. Today we have a contraceptive that, in addition to contraception, has a second indication for use - the treatment of premenstrual syndrome and premenstrual dysphoric disorder (this is a more severe condition). Its effect has been proven in placebo studies. In addition, women with premenstrual syndrome often experience fluid retention and swelling, and this drug prevents fluid retention.
- As I understand it, I cannot choose a hormonal contraceptive on my own?
It needs to be chosen and prescribed correctly, so we still do not recommend going to the pharmacy and buying it yourself. There are many nuances; drugs vary in composition and combinations of ingredients. For example, there are now drugs that contain folic acid in an active form, which serves to prevent defects in the fetal nervous system and also ensures a good mood. (It turned out that in Russia there are many women who have a defect in the enzymes involved in the metabolism of folic acid, so it is not always well absorbed). If a woman is pregnant, she is prescribed folic acid. But neural tube defects form until 28 days after conception, when a woman often doesn't know she's pregnant. Therefore, our task is to saturate her with folic acid before she becomes pregnant. Often women, unfortunately, become pregnant without planning. And if she takes contraceptives with folic acid and decides to get pregnant, then the issue of preventing the development of defects will be resolved. Today there are many women who care about feeling good, not getting old, and not developing menopausal syndrome.
And we have contraceptives for women after 40, which contain estradiol, identical to natural, although these contraceptives can be taken at any age, not only after 40 years. The period when a woman moves from reproductive age to menopause is very difficult: menstrual irregularities, estrogen deficiency, hot flashes, sweating, and functional cysts in the ovary may occur. By prescribing such a drug, we again solve the whole range of problems: contraception, prevention of cysts, reduction of menstrual blood loss, solution of menopausal symptoms. And body weight does not change.
Condom effectiveness twice as low than a hormonal contraceptive
- This old prejudice apparently concerned some of the first generation of contraception.
Yes, old contraceptives. Now we use other dosages and other combinations, especially since contraceptives with estradiol have appeared, which allows us to select the drug very individually. A woman should also understand that taking combined oral contraceptives is a real prevention of endometrial and ovarian cancer.
- How many years can you take hormonal contraceptives?
Today we do not have such restrictions. Unfortunately, in Russia more often than in European countries, gynecologists themselves recommend that a woman take a break from the drug. I believe that everything depends on goals and objectives: if a woman decides to realize her reproductive function, she stops taking contraceptives and becomes pregnant. If her plans don't change, what's the point of taking this vacation? If we are talking about the risks of hormonal contraception, the most significant (although it is very rare) is thrombosis. And this risk is greatest in the first six months of taking contraceptives. If we interrupt and start again, then the risk is exactly the same as if we start for the first time. In any decision - about starting or stopping contraception - you should consult a gynecologist. The doctor will always tell you what is the best thing to do.
- The problem is that people don’t really like to go to our gynecologists, as well as to other doctors.
I believe that today gynecologists are completely different. This past generation of doctors were hormonephobes; they were afraid of both hormonal contraception and hormone replacement therapy (during menopause). Today we have so many scientific articles and studies that we already understand exactly what we need to be afraid of and what we don’t need. After talking with the woman at the first visit, we can classify her into one group or another: low risk, increased risk, high risk.
- Risk of what?
Problems, complications, adverse events while taking hormonal contraception. A factor such as obesity makes you think about whether to prescribe the drug or not, because obesity itself entails a number of problems. Secondly, smoking is a very significant factor. It negatively affects not only reproduction, but also possible complications when taking any hormonal drug. Therefore, we do not prescribe hormonal contraceptives to women who smoke after 35.
- Why?
Because the risks are increasing. That's why we are against smoking: it negatively affects not only the condition of the vascular wall, but also the ovaries.
- That is, up to the age of 35, smokers can still take hormonal contraceptives?
Yes, and after 35, this is already a factor that stops us.
- The problem is that a woman cannot always remember that she needs to take a pill every day.
Soon we will have contraceptives that will have a special device with a reminder to take the pill. It really all depends on motivation. For a motivated woman who plans her life, this will not be a problem. She can set a reminder in her phone, for example.
About spirals, rings and injections
- Unfortunately, there are many disorganized women who cannot always remember that they need to buy a new package at the pharmacy every month.
There is another choice: there are intrauterine contraceptives, for example.
- But it seemed to me that intrauterine devices are only for women who have given birth.
No, they can also be used by nulliparous women. Moreover, today there is an intrauterine device that contains a medicinal substance that enhances the effect of the contraceptive and has a number of additional treatment options. It reduces the amount of blood loss, eases the pain of menstruation, and serves as a prevention of endometriosis. Naturally, women are different, and we cannot persuade everyone to use hormonal contraceptives. The main thing is that contraception is effective, that’s why it was designed. The spiral and combined hormonal contraceptives are highly effective means. I would also like to add that a hormonal contraceptive is not an abortifacient method, because if we take the same IUD, what happens? There are no conditions for an already fertilized egg to attach.
- But there is already a zygote.
Yes. And here we prevent this, and there is no trauma to the ovary. But again: if a young girl is rarely sexually active, then, of course, it is better for her to use a condom. In each case, the issue must be resolved individually. But you know that the effectiveness of a condom is two times lower than that of a hormonal contraceptive.
- Why? I don't understand.
Because they tear, they are put on incorrectly. And the first pregnancy that ends in abortion is an extremely undesirable situation for any woman. My main message to women is not to forget that the healthiest children are born to healthy and young mothers. Therefore, it is still advisable to resolve this issue before the age of 30, or better before the age of 25, if possible. Secondly, you need to use effective contraception in order not only to have healthy offspring, but also to maintain your health.
- I heard that contraceptive injections are popular in Latin America. What it is? This is very convenient: you get an injection and forget about protection for several years.
Yes, a progestogen component is introduced - for three years. In Russia there is also such an option, but one of the most common adverse events is intermenstrual bleeding, sometimes prolonged. And this leads to the woman refusing this type of contraception. Although most women experience amenorrhea when menstruation is absent. This is good for some, uncomfortable for others.
Secondly, the FDA ( American Food and Drug Administration. - Approx. ed.), where clinicians are required to report adverse events, a report was submitted that cases of premature ovarian failure have been reported with the use of these injections.
A big butt and a thin waist are, from the point of view of reproduction, the best option for a woman
Optimally - three years. It is believed that during this time the female body is completely restored. If the interval between births is shortened (less than three years), problems may arise more often.
- What if ten years?
Everything is individual. Of course, it is better to do this two or three times with an interval of three years, and then solve other problems. We understand that if a woman gives birth, then she needs to devote some time to this child. The first three years are important for a child to have his mother nearby.
- Is a long break between children harmful?
The longer the break, the older the mother’s age, respectively, the more complications during pregnancy, the higher the risk that the pregnancy will end in a cesarean section.
- When I was preparing for this interview, my colleagues asked you to find out whether cervical erosion is really a purely Russian invention, and European doctors do not know at all what it is and why we treat it.
This doesn't mean anything, it's a variant of the norm. In Russia they also think so now. This is not erosion, it is ectopia, which is often found in young women.
- They don’t burn her anymore?
In no case. They cauterize only if there is damage to the epithelium of the cervix, most often caused by papillomavirus. And this is a completely different problem. Erosion in itself is a variant of the norm, and there is no need to touch women.
- How do you feel about rings?
I have a normal attitude towards rings: for some people it’s convenient, why not? But it has been shown that there may be adverse effects such as heavy discharge and vaginitis. In terms of safety, it is the same as a tablet: the effectiveness and safety are the same. Another thing is that someone takes pills, and someone put a ring on themselves.
- What worries me about hormonal contraception: in order to use it, you need to have a regular sexual partner, and not everyone has this.
If a woman has many sexual partners, then a condom, even despite taking hormonal contraceptives, is mandatory. The risk of getting a sexually transmitted disease, including papillomavirus, in this case increases significantly. The more partners, the greater the risk - this has been proven. For women who have regular sex life with a regular sexual partner, hormonal contraceptives are more suitable. Women who have sex once a month do not need contraceptives, unless with their help we solve some additional problems (acne, PMS, migraines).
About sexual illiteracy
- How do you think things stand with sexual literacy today? You communicate with people who come to you.
I not only communicate with people, I have adult daughters. My daughters’ friends listened to me in surprise: they didn’t even know how the egg gets into the uterus. I think that people have become more literate, it is now possible to get information on the Internet, but, unfortunately, there are different sites and they write different things, often unreliable.
- Unfortunately, we live in a country in the capital of which adult women on the playground can tell each other that they protect themselves by douching.
This is scary, it shows our illiteracy. Douching is very harmful, because the vagina is a gateway for infection, so its mucous membrane also performs a barrier function. Lactobacilli create a special acidic environment in the vagina and thus protect it from the penetration of pathogenic flora. If it is washed away, completely unnecessary bacteria can settle there. In principle, there is no need to douche: nature is smarter than us.
- I mean douching after sexual intercourse as contraception.
This is an ineffective remedy if sexual intercourse has already occurred.
- Are there any effective postcoital contraceptives other than emergency contraceptive pills?
No. The fact is that there are highly fertile women and low-fertile ones. Highly fertile women ovulate every month and get pregnant easily. And there are women who ovulate maybe two or three times a year, and you need to understand what type of woman is in front of you.
- How can this be determined?
One option is based on body type. A typical woman with a gynoid (pear-shaped) body type, with a regular 28-day menstrual cycle, is the most ideal option for reproduction.
- Are these women with large breasts and narrow waists?
A big butt and a thin waist are, from a reproductive point of view, the best option for a woman. Men subconsciously choose this type because they intuitively understand that this is the kind of woman who will continue the family line. And women who do not have a waist (android type, or who have abdominal obesity) are less promising from the point of view of reproduction. They are more likely to have anovulation ( absence or irregular ovulation. - Approx. edit.).
About great love
- The second very popular folk method of contraception is interrupted coitus.
This only works for those who are not very fertile. The effectiveness of interrupted coitus is very low, less than 50%. Now there are ovulation tests that are useful both for those who want to get pregnant and for those who want to protect themselves. If everything is clear for a woman, she can understand on what days sexual intercourse will be safe. But sometimes there is one ovulation, and sometimes - due to positive emotions - there are two.
- How is that? What does it mean?
This means, for starters, that she may have fraternal twins.
- What are these “positive emotions”? Is ovulation susceptible to mood swings?
Including, of course.
- Big love?
With great love there is much more ovulation. There is even such a concept - “children of love”. Positive emotions improve all body functions and can also have a beneficial effect on ovarian function.
- That is, if a woman is deeply in love, she has an increased risk of getting pregnant?
This requires a separate scientific study, but my clinical practice says yes. In my practice, there have been cases when girls with amenorrhea, who have never menstruated, fell in love and became pregnant.
- Many people say that they unexpectedly get pregnant on vacation: they went to the sea together, the three of them returned.
Of course, stress is relieved and the woman experiences additional positive emotions. Under stress, the tubes contract more often; sometimes the egg enters the uterus prematurely, when the mucous membrane is not yet prepared to receive this embryo. With positive emotions, a lot of neuropeptides are produced, and the function of the ovaries is very closely related to the central nervous system. With depression, there is often no ovulation because the exchange of neuropeptides in the central nervous system is disrupted.
- They also say that in the first days of menstruation it is impossible to get pregnant.
It all depends on fertility. With age, in the first stage, the cycle may shorten and ovulation may sometimes occur earlier. There is no protection - you need to protect yourself. There is such a Russian “maybe”, “it won’t affect me.” Will touch. Now they have begun to take this more seriously and understand that abortion is not a solution to the problem either from a moral point of view or from the point of view of consequences for a woman’s health. We, gynecologists, are faced with the results of abortions: inflammatory diseases, infertility, and miscarriage. In Europe, abortion is performed only by vacuum aspiration or medication, and when this is done with a curette ( meaning scraping. - Approx. ed.), this is always a trauma for the endometrium.
- I can’t help but ask you, what do you think about the initiative to ban free abortions?
This is a very complex topic. Maybe this will increase responsibility, but I think this issue needs to be approached from a different angle. I would like a woman to understand that she is responsible for her health, so getting the desired pregnancy, preparing for pregnancy, planning a pregnancy is the most correct approach. An abortion is always a blow to a woman’s health, and she must understand this. This is not a simple procedure, it is not harmless, no matter what version it is. Treating a disease is much more difficult than preventing it. If this becomes inaccessible to some women, I believe that we will open the door to criminal abortions. If a woman does not want this pregnancy, she will use various, most terrible, methods to terminate this pregnancy. It seems to me that we need to approach it from the other side: increase literacy and expand the availability of contraception. Maybe government programs that distribute free contraceptives to women are the way to go. And the fact that we will increase the fee for abortion will be wrong.
After the wedding, we lived amicably and cheerfully all together: my mother, my grandfather and my husband and I. Yes, and the dog Prutik, such a feisty one, who loved only me.
Moreover, life was so fun that in the evening, when the whole family went to bed, my husband and I sighed freely, because he was 24 and I was 22 years old.
After three months of married life, I had many questions, but because of my upbringing, I was ashamed to ask my mother.
Five months have passed, and I, plucking up the courage, tell my mother about the strange things with my periods that disappeared after marriage. Surprised and clutching her head, she screamed for a long time in a mixture of Yiddish and Russian; I only made out the word “stupid.”
I said that I was not a fool, but that she was to blame for not talking to me about such topics.
Having calmed down, talking with all the relatives, we created a military council and decided to send me to a gynecologist. They made an appointment for me and I went...
I must say, since my mother was very sick and my husband was missing at work, I went alone.
I was invited into the office. I, with girly ponytails and in a small chintz dress, walked in... A woman doctor, looking at me with a disapproving look, ordered me to sit down to fill out a card.
For some reason it became creepy and scary.
She, having asked her first and last name, suddenly asks the following question: “Are you sexually active?”
I was stunned - how is this? And she began to explain, saying that I live with my family and sleep on the bed.
She giggled, asked for an apology and went out into the corridor.
And I sit and am more and more afraid, I clearly didn’t like something about her. Why the gender question and address? Maybe she wants to get into our house?
Then a crowd of doctors enters the office, and my fear immediately disappears. I ask if everything is really that bad, they tell me it’s an advanced case and ask me to repeat everything in detail.
I did this for my own good. However, when I heard moans and hiccups, I was completely confused...
Luckily for me, a DOCTOR entered the office where I sat, almost crying, and the doctors were doubled over with laughter.
He looked around and sent everyone out of the office to their work places, reminding them to wash their faces first.
It was the Chief Doctor - Denis Ivanovich.
After asking me to make myself comfortable, he started talking to me. He looked at the notes, smiled tenderly at me and said: “Poor girl, do you really know nothing?” I asked him: “What?”
And he said that sexual relations are sex, and, probably, my husband and I are doing it.
Phew, a heavy weight has been lifted from my heart, I finally understand what they want from me.
I answered in the affirmative: “Of course! Yes!". Then he asked: “And what happens after sex?” I mumbled: “Great...”.
THE DOCTOR smiled and again asked the question, do I know where babies come from?
And I, don’t be a fool, began to tell him everything I knew.
He stopped me with his hand and reported that I was pregnant.
I laughed and said: “This cannot be, because pregnant women feel sick, they always feel bad and always want something. But I don’t want anything, and I feel great! Only there are no periods...”
He said, since you came, take off your clothes, I’ll check now. I started to unbutton my blouse, he shook his head, pointing to the chair - I need to lie down.
I put my hands in these rings and wait. The DOCTOR's patience had apparently come to an end; he announced that the appointment was not being conducted by a proctologist, and he would have enough fun for today. He took me, laid me on a chair, pulled off my panties and positioned my shaking legs where they needed to be.
I was ashamed to the point of tears, but I didn’t let my emotions overwhelm me.
The horror was over, the DOCTOR invited me to get dressed and talk. I did exactly everything that was asked of me. And I burst into tears...
He hugged me and said that soon I would be a mother myself, and that next time I should only contact him.
Many years have passed since then. I remember him - my Denis Ivanovich, who so simply and clearly explained to me what every mother should explain to her growing daughter in time.
December 24, 2013, 04:31I was a romantic too... until I became a gynecologist.
Scientists, psychologists, have found that men choose the specialty of a gynecologist not by chance. Male gynecologists can be divided into two categories. The first are insecure people who, with the help of proximity (even medical) to women, hope to improve their personal lives: “what if something happens to me too.” And indeed, after a few years of working in their chosen specialty, the personal life of such doctors improves significantly: they can easily communicate with women and feel much more relaxed.
The second category, on the contrary, are men “sexy athletes” who are accustomed to close attention from women. But, in their opinion, there is never too much of a good thing. And Gynecology for them is just a goldmine where they can show off in all their sexual glory. But, alas, most women come to the doctor not to get pleasure, but to be treated. So in this sense, male doctors will be disappointed. Later they calm down and just continue to work calmly.
Georgy, 32 years old, gynecologist, reproductive embryologist:
My father advised me to become a gynecologist. I always wanted to be just a surgeon. But my father assured me that at one time he himself did not dare only because this profession obliges him to bear responsibility not only for the patient, but also for his child, i.e. for two. Since school, I have been very shy and, to be honest, at first I resisted my father’s persuasion. I thought about how I could look my grandmother in the eyes when she asked who I had finally become. For a Caucasian man, this is generally a shameful topic. Suffice it to say that when I got ready to get married, my profession became one of the stumbling blocks for the father of my bride. He told her: you will live with a man who will be surrounded by women every day!
But I did not regret that I chose this specialty. My purely academic and medical attitude towards my chosen specialty helped me in this. Of course, there are women who, for various reasons, would like to see a male gynecologist, but most of them (thank God) still feel a sense of shame, and if I behave “wrong,” I will simply lose my bread, my clientele. Over the years of work, I have already learned to behave in such a way with women that even those who, perhaps, were afraid to come to see me, after 10 minutes of conversation calm down 100%. At work - I’m not a man, I’m a doctor - an asexual being, and I personally can’t do it any other way! My personal opinion is that male gynecologists who are aroused by their patients should not be allowed to do such work at all. In this state, the head, to put it mildly, does not cook, and, therefore, instead of solving the problems with which they approached him, this doctor can only help with another issue (an issue that is addressed to completely different institutions). Honestly, I was scared (not by doctors) that in such a profession I would become impotent. And this worried me very much. I directly addressed this question to my female gynecologist friends. So they answered me in unison that most of the male gynecologists they know are not only impotent or homosexual, but even, in their opinion, on the contrary, sexually hyperactive. Later I experienced this myself...
Konstantin, 33 years old, obstetrician-gynecologist:
Why did you choose this specialty? I don’t even remember now - it was a long time ago, you know, Khrushchev leaves, Brezhnev comes, it’s difficult to get a job at a factory, no one takes you to a collective farm, and nearby there was a rural hospital with training courses for gynecologists, so I went there, graduated in 2 months and went to work... well, something like that (Laughs, narrowing his eyes slyly). Just kidding, of course. It just happened that way. I’m even surprised at myself, I was so shy! Of course, the specifics of the profession are reflected in intimate life, but rather in a good way - you don’t want casual relationships, because... many beautiful girls have big problems with gynecology - at best STIs (sexually transmitted infections - author's note), at worst HIV. But with regard to impotence, it is unlikely; impotence in men is caused by other reasons. Well, there wasn’t something like that - like sex in a gynecology office! The specificity of medicine is such that SICK people come to you who do not need sex, but a solution to their problems; test drives are discussed in car dealerships, not in technical centers! And so, some people like it as a person, some people don’t like it. Even towards the beautiful girls at the reception you don’t really feel any unprofessional feelings. There is no romance in the gynecological office! Affairs with patients among gynecologists are most likely less common than among doctors of other specialties (even less often, probably, only in psychiatry). The best option for dating is traumatologists...
Yuri, 42 years old, gynecologist:
How do I feel if a beautiful woman comes to my appointment? Nothing special. It is important to separate professional and personal. Then everything will be fine. The well-known Bykov (“Interns”) would make an excellent gynecologist. He, Bykov, is very close to me in spirit. Although, of course, anything happened in my youth, I won’t hide it. Eh, youth, youth... A member there, a member of the court... Over the years, professionalism came, which put everything in its place.
Vitaly, 33 years old, obstetrician-gynecologist:
What novels! Professionalism must come first. I've seen so many things that it's hard to surprise me with anything. A patient comes to us for an appointment, and we don’t perceive her as a woman. No, of course, we are not insensitive idiots... I remember, as a student, I did an internship in a antenatal clinic. A very beautiful 19-year-old girl came to the reception. So she undressed SO! Apparently, especially for me. I couldn’t even take tests from her; I asked the doctor to do it for me. Why couldn't I? I just couldn’t get up... But that was a long time ago! I was very young then.
Eduard, 37 years old, gynecologist:
Even in my 2nd year of medical school, I was fascinated by the complexity and at the same time fragility of the female reproductive system. That’s when I decided – this is mine! It happened, of course, that a very beautiful girl came to the reception, and I, as a man, naturally had not entirely professional feelings for her. It even happened that there was not just excitement or desire, but also more... Women came who tried to flirt with me, but in such situations a robe saves me. In general, over time you become terribly squeamish, sensitive to smells, etc. But with a certain circle of patients, special relationships are established, built on mutual sympathy, respect, and understanding. I highlight them because each of them is unusual in some way. In me they find a friend who understands them more than others and can help with advice. We often talk at receptions, and this does not prevent us from often being on good terms with their husbands. But I also saw jealousy towards me - this is when the husband did not reach the level of development of his wife. In short, there was mental intimacy, and we both received a lot from this communication. I didn’t lead to sex (it went). Did my profession affect my family life? I’ll say right away that it was not reflected negatively. But, firstly, it helped to better understand my spouse (I, too, am just a husband), and secondly, I began to make terribly high demands on the, uh, imaginary ideal.
So, based on the answers received from male gynecologists, here is what we can recommend. If you want to arouse not only professional, but also erotic interest in a doctor, then you need to choose someone who is just beginning his thorny path in gynecology. And if you just need to get to a smart doctor who doesn’t care what gender his patient is, then it’s better to go to a gynecologist with a lot of experience: he’s already seen so much that you can be calm about the chastity of his actions, thoughts and fantasies.
Just finishing the article, I suddenly remembered a couple I knew - he is a gynecologist, and she is a urologist. They were so beautiful, prominent, and always looked good together. I kept thinking: how is their intimate life after such work? But I was embarrassed to ask, it was still awkward. And recently I found out that they were divorced - she left her husband for her patient, whom she was treating for prostatitis...
If nothing worries you, then your first visit to a gynecologist can be made between the ages of 13 and 15 years.
Why go to the gynecologist if nothing worries me?
Doctors, including gynecologists, deal not only with the treatment of diseases, but also with their prevention. The doctor will make sure that your genital organs are developing well and correctly and that you are not at risk of any disease. In addition, the doctor can notice early signs of diseases that are invisible to you. It is much easier to recover if the doctor notices the symptoms of the disease at an early stage, when nothing bothers you yet.
If you are sexually active, your doctor can advise you on the best option and also tell you how to protect yourself from sexually transmitted diseases.
Do you need to shave before going to the gynecologist?
No, this is not at all necessary. The gynecologist does not pay attention to whether the hair in the intimate area is shaved. It's much more important that you take a shower and put on clean underwear.
When to shower or wash?
It is better to do this the evening before before going to the gynecologist. It is not advisable to wash yourself several hours before the examination, as you can “wash away the evidence” - discharge, which may be a sign of inflammation.
Is it possible to go to the gynecologist during menstruation?
It is possible, but not advisable. During this time, the gynecologist will not be able to perform a normal examination and therefore, most likely, will schedule a second appointment for you in a few days. For a preventive examination, it is better not to come to the gynecologist during your period.
But if you have any complaints during your period, then you don’t need to wait for the end of your period. In this case, you can come to see a gynecologist during your period.
What will happen at an appointment with a gynecologist?
If nothing worries you, during your first visit to a gynecologist you can just talk. The doctor may ask the following questions:
Have you started your period yet? If so, when was your first period and how long did it last? Do your periods come on the same days every month, or may they be absent for several months in a row? When was the first day of your last period?
Are you sexually active? Have you ever had sexual contact with anyone? If yes, how did you protect yourself (with or)? After sexual intercourse, did you have any unpleasant symptoms (abdominal pain, itching in the genital area)?
Is there anything that worries you that a gynecologist can help with?
Sometimes the gynecologist offers to undergo an examination on the chair during the first visit. Don't worry: this doesn't mean there's anything wrong with you. The doctor wants to make sure that your genitals are developing properly and that there is no reason to worry. If you are feeling very nervous, you can ask your mother to stand next to you during the examination.
What happens in the gynecologist's chair?
"Chair examination" is an expression that means a gynecological examination. You may not be very comfortable in the gynecologist's chair, since you will have to take off your underwear and spread your legs wide apart.
Be sure to make sure that a sterile napkin is placed under your butt. In smaller clinics, you may be asked to bring a towel or a disposable gynecological examination kit, which is sold at the pharmacy.
During the examination, the doctor will assess how well your genital organs are developed and whether there are any signs of inflammation. If you are a virgin, the gynecologist will not conduct a deep examination of the vagina so as not to damage the hymen. The gynecologist may insert a finger into the anus to check the elasticity of the vaginal wall and palpate (the uterus and ovaries).
If you are a virgin, but you have complaints about vaginal discharge or itching in the genital area, then the gynecologist can examine the vagina and take. Such an examination is performed with very thin instruments that cannot damage the hymen. If you are not a virgin, the gynecologist will examine your vagina using a special instrument called a speculum.
Before or after examining your genitals, the gynecologist will also examine and feel your mammary glands (breasts).
Is examination in a chair painful?
A gynecological examination may not be pleasant, but it is not painful. Some of the doctor’s manipulations may be inconvenient and not particularly pleasant. If during the examination you feel pain, be sure to inform your gynecologist about it.
Can a gynecologist determine that I am not a virgin?
Yes maybe.
How can I deceive the gynecologist if I am no longer a virgin?
Unfortunately, there are no ways to deceive a gynecologist. If you are already sexually active and do not want anyone to find out about it, then it is better to immediately tell your doctor about it.
If you do not initially deceive the gynecologist, he will trust you and will not make notes about yours (or rather, its absence), or inform your parents about it.
Does the gynecologist have the right to tell my mother that I am no longer a virgin?
The gynecologist has the right to inform your parents that you are no longer a virgin if you are under 15 years old. If you are 15 years old or older, then at your request the gynecologist is obliged to keep all information confidential. Article 54 of the law speaks about this “On the basics of protecting the health of citizens in the Russian Federation” dated November 21, 2011.
It is better to immediately establish a trusting relationship with the gynecologist so that he does not have the desire to inform your parents that you are no longer a virgin.
How often should I go to the gynecologist if nothing bothers me?
Once a year you need to visit a gynecologist for a preventive examination.
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