Who Needs a Gynecologist -- and When?

By Ishani Ganguli
Special to The Washington Post
Tuesday, October 2, 2007

Along with glass ceilings and high heels, a visit to the gynecologist falls somewhere on the dark side of being the fairer sex. It's something to which many women grimly resign themselves. That's because, from a woman's first signs of puberty to menopause and beyond, her gynecologic exams and relationship with the doctor who performs them can play a critical role in her health.

But the question that many face, and that experts still debate, is who should provide the care -- and when.

Some experts say women are often more comfortable being examined by their family doctor, whom they've known for years and can speak to frankly about intimate matters. General practitioners handle almost 20 percent of routine gynecologic exams, according to a study published last week in the Archives of Internal Medicine.

As long as a woman gets the care she needs, "it doesn't matter who renders it -- whether they see their pediatrician or go to the clinic or the nurse practitioner or the gynecologist," said Kenneth Blank, a gynecologist affiliated with the Georgetown and George Washington University medical schools.

Others say that although many family practice doctors are knowledgeable about the field, they may be too time-pressed to focus on gynecologic care. "I think our first choice should be for the OB-GYN to handle these kinds of problems, because that's what their training and experience allows them to do best," said Steven Sondheimer, co-chair of the gynecologic practice committee of the American College of Obstetricians and Gynecologists (ACOG) and a professor of OB-GYN at the University of Pennsylvania.

In fact, for many women, a gynecologist serves as primary care physician, the only doctor they visit routinely.

Annual gynecologic exams are still recommended by many physicians even though their value has long been contested. But the question of when to start and end gynecologic care is far from clear-cut.

About 19 million American women, or 18 percent of adult women, receive annual pelvic exams, at a cost of $2.6 billion a year, according to the Archives study.

"It's important for women to have a doctor who's comfortable dealing with reproductive and, if you will, genital issues, because, throughout a large part of our lives, that is where our health concerns are focused," said Marcie Richardson, a Boston-based obstetrician-gynecologist.

But starting that relationship often involves apprehension.

Primed by images of hard metal stirrups and a frigid speculum, "a lot of young women who have never been to the gynecologist are somewhat intimidated," Blank said.

In part to alleviate these fears, ACOG recommends that girls begin seeing a gynecologist between ages 13 and 15 -- not necessarily for a pelvic exam (unless they're sexually active) but to build a relationship with the doctor and to start tackling difficult issues such as first intimate relationships, birth control and sexually transmitted infections.

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