I Want To Be a Gynecologist

[happydays]

Go do the pelvic/bi-manual and rectal on her"...

What's a bi-manual? Both hands?

Just like Melana...

What's Melana?

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[Wahoos]

I am not the expert on pelvic exams, but here is what I still remember from medical school. The Pelvic exam is called the Bi Manual pelvic exam because you use both of your hands to perform the exam. Usually, the first step involves inserting the speculum into the vagina to visualize the cervix, which looks like a apple with the depression as the entrance to the uterus. You swab that area for G/C culture and also where you do the pap smear. After you do that and examed the outer structures (vulva, labia min/maj, etc) then you proceed to do the manual exam. You have to use both hands. 1 or 2 fingers into the vagina (your preference) with either your dominant or non dominant hand (again, this is your preference). Use the other hand, palm down to apply pressure on to the bladder and the uterus. Use both hands, you want to feel the cervix (kinda just wiggle it a little bit ) and if the pt has tenderness, then it is a good indication of PID (pelvic inflammatory disease), feel the bladder a little (tenderness = cystitis), then you move your fingers to the right and left side to feel for the adenexa = ovaries/fallopian tubes. hard to feel, but if painful, can be cyst, infection, tumor,etc. The last step, you keep your index finger in the vagina, and insert the middle finger into the rectum to feel for the membrane (any adhesions, fistula, hemmorrids, etc), then you wipe the stool on a guiac card to test for heme (+ = blood). Also having tenderness with the exam can also be a normal thing, but cervical motion tenderness is pretty much a buzz word for PID, and that is when the patient jumps on the table or very uncomfortable when you move the cervix.
Also experience plays a huge part in terms of what you can get from exam

That is the pelvic in a nutshell. If you want to know more, just Google it. If you want to be good at it before medical school start, just ask your girlfriend if you can practice a little for the sake of the educational experience. Anyways, you will have plenty of memories/experiences in medical school that will last you a life time. I can write about the first time I had to so a rectal exam on a standardized patient in my med school. (These people signed up to get fingers in their ....... by 130 medical students ????) Plus the guy I had was from a nudist community and it was just the weirdiest experience to have your finger in a guys butt, and have him tell you what you should and should not be doing with that finger.... . Now I really don't care about rectals anymore since I have done so many in the last year. Just it was weird doing it the 1st time.

One of the General Surgeons ask me this questions on rounds "son, when is the only time you should NOT be doing a rectal on a patient?" I don't know
"either the patient does not have an anus, or you do not have any fingers."

 

[LabMonster]

WOW, vaginas are fun AND educational!

 

[gujuDoc]

I am not the expert on pelvic exams, but here is what I still remember from medical school. The Pelvic exam is called the Bi Manual pelvic exam because you use both of your hands to perform the exam. Usually, the first step involves inserting the speculum into the vagina to visualize the cervix, which looks like a apple with the depression as the entrance to the uterus. You swab that area for G/C culture and also where you do the pap smear. After you do that and examed the outer structures (vulva, labia min/maj, etc) then you proceed to do the manual exam. You have to use both hands. 1 or 2 fingers into the vagina (your preference) with either your dominant or non dominant hand (again, this is your preference). Use the other hand, palm down to apply pressure on to the bladder and the uterus. Use both hands, you want to feel the cervix (kinda just wiggle it a little bit ) and if the pt has tenderness, then it is a good indication of PID (pelvic inflammatory disease), feel the bladder a little (tenderness = cystitis), then you move your fingers to the right and left side to feel for the adenexa = ovaries/fallopian tubes. hard to feel, but if painful, can be cyst, infection, tumor,etc. The last step, you keep your index finger in the vagina, and insert the middle finger into the rectum to feel for the membrane (any adhesions, fistula, hemmorrids, etc), then you wipe the stool on a guiac card to test for heme (+ = blood). Also having tenderness with the exam can also be a normal thing, but cervical motion tenderness is pretty much a buzz word for PID, and that is when the patient jumps on the table or very uncomfortable when you move the cervix.
Also experience plays a huge part in terms of what you can get from exam

That is the pelvic in a nutshell. If you want to know more, just Google it. If you want to be good at it before medical school start, just ask your girlfriend if you can practice a little for the sake of the educational experience. Anyways, you will have plenty of memories/experiences in medical school that will last you a life time. I can write about the first time I had to so a rectal exam on a standardized patient in my med school. (These people signed up to get fingers in their ....... by 130 medical students ????) Plus the guy I had was from a nudist community and it was just the weirdiest experience to have your finger in a guys butt, and have him tell you what you should and should not be doing with that finger.... . Now I really don't care about rectals anymore since I have done so many in the last year. Just it was weird doing it the 1st time.

One of the General Surgeons ask me this questions on rounds "son, when is the only time you should NOT be doing a rectal on a patient?" I don't know
"either the patient does not have an anus, or you do not have any fingers."

You always post some of the best posts and some of the most interesting posts too.


Is there some sub-area of orthopedics that you are considering??? Like strictly knee surgeries or strictly vertebral surgeries, etc. etc.??? You get the idea. I'm just curious.

 

[Wahoos]

Hey gujuDoc, thanks, I will probably do a sports med fellowship after my ortho residency. I really liked the things you can do in sports and the patient population. You work with the young and the old, you do a ton of arthroscopic surgeries (ACL, Meniscus repair, Shoulder, ankle, etc), nice hours, mostly elective cases, the patients are motivated to get better and are usually healthy with a active life style, you can be a team doc for the local high school/college/professionals, you can take trauma calls and do some nice bread butter trauma cases (although most orthopods as they get older tend to stay away from trauma call), you can do injections/casts/splints/closed fracture reduction/ect in clinic, the patients really appreciate the things you do for them, if you are out in a community you can even do primary joints (knee/hips) if you want.

The thing that attacted me to ortho is ........ well, how cool is it to be able to throw in a metal component into someone's body in 2 hours and have them walk out of a hospital after a huge accident or for someone who have >10 yrs of severe knee pain to be pain free, because of what you have done. Also, in the field of orthopedics, you can do a ton of different fellowships, including hand surgery (digit/limb transplant, tendon repair, fracture plating, wrist implant, etc), trauma (complicated pelvic fracture, open fem/tib/fib, if you can fx it, then it can be plated/screwed/or roded), peds (10 hr long scoliosis cases, double bar with screws to reduce a 80 degree curvature to 30 degrees or so, congential foot/limb/hand repair, etc), spine (lumbar fusion, cervical plating, traumatic fractures, etc), Tumor (resection of tumor from any bone, limb amputation, etc), Foot/Ankle (anything you can think off that happens to the bones of the foot can be repaired, arthodesis, ankle replacement, fxs, etc), Joints (total knee, total hip, large revisions, total elbow, total wrist, total ankle). The best part is how much you can do to change your patient's life. I have seen post op total knee patients cry in clinic on their followup to thank the orthopod for giving them their life back and after so many years of pain, they can not believe that there is no more pain any more. They are out walking and enjoying life again. The little kids love the different colored casts, they cry when you reduce the fracture but once you have put a cast on they are usually happy or playing with it. These are just a couple of stories.

The big misunderstanding that alot of people have about ortho is that it is just the bones. But as you can see, there is alot of opportunities that are open to the orthopedic field. Sure we work on the bones, but alot of things can happen to the bones and the muscles and the tendons and the joint space and the ligaments........ so it is a complicated field that requires one to master a lot of knowledge in residency. To give you an example, the bible of hand surgery is called Green's operative Hand surgery, it is a few thousands pages of material just on how to do hand surgery. And then you have the other sub spec of ortho....

Ok, back on to the soft tissue, here is a good website on how to the the proper pelvic exam, from one of my friends who is a current Ob/Gyn resident. Only for those who are interested for the educational value!

http://www.brooksidepress.org/Products/Military_OBGYN/Textbook/GynecologicExam/Pelvic/pelvicexam.htm

I can't believe there is almost 2000 hits on a post with the word "gynecologist" in the heading.

 

[happydays]

I am not the expert on pelvic exams, but here is what I still remember from medical school. The Pelvic exam is called the Bi Manual pelvic exam because you use both of your hands to perform the exam. Usually, the first step involves inserting the speculum into the vagina to visualize the cervix, which looks like a apple with the depression as the entrance to the uterus. You swab that area for G/C culture and also where you do the pap smear. After you do that and examed the outer structures (vulva, labia min/maj, etc) then you proceed to do the manual exam. You have to use both hands. 1 or 2 fingers into the vagina (your preference) with either your dominant or non dominant hand (again, this is your preference). Use the other hand, palm down to apply pressure on to the bladder and the uterus. Use both hands, you want to feel the cervix (kinda just wiggle it a little bit ) and if the pt has tenderness, then it is a good indication of PID (pelvic inflammatory disease), feel the bladder a little (tenderness = cystitis), then you move your fingers to the right and left side to feel for the adenexa = ovaries/fallopian tubes. hard to feel, but if painful, can be cyst, infection, tumor,etc. The last step, you keep your index finger in the vagina, and insert the middle finger into the rectum to feel for the membrane (any adhesions, fistula, hemmorrids, etc), then you wipe the stool on a guiac card to test for heme (+ = blood). Also having tenderness with the exam can also be a normal thing, but cervical motion tenderness is pretty much a buzz word for PID, and that is when the patient jumps on the table or very uncomfortable when you move the cervix.
Also experience plays a huge part in terms of what you can get from exam

That is the pelvic in a nutshell. If you want to know more, just Google it. If you want to be good at it before medical school start, just ask your girlfriend if you can practice a little for the sake of the educational experience. Anyways, you will have plenty of memories/experiences in medical school that will last you a life time. I can write about the first time I had to so a rectal exam on a standardized patient in my med school. (These people signed up to get fingers in their ....... by 130 medical students ????) Plus the guy I had was from a nudist community and it was just the weirdiest experience to have your finger in a guys butt, and have him tell you what you should and should not be doing with that finger.... . Now I really don't care about rectals anymore since I have done so many in the last year. Just it was weird doing it the 1st time.

One of the General Surgeons ask me this questions on rounds "son, when is the only time you should NOT be doing a rectal on a patient?" I don't know
"either the patient does not have an anus, or you do not have any fingers."

I don't think I'm following your amazingly detailed ( ) and graphic description very well...would you please show me using my body?

 

[Gerrymandering]

^^You know Doctor wahoos i was just about to mention the 2000 hits^!! it's really absurd, but at the same time very entertaining...i think they found your rectal exam discussion quite interesting

 

[Wahoos]

Happydays,

You can come to the Orthopedic Sports clinic next week and say that you have right ankle pain.

"So Miss Happydays, I see that you have pain in your right ankle, how long have that been going on and did you hurt it in any way............"

"I see,..... you know, according to the literature, there is a condition described on pages 123-128 of the August, 2005, issue of the American Academy of Orthopedic Sports Medicine Journal talking about the possibility of a cervical infection that can radiate down to the right ankle which can present as ankle pain. The recommendation was to have all orthopedic surgeons perform pelvic exam on patients who present to the clinic with ankle pain. So Miss Happydays, why don't you take off your cloth and I would need to do a pelvic exam just to make sure that I don't miss anything."

"Oh by the way, have you had your yearly breast exam..... No, why don't we do that here in the office just to save you a trip to your primary care doctor."

I love being a Orthopod!

Another interesting experience regarding the pelvic, it was probably one of the 1st pelvic I had to perform as a medical student in 3 rd year. I walked into the room of this 22 yr old girl, who was not the typical Gyn patient, she actually looked liked a model. My attending was in the room with me and said "do you mind if the medical student do the pelvic/pap smear on you". She looked over at me, smiled/giggled, and said "no problem". (that was weird to have the patient flirt with you and you had to do the pelvic on her)
So we walked out the room and came back in after she was set up on the pelvic bed in the lithotomy position. Just when I got into position, I looked and saw this metal ring on her ....... . I said "That looks like it would hurt quite a bit?!", the young lady looked at me and smiled again, and said "No, it actually feels pretty good." . A momment of slience in the room..... Me and my attending looked at each other,... that was a awkward momment. That was one of my first pelvic exams and needless to say, I had no idea what I was feeling down there.

 

[happydays]

Yes, doctor, my ankle has been hurting for weeks. You better take a loot at it...a good look.

That was one of my first pelvic exams and needless to say, I had no idea what I was feeling down there.

Riiiight....

 

[jebus]

She looked over at me, smiled/giggled, and said "no problem". (that was weird to have the patient flirt with you and you had to do the pelvic on her)

Wow, I didn't think there were guys out there who were so clueless. What you saw as smiling and giggling was probably a nervous "oh my god what is this molester going to do with me?" through clenched teeth reaction.
Or she was just waiting for you to hump her right then and there and you blew your chance.
Anyway...

 

[Wahoos]

Jebus, sorry dude, Orthopods are usually clueless when it comes to the members of the opposite sex.

Just from my experience seeing patients in the OB/Gyn clinic, most people don't smile/giggle when you ask them permission to do a pelvic exam. Maybe she was nervous and thinking "what is this molester going to do with me?" or maybe I missed my opportunity, but hey, what do I know anyways compared to all the clinical experience that you have in the Gyn clinic.

 

[jebus]

i was just giving you a hard time, man. it's all good.

 

[Gins]

You will not be seeing to many Jessica Alba's.

I happened on to this site after googling "male obgyn" "coping."

I realize this a med school forum but female patients are out there reading these comments about male doctors being bummed out at not seeing sexy young female patients.

Now this attitude is eactly what many female patients fear about male doctors - that a male obgyn cannot seperate the sexual from the clinical and in fact see their female patients in a sexual manner first and then diagnose second.

I am about to have my first gyno exam in 2 weeks with a male doctor and I am really freaked out and my blood pressure has shot up. So reading comments like this is just awful and only reinforces every fear women have of male doctors and then some of you want to be upset that women are flocking to female doctors?

Whether a female is rough or not, at least she will be diagnosing first second and third and there is no risk of feeling violated in some manner by some young male doctor who may be thinking "hmmm nice boobs!!!" or "tight pu--y!!!"

You guys need to be more professional with your comments on these sites as comments like those above and others like it are not helping females feel safe and secure in going to male doctors. Comments like that only give validity to females perferring female doctors. Comments like these make male doctors look like perverts who enter the med profession to cop a feel!

Watch what you say!

 

[coralfangs]

well, by the time most male obgyns are ready, they are desensitized by the female genitals
thats what i think at least
my uncle is a male obgyn, he said to me when i was around the age of 10, "never become a male obgyn, boy, u will understand when u grow up"
well, he went through divorce twice over the last 15 yrs

 

[45408]

I happened on to this site after googling "male obgyn" "coping."

I realize this a med school forum but female patients are out there reading these comments about male doctors being bummed out at not seeing sexy young female patients.

Now this attitude is eactly what many female patients fear about male doctors - that a male obgyn cannot seperate the sexual from the clinical and in fact see their female patients in a sexual manner first and then diagnose second.

I am about to have my first gyno exam in 2 weeks with a male doctor and I am really freaked out and my blood pressure has shot up. So reading comments like this is just awful and only reinforces every fear women have of male doctors and then some of you want to be upset that women are flocking to female doctors?

Whether a female is rough or not, at least she will be diagnosing first second and third and there is no risk of feeling violated in some manner by some young male doctor who may be thinking "hmmm nice boobs!!!" or "tight pu--y!!!"

You guys need to be more professional with your comments on these sites as comments like those above and others like it are not helping females feel safe and secure in going to male doctors. Comments like that only give validity to females perferring female doctors. Comments like these make male doctors look like perverts who enter the med profession to cop a feel!

Watch what you say!

Relax a little bit, mmmkay? A beautiful woman is going to make a beautiful patient, and you can't make yourself think she's a hideous beast. Of course, doctors should always be professional - but you're not talking to doctors right now, you're talking to a bunch of male college students, remember? There's always going to be a different aspect to the fields of medicine that deal with bodyparts that you keep hidden for 99% of daily life.

 

[Gins]

Relax a little bit, mmmkay? A beautiful woman is going to make a beautiful patient, and you can't make yourself think she's a hideous beast. Of course, doctors should always be professional - but you're not talking to doctors right now, you're talking to a bunch of male college students, remember? There's always going to be a different aspect to the fields of medicine that deal with bodyparts that you keep hidden for 99% of daily life.

hhhmmmmm .... but can u make yourself think of her as a patient period? or do you notice her breasts and her vagina, legs, butt, whatever? Lets be honest. What do you male doctors/interns think when you have a young semi-very-awesomly-attractive female patient on your examination table?

Do those thoughts cross your mind and how do you feel the female patient should feel about that?

 

[jebus]

hhhmmmmm .... but can u make yourself think of her as a patient period? or do you notice her breasts and her vagina, legs, butt, whatever? Lets be honest. What do you male doctors/interns think when you have a young semi-very-awesomly-attractive female patient on your examination table?

Do those thoughts cross your mind and how do you feel the female patient should feel about that?

Gins, I understand your trepidation, however, we are all pre-meds here. Hopefully, for your sake and our own, our attitudes, perceptions, and actions will evolve as we proceed down this path.
Gah... I hate being serious.

 

[Gins]

Gah... I hate being serious.

You getting serious is just fine with me

Actually that's the best thing you could have said.

All of you young pre-med male students please just realize its not easy being in those stirrups being examined by a man no matter how well intentioned he HOPES to be.

 

[Risa]

Gins, I understand your trepidation, however, we are all pre-meds here. Hopefully, for your sake and our own, our attitudes, perceptions, and actions will evolve as we proceed down this path.
Gah... I hate being serious.

Woah... I think I just felt the earth shake a little.

To Gins: What Jebus said. This is an internet forum for pre-meds... and so no, most people here are not going to behave professionally in any way, shape, or form. If anything, this is a highly immature cross-section of the population. They are far removed from the doctor you'll be seeing.

Be that as it may, though, if seeing a male gyn. makes you uncomfortable, don't do it! There are plenty of women out there... I see a female nurse practitioner and she's great. As for the exam itself... the anticipation for your first time will be approximately a zillion times worse than the actual thing, which takes like 2 minutes and is not a big deal at all. I'm sure you know that, and it still doesn't take away the anxiety. But you'll be fine!

 

[stiffany]

you DO know that you are supposed to get pap smears yearly, once you turn 18, regardless of your virginity or lack thereof right?

put that one up there in the note to self category, okay?

This can be oh so uberly debated. We're one of the few countries that say women should have annual pap smears regardless of whether or not they are sexually active. (For instance, in England it's once every three years after your first unless you have abnormal results). In fact, current recommendations stand at having women in their 20s have an annual pap smear and increasing this to every 2-3 years for women without immunocompromise and a few other risk factors (such as previous history of abnormal smears) for women over 30. And, one of the main reasons sighted for that recommendation in young women is their tendency to be more promiscuous then older women and less forthcoming about their sexual history. So, it's like a better safe than sorry liability decision more so then a definitive clinical one to insight that nonsexually active women (or sexually active women who are not at risk for STDs or pregnancy) get a pap smear every year after their first few normal results.

 

[Gins]

Woah... I think I just felt the earth shake a little.

To Gins: What Jebus said. This is an internet forum for pre-meds... and so no, most people here are not going to behave professionally in any way, shape, or form. If anything, this is a highly immature cross-section of the population. They are far removed from the doctor you'll be seeing.

Be that as it may, though, if seeing a male gyn. makes you uncomfortable, don't do it! There are plenty of women out there... I see a female nurse practitioner and she's great. As for the exam itself... the anticipation for your first time will be approximately a zillion times worse than the actual thing, which takes like 2 minutes and is not a big deal at all. I'm sure you know that, and it still doesn't take away the anxiety. But you'll be fine!

Risa, thanks sooooooooooooooo much for your perspective

I have to say I am most confused at the impatience and annoyance expressed by the male students here at female patients perferring female doctors in light of their attitudes and comments on this thread.

Seems they want their cake and to eat it too but as you said it does seem to be a higly immature cross section.

Good luck with your studies!!!!!

 

[stiffany]

You getting serious is just fine with me

Actually that's the best thing you could have said.

All of you young pre-med male students please just realize its not easy being in those stirrups being examined by a man no matter how well intentioned he HOPES to be.

Heya Gins. Echoing Rita, you'll be fine. I too tend to prefer having a female physician (or nurse practitioner in the case of the women's health section of my college's health center) examine me for reproductive related issues. It's a personal choice and when I recently expressed this to a male physician scheduling a follow-up appt (for IUD placement), he had absolutely no problem with it. For me, it's not so much being worried about being "man-handled" since I would hope that very very very rarely happens, but instead I just know that I find it easier to talk about certain things face-to-face with females with similar anatomy and experiences than males I don't know. Still, I have friends who swear by their male physicians and think seeing a female doctor is actually worse. So, it's just your comfort level.

It's perfectly normal to be worried/anxious about having your first gyn exam. Just think about it: It's only culturally acceptable for certain people to intimately touch our bodies and while doctors are put into that category out of necessity, it's still an odd idea to have someone you don't know A. see you naked and B. perform an invasive procedure in a sensitive area. That being said, the anxiety pre-procedure is actually worse than undergoing the actual procedure itself. My first time my blood pressure was high (apparently normal for "first timers" according to my NP), but with talking through the procedure with the NP both before and during, I was less nervous. In fact, it really helped me to know exactly what instruments and steps would be taken, so I myself did a google search. The actual procedure itself only takes a very short amount of time and everyone I've ever seen has been highly professional about it (and willing to acknowledge my nervousness). If you don't have that kind of supportive experience the first time or even if you don't feel comfortable with the physician you're assigned, it's perfectly okay to ask for/find another physician male or female. In fact, it's one of your rights as a patient.

 

[Gins]

Heya Gins. Echoing Rita, you'll be fine. .....

Reeeaallleally glad I found this site!

You and Rita have been great!!!!!

 

[jebus]

You and Risa have been great!!!!!

ahem!
you're welcome....