The Village finally plucked up the courage and decided to ask questions about the most important thing: why coitus interruptus is a so-so way, 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 changing so quickly now that even specialists do not keep up with the changes, let alone ordinary citizens. Therefore, under the heading "What's new?" every week we hear from scientists, doctors and other professionals about how their fields of activity are changing and what these changes mean for mere mortals.
In this practically last issue of our medical detective, The Village correspondent Alexandra Sheveleva met with Svetlana Yureneva, MD, Leading Researcher at the Department of Gynecological Endocrinology of 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 kindly ask all our readers to read this interview - regardless of gender, race, religious beliefs and sexual experience.
On postponing children
- I must admit that even adult educated people know regrettably little about contraception. Hormonal contraception in Russia is still treated with distrust.
Before starting a conversation about modern contraceptives, I would like to give an understanding of what is happening in the modern world with women. Women began to care more about their education, about their careers, they marry later and, accordingly, the issue of implementing the 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 to a later date, we have to deal with the problems that a woman has accumulated throughout her life. Secondly, life expectancy has changed. Today, a woman lives long enough, but the 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 periods and ovulations in women was limited: the woman was either pregnant or lactating. During pregnancy and lactation, the egg does not mature in women, this is the time of "rest" of the ovaries. Very few women recover their menstrual cycle and ovulation while breastfeeding. For most, ovulation does not occur due to very high levels of the hormone prolactin, which is responsible for milk synthesis. Now watch: age of menarche ( start of menstruation. - Approx. ed.) - 12 years old (from 11 to 14 years old).
- Is it true that now girls mature earlier?
There is such a trend. Maturity is closely related to height and weight, especially weight. Thin girls have periods later; those who are obese - earlier (more adipose tissue and more estrogens). So what's the problem? A woman is mature, but she does not realize her reproductive function, does not use contraceptives that block ovulation, lives a normal life, can have several abortions before she decides to become pregnant (and we understand that abortion has a very serious effect on reproductive function). This means that her ovaries do not rest 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, the risk of acquiring sexually transmitted infections is high. 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 at a time when 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 to the abdominal cavity. If it meets with a sperm, it enters the uterus through the tubes and is already there, fertilized, attached. In the place where the egg was released in the ovary, a 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 maturation of the next follicle, the ovaries rest and therefore are not injured. The fact is that the rupture of the egg and its release into the abdominal cavity is always an ovarian injury, which increases the risk of endometriosis and ovarian cancer. It's not useful. Nature did not foresee for many years (from 20 to 30 years, for example) monthly ovulation. Menstruation is generally not always desirable: due to injury to the ovary, and due to the fact that menstrual blood can be thrown through the tubes into the abdominal cavity and, theoretically, the risk of developing endometriosis increases. As a result of such work of the ovaries without “rest”, disorders may 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 postpones the birth of her first child, then the most correct thing is use contraception to stop ovulation
- The worst thing is that it happens even to young girls.
That's right, because the process is broken. What is a functional cyst? When the follicle does not rupture at the right time, it begins to grow, produces a lot of estrogens, and then this cyst can rupture. Due to anatomical features, cysts in the right ovary are more likely to rupture. This functioning of the ovaries without rest is not physiological, so the pharmaceutical industry has come up with 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 a real prevention of functional cysts. Secondly, these contraceptives allow the ovaries to rest. This, of course, is not a chemical pregnancy, but the state closest to this situation. Therefore, the recommended duration of taking contraceptives is at least a year and a half, because pregnancy lasts for nine months and lactation lasts for about nine months.
About egg reserves
At what age do you recommend starting hormonal contraceptives?
It depends on when a woman begins to live sexually. Hormonal form of contraception is preferred for many women. There is another important point that women who are going to delay the birth of a child should be aware of: we are all born with a different ovarian reserve (the number of eggs in the ovaries). One can afford to give birth both at 35 and 40, while at the other, at the age of 30, he is already exhausted. Then we can't do anything.
- And I thought that they all had the same - about 250 thousand.
For most, this reserve is large and begins to be depleted during life, but some women are initially born with a very low reserve. Therefore, we recommend young people to be tested for anti-Mullerian hormone, which is an indicator of this ovarian reserve. So they can understand what they have with reproduction and whether they can afford to postpone the birth of their first child until later. I have had cases in practice when in girls at the age of 20 the anti-mullerian hormone was so low that problems had already begun. We have two of the most important markers for assessing ovarian reserve - anti-mullerian hormone and counting the number of follicles according to ultrasound diagnostics. All this is absolutely accessible, but it allows you to program a woman's life and not face a problem when at the age of 20 we can no longer do anything. If the reserve is small, then you urgently need to become pregnant, give birth, or use new approaches: before the age of 20–25, take tissue from the cortical substance of the ovaries in order to get something out of it later. We have already learned how to freeze embryos, eggs, but what is even better and even more promising is to take a little ovarian cortex. True, after 25 years it makes no sense to do this. It is believed that only 1% of women have a low ovarian reserve, but I think that now there are more of them.
- Why?
There are many factors. First, genetic predisposition. For girls whose mothers have stopped menstruating early, we recommend that you determine the ovarian reserve. The average age of menopause is 45–55 years. If a mother's ovaries turn off before the age of 45, her daughter must determine her reserve. Secondly, various drugs, smoking, radiation, immune problems adversely affect the ovarian reserve.
It has been proven that in women who smoke, infertility is more common and ovarian function is turned off earlier. After all, germ cells are the most sensitive to any toxic effects. Today, combined oral contraceptives, which include both estrogen and progestogen, are the most biologically justified in terms of preventing many gynecological problems. In addition, the viscosity of mucus increases, the penetration of pathogenic agents is less likely, which means there are fewer inflammatory diseases.
Women without ovulation no premenstrual syndrome
- But people are still afraid of the word "hormonal".
Hormonal contraception using combined oral contraceptives is the most effective (98%). Someone is afraid of hormones, someone is afraid that they will get better, but women do not gain weight from modern contraceptives (a large number of studies have been conducted). We now use other doses, today contraceptives have appeared, which include not synthetic ethinyl estradiol, but estradiol, which is identical in chemical structure to estrogen, which is synthesized in the ovaries of a woman. 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 besides contraception that we can help solve. For example, painful or heavy periods, migraines during menstruation, acne, 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 against unwanted pregnancy in a contraceptive, it decreases if a person simply forgets to take it according to a certain scheme.
In the course of clinical practice, doctors realized that the greatest 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 a contraceptive 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 pill, it will not greatly affect the effect of the drug. There is also a myth that taking hormonal contraceptives can lead to infertility or difficulties with the onset of pregnancy. In fact, with the end of the last pill, the effect of the contraceptive ends. The last pill and fertility is restored. Now they still use such flexible regimens for taking the drug, when a woman can take pills continuously for 120 days and then, when she wants, take a four-day break. It is convenient and corresponds to physiology. Everything develops, and hormonal contraception too.
- How to choose a hormonal contraceptive?
I think that it is necessary to do an ultrasound: now even young girls have problems. To pick up contraceptives, no strong special examinations are needed, especially in young people. We always evaluate the risks of possible complications when deciding on the choice of contraception, and every gynecologist knows them.
About premenstrual syndrome
- And what is, from a scientific point of view, premenstrual syndrome?
Premenstrual syndrome is an abnormal reaction 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 without ovulation do not have premenstrual syndrome.
- It turns out that premenstrual syndrome is good.
Of course, not very good, but it happens only in women with ovulation. We now 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 serious condition). Its effect has been proven in placebo studies. In addition, in women with premenstrual syndrome, fluid is often retained and edema occurs, and this drug prevents fluid retention.
- As I understand it, I cannot choose a hormonal contraceptive on my own?
It must be chosen and prescribed correctly, so we still do not recommend going to the pharmacy and buying it yourself. There are a lot of nuances, preparations are different in composition and combinations of ingredients. For example, now there are drugs that include folic acid already in its active form, which serves as a prevention of defects in the nervous system of the fetus, and also provides 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 up to 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, so that menopause does not develop.
And we have contraceptives for women over 40 that contain natural-identical estradiol, although these contraceptives can be taken at any age, not just over 40. The period when a woman passes from reproductive age to menopause is very difficult: there may be menstrual irregularities, estrogen deficiency, hot flashes, sweating, functional cysts in the ovary. By prescribing such a drug, we again solve the whole range of problems: contraception, prevention of cysts, reduction of menstrual blood loss, resolution of menopausal symptoms. And body weight does not change.
Condom effectiveness two times lower than a hormonal contraceptive
- This old prejudice, apparently, concerned some first generation of contraception.
Yes, old contraceptives. Now we use other dosages and other combinations, especially since contraceptives with estradiol have also appeared, which allows us to select the drug very individually. Another woman should understand that taking combined oral contraceptives is a real prevention of endometrial cancer and ovarian cancer.
- How many years can I take hormonal contraceptives?
We don't have such restrictions today. 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 the 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 doing this vacation? If we are talking about the risks of hormonal contraception, then the most significant (although it is very rare) is thrombosis. And this risk is highest in the first six months of taking contraceptives. If we interrupted and started again, then the risk is exactly the same as if we start for the first time. In any decision - to start or stop taking contraception - you need to consult a gynecologist. The doctor will always tell you what is best to do.
- The problem is that people do not 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 hormonophobes, they were afraid of both hormonal contraception and replacement (during menopause) hormonal therapy. Today we have so many scientific articles and studies that we already understand exactly what to be afraid of and what not to. After talking with a woman at the first visit, we can assign her to one or another group: low risk, high risk, high risk.
- Risk of what?
Problems, complications, adverse events while taking hormonal contraception. A factor such as, for example, obesity, makes one wonder whether to prescribe a 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 smoking women after 35.
- Why?
Because the risks are rising. Therefore, we are against smoking: it negatively affects not only the state 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 can not always remember that every day you need to take a pill.
Soon we will get contraceptives that will have a special device with a reminder to take a pill. It really depends on motivation. For a motivated woman planning her life, this will not be a problem. She can set a reminder on her phone, for example.
About spirals, rings and injections
- Unfortunately, there are many unorganized women who cannot always remember 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 therapeutic options. It reduces the amount of blood loss, reduces 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 be effective, for the sake of which it was conceived. Spiral, combined hormonal contraceptives are highly effective means. I would also like to add that hormonal contraception is not an abortion method, because if we take the same coil, what happens? There are no conditions for an already fertilized egg to attach.
- But the zygote is already there.
Yes. And here we prevent it, and there is no injury to the ovary. But then again: if a young girl rarely has sex, 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 do not understand.
Because they are torn, they are put on incorrectly. And the first pregnancy, which ends in an abortion, is an extremely undesirable situation for any woman. My main message to women - do not forget that after all, the healthiest children are born to healthy and young mothers. Therefore, it is still desirable to resolve this issue before the age of 30, and preferably up to 25, if there is such an opportunity. 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: I took an injection and forgot 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 fact that a woman refuses this type of contraception. Although most women experience amenorrhea when menstruation is absent. For some it's good, for some it's uncomfortable.
Secondly, to the FDA ( US 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 noted with the use of these injections.
A big booty and a thin waist are, from the point of view of reproduction, the best version of a woman
Optimal - three years. It is believed that during this time the female body is fully restored. If the interval between births is shortened (less than three years), problems may occur more often.
- And if ten years?
Everything is individual. Of course, it is better to do this two or three times with a break of three years, and then solve other problems. We understand that if a woman has given birth, then she needs to give some time to this child. For a child, the first three years are important so that the mother is near.
- Is a long break between children harmful?
The longer the break, the older the mother, respectively, the more complications during pregnancy, the higher the risk that the pregnancy will end in a caesarean section.
- When I was preparing for this interview, my colleagues asked you to ask if cervical erosion is really a purely Russian invention, and European doctors do not know at all what it is and why we treat it.
It doesn't mean anything, it's the norm. In Russia, they also think so now. This is not an erosion, it is an ectopia, which is often found in young women.
- They don't burn her anymore?
In no case. Cauterized 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 women do not need to be touched.
- How do you feel about rings?
I normally treat rings: it is convenient for someone, why not? But it has been shown that there can be side effects such as heavy discharge and vaginitis. In terms of safety, this 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 himself.
- What worries me about hormonal contraception: in order to use it, you must have a permanent 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. Women who live a regular sexual life with a regular sexual partner are more suitable for hormonal contraceptives. Women who have sex once a month do not need contraceptives, unless with their help we solve some additional problems (acne, PMS, migraine).
About sexual illiteracy
- And how do you think the situation with sexual literacy is today? You communicate with people who come to you.
I not only communicate with people, I have adult daughters. The daughters' friends listened to me with surprise: they did not know at all how the egg gets into the uterus. I think that people have become more literate, it has become possible to receive information on the Internet, but, unfortunately, sites are different and they write different things there, often unreliable.
- Unfortunately, we live in a country in the capital of which adult women on the playground can tell each other that they are protected by douching.
It's scary, it speaks of our illiteracy. Douching is very harmful, because the vagina is a gateway for infection, so its mucosa 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 out, completely unnecessary bacteria can settle there. In no case, in principle, douching is not necessary: nature is smarter than us.
- I mean douching after intercourse as contraception.
This is an ineffective remedy if sexual intercourse has already occurred.
- Are there any effective postcoital contraceptives, except for emergency contraceptive pills?
No. The fact is that there are high-fertile women and low-fertile ones. Highly fertile women ovulate every month and get pregnant easily. And there are women who can ovulate 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 body type. A typical gynoid (pear-shaped) woman with a regular 28-day menstrual cycle is the most ideal for reproduction.
- Are they women with large breasts and a narrow waist?
A big booty and a thin waist are, from the point of view of reproduction, the best version of a woman. Men subconsciously choose this type, because they intuitively understand that such a woman will continue the race. And women who do not have a waist (android type, or who have an abdominal type of obesity), they are less promising in terms of reproduction. They are more likely to anovulate absence or irregular ovulation. - Approx. ed.).
about great love
- The second very popular folk method of contraception is interrupted sexual intercourse.
This only works for those who are not very fertile. The effectiveness of coitus interruptus is very low, less than 50%. Now there are ovulation tests that are useful for both those who want to get pregnant and those who want to protect themselves. If everything is clear for a woman, she can understand on which days sexual intercourse will be safe. But sometimes there is one ovulation, and sometimes - on positive emotions - there are two.
- What is it like? What does it mean?
This means, for starters, that she could have fraternal twins.
- What are these "positive emotions"? Is ovulation subject to mood swings?
Including, of course.
- Big love?
With great love, there are much more ovulations. There is even such a thing - "children of love." Positive emotions improve all bodily functions and can also have a beneficial effect on ovarian function.
- That is, if a woman is very in love, she has an increased risk of becoming pregnant?
This requires a separate scientific study, but my clinical practice says yes. In my practice, there were also cases when girls with amenorrhea, who never had a period, fell in love and became pregnant.
- Many people say that they suddenly get pregnant on vacation: they went to the sea together, the three of them returned.
Of course, stress is relieved, a woman experiences additional positive emotions. Under stress, the tubes contract more often, sometimes the egg enters the uterus ahead of time, when the mucous membrane is not yet prepared to accept 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 disturbed.
- They also say that in the first days of menstruation it is impossible to get pregnant.
It all depends on fertility. With age, at the first stage, the cycle may be shortened and ovulation may sometimes occur earlier. There is no protection - it is necessary to be protected. There is such a Russian "maybe", "it will not affect me." Touches. 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 the consequences for a woman's health. We, gynecologists, are faced with the results of abortions: these are inflammatory diseases, infertility, and miscarriage. In Europe, abortion is done only by vacuum aspiration or medically, and when it is done with a curette ( it means scraping. - Approx. ed.), it is always a trauma to 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 that this issue should 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. 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, in whatever version it may be. Treating the disease is much more difficult than preventing it. If this becomes unavailable to some women, I believe that we will open the way to criminal abortions. If a woman does not want this pregnancy, she will use different, the most terrible, ways to terminate this pregnancy. It seems to me that we need to approach from the other side: to increase literacy and expand the availability of contraception. Maybe government programs that distribute free contraceptives to women is the way to go. And the fact that we will increase the abortion fee will be wrong.
After the wedding, we began to live amicably and cheerfully all together: my mother, my grandfather and my husband and I. Yes, and the dog Prutik, the 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 muster up the courage to tell my mother about the strangeness with menstruation that disappeared after marriage. Surprised and clutching her head, she screamed for a long time in a mixture of Yiddish and Russian; I made out only the word "stupid".
I said that I was not a fool, but she was to blame, since she did not talk to me on such topics.
Having calmed down, having talked 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 disappeared at work, I went alone.
I was invited to the office. I, with girly ponytails and in a small chintz dress, came in ... The female doctor, looking at me with a condemning look, ordered me to sit down to fill out the card.
For some reason it was creepy and scary.
She, having asked for her first and last name, suddenly asks the following question: “Do you live sexually?”
I was stunned - how is it? And she began to explain, they say, 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 I’m more and more afraid, I obviously didn’t like something in it. What is the gender question and address for? Maybe she wants to sneak into our house?
Then a crowd of doctors enters the office, and my fear immediately disappears. I ask if everything is really so bad, they tell me that the case is neglected and they ask me to repeat everything in detail.
I did this for my own good. However, when I heard groans and hiccups, I was completely confused ...
Fortunately for me, a DOCTOR entered the office where I was sitting, almost crying, and the doctors doubled over with laughter.
He, looking around, drove everyone out of the office to their workplaces, reminding them to wash their faces first.
It was the Chief Physician - Denis Ivanovich.
Asking to get comfortable, he started a conversation with me. He looked at the notes, smiled at me affectionately 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, "Hey...".
The DOCTOR smiled and again asked the question, do I know where babies come from?
And I, don't be a fool, started telling 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. And I don't want anything, and I feel great! Only now there is no monthly ... ".
He said, since you came - undress, now I will check. I started unbuttoning my blouse, he shook his head, pointing to a chair - you need to lie down.
I put my hands in these rings and wait. The DOCTOR's patience, apparently, came to an end, he announced that the reception was not conducted by the proctologist, and for today he would have enough fun. He took me, laid me on a chair, pulled off my panties and attached my shaking legs where necessary.
I was ashamed to tears, but I did not let my emotions overwhelm me.
The horror ended, the DOCTOR suggested that I get dressed and talk. I did exactly what was asked of me. And she cried...
He hugged me and said, soon I will 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 also a romantic...until I became a gynecologist.
Scientists psychologists have found that men choose the specialty of a gynecologist for a reason. Male gynecologists can be divided into two categories. The first are people who are insecure in themselves, who, with the help of proximity (even if only medical) to women, hope to improve their personal lives: “what if something happens to me too.” And indeed, after several years of work in the chosen specialty, the personal life of such doctors is improving significantly: they already easily communicate with women and feel much more relaxed.
The second category is, on the contrary, men "sexual athletes" who are used to close attention from women. But, in their opinion, good things do not happen much. And Gynecology for them is just a gold mine, where they can shine in all their sexual glory. But, alas, most women come to the doctor not to enjoy, but to be treated. So in this sense, male doctors will be disappointed. In the future, they calm down and continue to just calmly work.
George, 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 he himself had not made up his mind at one time only because this profession obliges one to bear responsibility not only for the patient, but also for his child, i.e. for two. From school I was very shy and, to be honest, at first I resisted my father's persuasion. I thought how I could look my grandmother in the eyes when she asks: what have I finally become. For a Caucasian man, this is generally a shameful topic. Suffice it to say that when I was about to get married, my profession became one of the stumbling blocks for the father of my fiancee. 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 to the chosen specialty helped me in this. Of course, there are women who, for various reasons, would like to get an appointment with a male gynecologist, but most of them (thank God) still feel a sense of shame, and if I behave "wrongly", 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 my appointment, after 10 minutes of conversation, calm down 100%. At work - I'm not a man, I'm a doctor - a sexless creature, otherwise I personally can't! My personal opinion is that male gynecologists who are aroused by their patients should not be allowed to do this kind of work at all. In this state, the head, to put it mildly, does not cook, which means that instead of solving the problems that they turned to him, this doctor can only help in another matter (the issue that is addressed to completely different institutions). To be honest, I was scared (not by doctors) that in such a profession I would become impotent. And that worried me a lot. I directly addressed this question to my female gynecologists. So they answered me in chorus that most of the gynecologists of the male colleagues they know are not only not impotent or homosexual, but even, in their opinion, on the contrary, sexually hyperactive. Later I experienced it myself...
Konstantin, 33 years old, obstetrician-gynecologist:
Why did you choose this specialty? I don’t remember now - it was a long time ago, you yourself understand, Khrushchev leaves, Brezhnev comes, it’s difficult to get a job at the factory, no one takes it to the collective farm, and there was a rural hospital nearby with training courses for gynecologists, well, I went there, unlearned in 2 months and went to work .... well, something like this (Laughs, slyly screwing up his eyes). I'm kidding, of course. It just happened. I even surprise 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 that other causes cause impotence in men. Well, there was nothing like that - like sex in the gynecology room! The specificity of medicine is such that SICK people come to you who need not sex, but a solution to their problems, test drives are discussed in car dealerships, and not in technical centers! And so, someone likes it as a human being, someone does not like it. Even to beautiful girls at the reception, you don’t feel any unprofessional feelings. There is no romance in the gynecological office! Romances with patients in gynecologists are likely to be less common than in doctors of other specialties (even less often, probably only in psychiatry). The best option for dating - traumatologists...
Yuri, 42 years old, gynecologist:
How do I feel when a beautiful woman comes to the reception? Nothing special. It is important to separate professional and personal. Then everything will be gut. The notorious Bykov ("Interns") would make an excellent gynecologist. He, Bykov, is very close to me in spirit. Although, of course, everything happened in my youth, I will not 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! First of all, there must be professionalism. I've seen so many things that it's hard to surprise me with something. A patient comes to us for an appointment, but we do not perceive her as a woman. No, of course, we are not insensitive blockheads ... I remember, as a student, I did an internship in a women's clinic. A very beautiful girl of 19 years old came to the reception. So she was THAT undressed! Apparently, especially for me. I could not even take tests from her, I asked the doctor to do it instead of me. Why couldn't? I just couldn’t get up… But that was a long time ago! I was quite young then.
Eduard, 37 years old, gynecologist:
As early as my 2nd year of medical school, I was fascinated by the complexity and at the same time the 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 as a man, naturally, I had not quite professional feelings for her. It happened, even, not just excitement or desire, but more ... Women came who tried to flirt with me, but in such situations a bathrobe 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 single them out because in some way each of them is unusual. In me they find a friend who understands them more than others, can help with advice. We often talk at the reception, 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 his wife in terms of development. In short, there was mental intimacy, and we both got a lot from this communication. Before sex, I did not bring (gone). Did my profession affect my family life? I will say right away - it did not reflect negatively. But, firstly, it helped to better understand the spouse (I'm also just a husband), and secondly, I began to make terribly high demands on, mmm, an imaginary ideal.
So, based on the responses received from male gynecologists, here is what we can advise. If you want to arouse in the doctor not only professional, but also erotic interest, then you need to choose someone who is just starting his thorny path in gynecology. And if there is simply a need to get to an intelligent doctor who does not care what gender his patient is, then it is better to go to a gynecologist with great experience: he has already seen enough that you can be calm for the chastity of his actions, thoughts and fantasies.
Already finishing the article, I suddenly remembered one familiar couple - he is a gynecologist, and she is a urologist. Such beautiful, prominent, always looked good together. I kept thinking: how is their intimate life after such work? But I was embarrassed to ask, it's inconvenient after all. And recently I found out that they were divorced - she left her husband for her patient, whom she was treating for prostatitis ...
If nothing bothers you, then the first visit to the gynecologist can be done at the age of 13 to 15 years.
Why go to the gynecologist if nothing bothers me?
Doctors, including gynecologists, are engaged not only in the treatment of diseases, but also in their prevention. The doctor will make sure that your sexual organs are developing well and correctly and that no disease threatens you. In addition, the doctor may notice early signs of illness 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, then the doctor can advise you on the best one, as well as tell you how to protect yourself from sexually transmitted diseases.
Do I need to shave before going to the gynecologist?
No, it's not necessary at all. 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 going to the gynecologist. It is undesirable to wash a few hours before the examination, as you can "wash away the evidence" - discharge that may be a sign of inflammation.
Is it possible to go to the gynecologist during menstruation?
It is possible, but not desirable. During this time, the gynecologist will not be able to perform a normal examination and therefore, most likely, will appoint you a second appointment in a few days. For a preventive examination, it is better not to come to the gynecologist during critical days.
But if during menstruation you have any complaints, then you do not need to wait for the end of menstruation. In this case, you can come to the gynecologist during your period.
What will happen at the appointment with the gynecologist?
In the event that nothing bothers you, during the first visit to the gynecologist, you can just talk. The doctor may ask the following questions:
Have you already started your period? If so, when did you have your first period and how long did it last? Do periods come on the same days every month, or can they be missing 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 (using or )? Did you have any unpleasant symptoms after sexual intercourse (abdominal pain, itching in the genital area)?
Is there anything that worries you and how can a gynecologist help?
Sometimes the gynecologist offers to undergo an examination on the chair during the first visit. Do not worry: this does not mean that something is wrong with you. The doctor wants to make sure that your genitals are developing properly and that there is nothing to worry about. If you are feeling very anxious, you can ask your mother to stand by you during the examination.
What happens in the gynecologist's chair?
"Examination on a chair" is an expression that means a gynecological examination. In the gynecologist's chair, you may not be very comfortable, as you will have to remove your underwear and spread your legs wide apart.
Be sure to make sure that under the ass you put a sterile napkin. In smaller clinics, you may be asked to bring a towel or a disposable gynecological exam kit, which is sold at the pharmacy.
During the examination, the doctor will assess how well your genitals are developed, whether there are any signs of inflammation. If you are a virgin, then 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 feel (uterus and ovaries).
If you are a virgin, but you have complaints of vaginal discharge or itching in the genital area, then the gynecologist can examine the vagina and take it. Such an examination is carried out with very thin instruments that cannot damage the hymen. If you are not a virgin, the gynecologist will examine your vagina with a special tool called a speculum.
Before or after a genital exam, the gynecologist will also examine and feel your mammary glands (breasts).
Inspection in a chair - does it hurt?
You can not call a gynecological examination pleasant, but it does not hurt. Some of the doctor's manipulations can be inconvenient and not very pleasant. If during the examination you feel pain, be sure to inform the gynecologist about it.
Can a gynecologist tell if I'm not a virgin?
Yes maybe.
How to deceive a 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 know about it, then it is better to tell the doctor about it right away.
If you do not initially deceive the gynecologist, he will trust you and will not take notes about your (or rather, her absence), and also 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 tell your parents that you are no longer a virgin, if you are not yet 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 says this. "On the fundamentals 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 a desire to tell 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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