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Only a quarter of Russian women of reproductive age immediately see a doctor in the event of anxiety symptoms, the rest prefer to wait until "it goes away by itself." And less than a third undergo a preventive examination by a gynecologist as recommended by experts - every six months. Such data was obtained by the All-Russian Center for the Study of Public Opinion (VTsIOM) in the course of a survey devoted to the study of the level of medical literacy of Russian women in matters of women's health. The result of such carelessness is a high mortality rate from diseases that are considered absolutely preventable, experts say.
What VTsIOM found out
The all-Russian survey "Gedeon Richter Women's Health Index" was conducted by VTsIOM on March 20-25 as part of the Women's Health Week social project aimed at raising awareness of reproductive health issues. 1,200 women aged 18-45 from all regions of Russia were interviewed and an additional 360 women from Moscow, St. Petersburg and Yekaterinburg. The results of the study were presented to journalists by the head of the department of social and political research of VTsIOM, member of the Public Council under the Ministry of Health Kirill Rodin.
Infographics: VTsIOM
Surveys have shown that the proportion of women of reproductive age who annually undergo a preventive examination by a gynecologist is 74%, including 29% come for a consultation every six months (the frequency recommended by doctors). Women 18-34 years old (34%), as well as women with high, according to their estimates, wealth (37%) take their health more seriously than others. The share of women who do without preventive consultations is 14%, another 1% of those surveyed reported that they had never been examined by a gynecologist at all. Women who refuse to regularly visit a doctor explain this by the absence of health complaints, the presence of a permanent sexual partner, as well as the lack of time and the high cost of tests and medications.
In the event of the appearance of alarming symptoms of the disease, only 27% of the women surveyed immediately make an appointment with the doctor. Another 59% of women go to a gynecologist after a while (if the symptoms do not go away on their own), another 14% can wait quite a long time and seek medical help only if the situation noticeably worsens.
Infographics: VTsIOM
Sociologists found out the preferences of Russian women when choosing a gynecologist. Thus, the majority of the respondents prefer to visit the same specialist: 32% always go to “their doctor,” 49% usually do the same, but sometimes they can seek advice from another gynecologist. Most often, our compatriots go to the district clinic (67%), much less often - to departmental clinics (7%). Another 26% of women attend private consultations (which is 4-5 times more than the share of visits to private medical institutions of Russians in general).
Internet versus doctor
About half of the surveyed Russian women (47%) said there is a shortage of competent qualified gynecologists in their city. And we are talking not only about the outback - the qualifications of gynecologists do not suit every second Muscovite. However, according to Rodin, this indicator cannot be considered objective. Since patients who do not have special knowledge cannot assess the level of professionalism of a gynecologist, this indicator can be considered a kind of “social demand for the quality of medical care and a constructive dialogue with a doctor,” the sociologist explained.
The head of the department, who commented on the results of the study. Head of the Department of Obstetrics and Gynecology with a course of neonatology at the RUDN University, Professor Viktor Radzinsky recalled an anecdote on this occasion about how God decided to take up medicine in a district clinic. “A disabled person comes to a reception on crutches, and God tells him: 'get up and go.' He easily runs out into the corridor, where the queue asks how he liked the new doctor. Yes, the same, he answers, like the others - inattentive, did not ask how I feel, did not measure the pressure, "- joked Radzinsky.
But seriously, according to the professor, a modern woman no longer blindly follows the recommendations, but takes part in the choice of diagnostic and treatment methods. “Thanks to the Internet, the patient knows a lot about diseases, and sometimes she is able to 'corner' her gynecologist,” says Radzinsky. “And in order to keep up with patients, doctors must constantly develop and gain new knowledge. In addition, for women to be adherent to therapy, gynecologists must clearly explain what and why they are prescribed. Alas, not everyone is ready for this yet. "
Infographics: VTsIOM
"Fight against indifference"
On the other hand, according to the expert, it is gratifying that, although only 47% of Russian women trust the level of gynecologists, 67% of women come to the annual examination. “Probably, all the same, with what feelings, just to visit the doctor. It’s worse when they don’t come at all, ”the professor said. - Yesterday we received a 42-year-old woman with disintegrating cervical cancer, an absolutely preventable disease. But for the past five years, she simply did not show up to the gynecologist. The other day we operated on a 64-year-old woman who had a spiral for more than 20 years. And sometimes we detect advanced stages of cancer even during pregnancy. "
V The Soviet Union cervical cancer ranked first in terms of detection, Radzinsky said. Each polyclinic had an examination room, bypassing which no woman could get to either the ophthalmologist or the dentist. “It was such a fight against indifference,” said Radzinsky. - The midwife in the examination room performed what we now call screening for cancer of five localizations - she examined the breast, genitals, rectum, skin, and mouth. After all, the same cervical cancer does not develop instantly, it takes from 5 to 12 years, and at the precancerous stage, the disease is completely curable. But, alas, sometimes we are faced with such advanced forms of cancer, which indicate that the patient has not been to the gynecologist for more than 5-7 years. "
Why do gynecologists treat patients in such a way that they pull to the last and decide to come for an examination only when they are already completely pinned down? And why are female gynecologists the most rude and indelicate? Our expert, obstetrician-gynecologist Dmitry Lubnin understands what is behind the amazing tradition of “punitive gynecology”.
To simplify the discussion, I will make several disclaimers at once. No, I do not consider myself smarter, better and more professional than all other gynecologists, I sincerely respect and appreciate the professional qualities of many of my colleagues, but not all. I raise this topic because I believe that there is a very serious problem in Russian gynecology, which not only negatively affects the reputation of our profession, but also affects the quality of services and the quality of life of patients. And this problem is not discussed as actively as other similar problems in domestic medicine - this is largely due to the intimate nature of our medical specialty. Try to see in my text not a desire to offend all gynecologists by posing as a kind of smart guy, but just a look from the inside at the disadvantages of the existing gynecological practice.
I will answer right away to everyone who argues that they have an excellent doctor and that they have never encountered such problems: you are very lucky. There are good doctors, there are many of them, but your positive experience will in no way reassure the patients who were treated rudely and unfairly. I hope this preface will at least slightly anticipate a possible negative reaction from some readers.
Medical attorney
Some time ago, I began to actively engage in educational activities - I began to tell patients in detail all the nuances of gynecological work. It is very important for me to ensure that patients are protected in the not-so-fair game that they have to play when they try to get medical help. A patient who comes to an appointment simply does not know the rules and blindly agrees to the examination and treatment proposed by the doctor, without being able to assess how adequate what is offered to him. Often this situation is aggravated by an atmosphere of fear and excitement. Actually, all my publications, books and public lectures are aimed at educating patients, allowing them to interact with the doctor at a more advanced level.
A clear realization prompted me to engage in such a lawyer's activity: something has long rotted in the gynecological kingdom. I often have to act as the doctor to whom people turn for a "second opinion", and patients come not only from Moscow, but also from all over Russia. I am an active medical practitioner, and literally all of my patients have one thing in common: they are very scared and extremely upset not only by what happened to them, but also by the way this problem was presented to them. Often, doctors bring the patient to such a state that before she musters up the strength to come to another consultation with another doctor, she cries for weeks and tries to come to her senses.
Why it happens? Many citizens of our country have long been accustomed to the aggressive and boorish attitude of doctors, but why exactly obstetrics and gynecology hold the palm in this area? It seems to me that I partly understand the reason for this bias. Here's my version.
What's wrong with our gynecologists?
I'll start from the very beginning - who goes to gynecology? Studying at a medical university is organized as follows: first, all students study to be a general practitioner, and only then, after completing an internship, they can get a narrow specialty. All students already from the first year know that there are three "trump" specialties, the residency in which will not be available to everyone: gynecology, urology and dermatovenerology. It has become a tradition for a long time, the explanation is simple: since Soviet times, doctors of these particular specialties have been accepted to pay for the provision of medical services, and pay a lot. Plus connections, which are sometimes more expensive than fees. Obviously, first of all, the places in residency in these specialties were distributed among thieves and wealthy students, in fact, this is the case with rare exceptions now.
As I remember from my training, which took place in the late 90s, thieves students already in their first year confidently asserted that they had prepared a place in a residency in gynecology and frankly ignored it. O most of the training, stating that it just won't be useful to them at work. That's exactly what they said: "I only need the anatomy of the uterus, the menstrual cycle and then 2 weeks of obstetrics in the fifth year - that's all." Neurology, cardiology, gastroenterology and all other specialties were ignored under the sauce of uselessness. It is obvious that such training in medicine forms a paramedic narrowness of consciousness. Feldsherism is a “pill for the head, a pill for constipation” instead of treating the body as a whole.
I remember my conversations with such future "stars" of obstetrics and gynecology. To my botanic question why they do not teach anything, the answer was one: "Come to work - we will learn." Then, in residency, I saw how it happened: "Can you tell me, with this analysis result, what do you prescribe?" - write down and then all the same and prescribe, without going into the nuances. Such one-dimensionality of thinking leads to the appropriate behavior of the doctor at the appointment: misunderstanding of the essence of the disease, fear of making a wrong diagnosis, under-examination or under-treatment is manifested in the redundancy of the doctor's actions and aggressive intimidation with the consequences - “out of harm's way”.
Ultimately, out of the entire stream of students, most often the most capable and well-trained students find themselves in more accessible and less rogue specialties (therapy, general surgery). The three "golden" specialties collected and are collecting first of all "difficult" students, and diligent ones - on a leftover principle.
I will summarize in between: most often students who study not the best, but who are accustomed to their special status, get into gynecology. This is the first factor that influences, I believe, the problem we are discussing.
Classical medicine, which is often ignored during training, involves a detailed conversation with the patient, a thorough examination, a preliminary diagnosis, and tests should only confirm this diagnosis. A confident shooter takes aim and makes only one accurate shot without fuss. If you are not sure, then they shoot a lot, chaotically, aggressively, hoping to hit the target at least by accident. Rudeness, running over a patient is often a defensive reaction in a situation of one's professional uncertainty and fear of taking responsibility for the decision.
For example, if a patient has uterine fibroids, doctors often immediately suggest cutting off the uterus, and at the same time the ovaries, as well as the cervix (and then you never know what will happen, suddenly cancer?). All this is motivated by the fact that the uterus is not needed if the patient is no longer going to give birth to children. We will talk about this attitude to the reproductive organs later, now - about the doctor's decision itself. In fact, with such aggressive radicalism, the doctor first of all defends himself, reinsures himself. In principle, such a radical approach to the treatment of fibroids is permissible, but in modern conditions it is possible to act differently. But such a doctor either does not know how to do it differently, or simply does not want to take responsibility - "otherwise what will happen if you leave it and not cut it off."
Women's prison, garment factory and other interesting places
The next interesting aspect of the profession is mono-gender. Simply put, in gynecology, the vast majority of doctors are female. For many, this is not strange, well, really, but how else? They just forget that gynecology is a branch of medicine, and you cannot treat it like a women's bath. Yes, it would be strange if a man worked in a women's bath, but in medicine, the presence of a man does not surprise or doubt anyone. It is often possible to hear that a woman understands a woman better, so she turns out to be a good gynecologist, but this is absurd, as if we said that a doctor who has had a myocardial infarction better understands heart attack patients and will treat them better. Yes, quite a lot of women cannot decide to go to a male gynecologist - they cannot separate medicine and the gender of the doctor, without thinking that they go first of all to a professional who must solve their problem, and it does not matter what gender he is. This is how a gender bias was formed in our specialty, in which the number of male gynecologists is significantly inferior to the number of female doctors.
Monogendarity always gives rise to special forms of interpersonal relations, be it the army, a garment factory or a female dormitory. There is a simplification of communication, rudeness, impudence, neglect are allowed. A feature of a female monogender society is a rather pronounced and vivid evaluative rhetoric, open aggression towards more attractive and successful women.
Probably the most striking external manifestation of simplified communication, which is characteristic of a monogender society, is the almost obligatory transition of gynecologists to “you”. To some, it may even seem, on the contrary, a manifestation of the good disposition of a doctor, but this can be so in any other matter, just not in medicine. Simplified communication is harmful, since it reduces the process of medical activity to social or friendly conversation, during which a structured admission scenario (taking anamnesis, examination, discussion of diagnosis and treatment) is replaced by a doctor's benefit. The patient, on the other hand, must become an unwitting spectator of this benefit, in which there will be many emotional assessments and judgments that are far from medical science. The transition to "you" is often the first "bell" indicating that the doctor will build his communication in a simplified form, not showing due respect to you. The option “between us girls, you can do it” in the field of medicine is incorrect. Perhaps this is just my opinion. I would like to emphasize once again that if you have an excellent doctor and you are on good terms with him, this is very good, but this is more the exception than the rule.
Of course, male gynecologists are not without flaws, among them there are also rude, aggressive and ill-mannered people. But most often from a male gynecologist, a patient can hear kind words, a compliment and get a more respectful attitude. And male gynecologists are usually not eager to switch to "you" - it is important for them to draw professional boundaries.
Cut or mend?
My main topic in gynecology is the treatment of uterine fibroids, one of the most common benign tumors of the female genital organs. V currently I advise women from all over Russia and neighboring countries, and during this time I have accumulated quite a few stories from my patients about communicating with gynecologists.
The specificity of fibroids is that because of this disease, women are often removed from the uterus. To understand the scale of the problem - simple numbers: in Russia, every third woman over 50 has a uterus removed, and average age surgery to remove the uterus - 43 years. It should be noted that the removal of this organ is quite difficult for women not only physically - after such operations, severe syndromes develop (side effects - from an increased risk of cardiovascular diseases to early menopause and problems in sexual life), but also morally. For many women, removal of the uterus significantly disrupts their sense of femininity and affects their self-esteem. Severe depressive conditions are often observed.
You might be surprised, but there is an alternative to removing the uterus. This is a fairly simple and harmless procedure called uterine artery embolization (UAE). It allows you to cure the disease, not to remove the organ and allow the woman to continue living a full life.
For 15 years now, my colleagues and I have been striving to save as many women as possible from the removal of the uterus, telling and popularizing the UAE method. It is quite difficult to do this, since there is a very serious opposition from gynecologists. The reason is simple: the procedure is performed not by gynecologists themselves, but by doctors of another specialty - endovascular surgeons. In other words, gynecologists lose most of their patients due to this operation. Therefore, patients in various ways are intimidated and dissuaded from UAE - and here you can especially clearly trace all the negative attitude of gynecologists towards their patients.
Most often, gynecologists conduct a dialogue with the patient like this: “Woman, why do you need a uterus, that you grabbed onto it? Let's cut it all off - and that's the end of it, the operation is not difficult, you say thank you later. I would cut everything off for myself too. And do not tell your husband anything, we will write him a separate reference that the cyst has been removed, but we will not say anything about the uterus. If he does, you dirty the gasket once a month and throw it into the bucket, he won't guess anything. "
In this typical phrase, in my opinion, there is everything: the attitude towards the patient, towards femininity and towards the female body in general, towards relationships in marriage, towards sex, finally.
I even had a downright conspiracy theory that such an ardent desire of female gynecologists to cut off the uterus of all their patients has deep evolutionary roots - something like an unconscious struggle with competitors for the ability to leave offspring, realized in such a perverse way. Someone will say that I have too rich imagination, but perhaps there is something in it.
The overwhelming majority of my patients say that gynecologists brought them to a nervous breakdown and they left them in tears, continuing to worry at home. Judging by their stories - and they are frighteningly repeated up to certain turns of speech and sequence of scenes - gynecologists tried first of all to intimidate the patient with their personal reactions to their disease: “What a horror! How do you go with that ?! " Then draw a terrifying prognosis: "We urgently need to remove everything, there is a risk of oncology." And then show the hopelessness of the situation: "You have no choice, no one can help you."
I have repeatedly asked the question: why do doctors scoff at their patients so subtly? What is the reason for demoralizing a woman and bringing her to a helpless, humiliated state? What is it - the enjoyment of power, an attempt to take revenge on another person for his own problems and failures in life, just a dislike for people or people of the same sex in particular? Maybe this is a vivid manifestation of the popular and not unfounded stereotype that there is no female friendship and all women hate each other? Honestly, I'd love to think that I'm wrong.
"To spite my mother, I will frostbite my ears" (if only my ears!)
What do we have in the bottom line? There are many worthy doctors in my profession, but the general feeling from Russian gynecology is rather negative. But should it be that in such an intimate and subtle matter from the point of view of psychology, outright rudeness and humiliation is practically considered the norm? But the result of such aggression is the reluctance of the overwhelming majority of women to regularly visit a gynecologist for preventive purposes, and in gynecology this is extremely important. Most serious gynecological diseases develop over the years and are completely asymptomatic. They can be detected, stopped and treated early, rather than being triggered to the point where they start to show symptoms and require serious and expensive treatment.
If you ask a woman why she does not go to a gynecologist, most often she will answer that she is emotionally not ready for everything that can be expected of her at a doctor's appointment: a story about the intimate sides of her life, a doctor's condemnation, an unpleasant examination on a chair, etc. d. All this is rather difficult for the female psyche. But the flip side of this situation is neglected diseases, the treatment of which already requires serious material costs, surgery and may affect the ability to have children.
As a doctor, I can tell you: if a woman from the age of 18 visits a gynecologist once a year, does an ultrasound scan and take a cytological smear from the cervix, it will be possible to reduce gynecological morbidity by at least 90 percent, and leave surgical interventions only for rare emergency situations. Consequently, a woman's health directly depends on the comfort that a gynecologist can create for her, so as not to discourage her from regularly going for preventive examinations.
I don’t know how you can change the system as a whole. For my part, I am all available ways I try to educate and educate patients so that they can correctly assess their condition, take tests on time and ultimately look for a doctor with whom they will be comfortable. And most of all, I would like to warn everyone against a situation when, offended by all the gynecologists of this world for their rudeness and incorrect behavior, women, according to the principle "to spite my mother, I will frostbite my ears" stop going to the doctor altogether.
Why you need to stop being afraid to go to the gynecologist, what diseases will help prevent examination and in what cases you need to immediately go to the doctor - we answer these and other questions.
Doctors need to be visited annually and, depending on age, gender, and family history, have minimal screening. The main professionals who need to make regular appointments are the therapist (or family doctor), dentist and ophthalmologist. For women there is also a gynecologist, for men - a urologist.
Fear of being examined by a gynecologist is often passed on to girls "by inheritance" - from mothers and grandmothers, who colorfully talk about all the horrors of "Soviet" gynecology. They do not take into account the huge progress in medicine at all: in the relationship between the doctor and the patient, in instruments - instead of metal mirrors, disposable plastic ones are used, they are of different sizes and are much more comfortable for patients - in compulsory anesthesia. Society still unanimously believes that a gynecologist is one of the most "scary" and disliked doctors for women.
Most women necessarily associate a gynecological examination with feelings such as pain, shame, awkwardness, and humiliation. Previously, people underwent mandatory preventive examinations, women visited a gynecologist. The examinations were superficial - very little time was allotted for each patient. The main task was to take a smear for oncitology (an analysis that allows you to detect precancerous cells in the cervical region. - Approx. ed.) - to reduce the incidence of cervical cancer. In this respect, such examinations were effective. But psychologically they are extremely uncomfortable. And without a medical examination, for example, they did not sign a vacation application.
The obstetrician-gynecologist accompanies girls throughout their lives - he deals with women's health in general. The specialty is called "obstetrics and gynecology" for a reason: everything related to the period of pregnancy refers to obstetrics; everything about a woman's health outside of pregnancy - to gynecology. Therefore, an obstetrician-gynecologist for women is considered a primary care physician - as a therapist.
Why visit a gynecologist regularly
You need to visit a gynecologist from childhood. Of course, the first visits to the doctor will be with the parents and are devoted to routine examination and evaluation of the girl's development. This is an opportunity to discuss hygiene with a doctor, changes in the body, to ask some questions specifically to the doctor. Going to the doctor in childhood forms the culture of visiting the gynecologist and relieves the fear of examinations. It is important.
When a girl turns 15, she becomes independent and has the right to medical confidentiality. From that time on, the doctor cannot tell the relatives anything about the girl's state of health without her consent.
The task of the annual examination by a gynecologist is to identify various diseases before the first symptoms appear. For example, heavy periods can lead to the development of iron deficiency anemia. This is a serious disease, as a result of which, due to a lack of iron, the blood begins to carry much less oxygen, which can provoke problems with the skin, hair, digestion and even the cardiovascular system. A woman in the early stages may not feel the approach of the disease in any way, but a regular visit to the gynecologist can help her recognize and prevent the disease in time.
The first changes, which in 10-15 years will lead to cervical cancer, also do not manifest themselves. They can only be found as a result of special analysis. Changes in the mammary glands, such as fibroadenoma, are not always noticed by women on their own. The annual gynecological examination necessarily includes breast palpation.
A modern examination is impossible without an ultrasound examination of the pelvic organs - the uterus and ovaries. It should be carried out annually at any age. Ovarian cysts and pathology of the uterine cavity can often only be detected in this way.
Many women, with the cessation of menstruation and the onset of menopause, cease to be observed by a gynecologist - this is wrong. At different ages, there are various diseases of the female reproductive system. The main tasks of the obstetrician-gynecologist change with the age of the patient.
Examination by a gynecologist must be carried out at least once a year (preferably once every six months), if there are no complaints. This frequency is sufficient to monitor a woman's health status. On the eve of visiting a gynecologist, intimate relationships are not recommended. The ideal time for a check-up is right after your period ends.
Girls must understand: they have their own makeup artist, hairdresser or cosmetologist - there must be their own gynecologist, the patient can trust him and ask any questions about women's health.
In what cases it is necessary to visit a gynecologist unscheduled
The reason for an unscheduled visit to a gynecologist should be any deviations from the usual regimen, the duration and abundance of menstruation, the appearance of pain, bloody discharge of any intensity outside the period of menstruation, changes in personal life(change of partner or marriage), pregnancy planning.
Another important reason to make an appointment with a gynecologist is the choice of contraception. It takes place together with a doctor on the basis of an examination of the patient and a special survey about the risk factors for possible complications. For example, women over 35 who smoke should not take combined oral contraceptives - a combination of substances from tobacco smoke and estrogen negatively affects the walls of blood vessels, there is a risk of blood clots and thromboembolism (acute blockage of a blood vessel by a blood clot. - Approx. ed.). Therefore, you can not start taking pills on the recommendation of friends or based on the reviews of other girls on the Internet.
Hormonal contraceptives are taken not only for protection. Their use can help to cope, for example, with diseases such as acne and premenstrual syndrome. Some modern contraceptives contain folate, or vitamin B9. They are necessary to reduce the risk of fetal malformations. Hormonal contraceptives have other non-contraceptive benefits as well. They can reduce the profusion of menstruation, make them less painful. With their help, you can postpone your period if it falls on a vacation or an important event.
To select the right oral contraceptive (OC), you need to have a general pelvic examination, have your blood pressure measured and discuss possible risk factors with your doctor and take the necessary tests, which your gynecologist will tell you about. If you decide to stop using condoms with your partner in favor of OC, do not forget to discuss joint testing for HIV, hepatitis B and C, syphilis, chlamydosis and trichomoniasis with him.
What tests do girls need to take regularly?
Mandatory analysis: testing for atypical cells from the cervix - smear for oncocytology or PAP test. It must be taken by every woman from 21 to 65 years of age. These analyzes are essentially the same, but the methods of execution are different. A smear for oncocytology is performed annually, and a liquid PAP test is performed every 2-3 years. Oncitology allows you to identify patients who are at high risk. In this case, the gynecologist offers them a special examination to prevent cervical cancer.
Testing for human papillomavirus in Russia is not mandatory health insurance and in the plan of many voluntary medical insurance and, as a rule, is performed secondarily - if necessary.
Infection testing is necessary if the sexually active woman is unmarried and wants to be tested.
Therefore, every woman at any age should regularly visit a gynecologist at least once every six months - a year in order to avoid serious health problems. You should not wait for the manifestation of symptoms - the main part of the so-called female diseases at the initial stage is asymptomatic, and when some signs of ill health appear, it means that the disease is already progressing.
The main task of a gynecologist is to preserve the health of a woman, and not at all to treat. That is why doctors so often remind about the need for regular preventive examinations. Medical statistics show that 8-10 percent of women have gynecological diseases of varying severity, including oncological diseases, are detected precisely during the prophylactic examinations. Although the patients do not complain about anything and claim that they feel completely healthy.
Modern technologies make a complete gynecological examination quite easy - it is carried out in one appointment with a doctor: examination, colposcopy, sampling, analysis, ultrasound. The new generation of colposcopes (an apparatus for examining the mucous membrane of the walls of the vagina and the vaginal part of the cervix under high magnification) has such a resolution that with its help an experienced doctor is able to detect oncological diseases of the cervix of the uterus in the early stages, since changes in the vascular pattern characteristic of oncological processes are noticeable ... In such cases, the doctor prescribes additional laboratory tests.
Mixed infections are the trouble of our time. They cause the most serious female diseases, up to infertility (chlamydia, ureaplasma ...) and cancer (herpes, papillomavirus). In modern laboratories today, real-time PCR analyzes are performed, which almost 100 percent detects latent infections at the level of a single microbial factor, which may not be detected by the usual method.
The problem is that venereal and inflammatory diseases in women, unlike men, often go unnoticed. If they are found in time, they heal quickly and pass without a trace. But if not regularly examined, the infection is detected already in a chronic form, which, of course, can be fought, but difficult. And any advanced infection has serious consequences, such as infertility, inflammation of the pelvic organs ...
However, serious consequences can cause seemingly harmless bacterial vaginosis, which many women are able to suspect themselves, since it is accompanied by discharge, discomfort during intercourse, burning sensation ... The development of bacterial vaginosis can be facilitated by various endogenous and exogenous factors: a change in hormonal status, a decrease in immunological reactivity , violation of intestinal microbiocenosis, previous inflammatory diseases of the genitourinary tract, the use of hormonal agents, immunosuppressants. Infections easily penetrate into the uterus due to a violation of the composition of the vaginal microflora and a decrease in its protective function, as a result of inflammatory diseases and their consequences account for about 60-70 percent of the total number of gynecological diseases. And timely treated inflammation does not leave the disease a chance for development.
Treatment, as a rule, is outpatient - physiotherapy (laser therapy), protivinflammatory and immunocorrective.
Olga Nikolaeva
Dr. Peter
Natalya Mikhailovna, please tell us why family doctors force women to visit a gynecologist every year?
Often women, having come to a gynecologist for an examination, begin with the phrase: "Oh, how I do not like going to gynecologists and dentists!" And who loves ?! Probably, there is no woman who enjoys it! I think that the origins of this attitude lie in the fact that for a long time we “had no sex”, and everything below the belt was ashamed and forbidden. But you have to love yourself and know what it is for. Unfortunately, our patients most often come to the doctor only when they feel so bad that they cannot but come. This is very bad. There are diseases that can be diagnosed and treated in the early stages, without bringing them to critical situations.
The annual prophylactic oncological examination serves this very purpose. It is aimed at identifying the early forms of cervical cancer and breast cancer, which is one of the most common forms of cancer in our country. And this is simply awful, because the mammary glands are available for examination and self-examination, and it is not difficult to identify their pathology in most cases, even with the help of a simple examination and manual examination.
At the oncological examination, a special smear is taken from the cervix of the uterus for a cytological examination, which reveals the initial forms of cervical cancer and even precancerous processes - dysplasia. Moreover, these initial forms can and should be treated, and treatment allows you to prevent the development of a malignant disease. During oncological examinations, a lot of other, non-oncological, pathology is revealed, which for the time being may not bother a woman, but is an indicator that something is wrong in the body. Ovarian cysts, uterine fibroids are detected. Small fibroids can be asymptomatic for a very long time. Or the woman simply does not pay due attention to these symptoms, for example, a slight increase in the time of menstruation, or the fact that they have become more abundant, or spotting appeared in the middle of the cycle, somewhere something aches, etc. That's what you need oncological examinations.
During the oncological examination, the doctor will definitely ask the woman if she examines the mammary glands on her own. True, not everyone knows how to do it correctly. If you do not know this, be sure to ask your family doctor or gynecologist to explain this to you. But it is imperative to look at your breasts yourself! According to some reports, in 90% of cases, breast cancer is first detected by the patients themselves. It is very disappointing when a woman with advanced breast cancer is seen.
It is also very offensive when a woman comes for an examination and says: "Oh, I don't want to be examined, just write to me." In this regard, I would like to draw your attention to the following fact. Abroad, when concluding a contract for health insurance, a person signs a contract in which he undertakes to undergo the necessary examinations in a timely manner. And if he does not fulfill these obligations, does not take tests, does not undergo preventive examinations, does not make the necessary vaccinations, then the insurance company may subsequently not pay his treatment costs. It’s a pity that we don’t have this.
Well, well, why do women need to visit a gynecologist who are in menopause and who are not sexually active?
If a woman has not changed her sex, then she remains a woman for life, and she needs to visit a gynecologist every year at any age, including menopause. We have had several cases in a row when women in menopause did not visit a gynecologist for a long time, despite the fact that they periodically had spotting from the genital tract. I want to draw special attention to the fact that in such situations it is imperative to consult a doctor, because there should not be any bleeding during menopause. If they appear, this is a very unfavorable symptom that suggests the presence of an oncological disease. Menopause is the absence of menstruation for a year after the last menstrual period. After menopause, there should be no more bleeding. If any alarming symptoms appear, it is better to go to the doctor once again, not to wait until the family doctor directs you to the gynecologist.
Do I need to see a gynecologist for women entering menopause?
Women often think when they start menopause and have such unpleasant symptoms as hot flashes, dryness in the vagina, urinary incontinence, weight gain, etc., it should be so. Because it was like that with her mother and grandmother. And all these problems are taken for granted. This is not true. All of these can be treated. I cannot say that it is in the power of the doctor to completely eliminate, "cure" all the symptoms of menopause in absolutely all women, but it is quite possible to alleviate the condition of a woman.
Do you mean hormone replacement therapy?
Many women categorically refuse hormone replacement therapy. It must be said that, firstly, these refusals in most cases are unjustified; and secondly, in addition to hormonal drugs, the doctor may prescribe others that will prevent damage to the osteoarticular system, normalize the neuropsychological status, etc. gymnastics, diets, etc. After all, in addition to the woman herself, her loved ones also suffer, since a woman at this time may have a depressive mood and other changes in her psyche.
How to properly prevent pregnancy?
Please tell us how to choose a method of contraception, and when, in general, do you need to be puzzled by this question for the first time?
This situation is not uncommon. A young girl comes to the reception. We ask: "Do you live sexually?" "I live." "Are you protecting yourself?" "I am not protecting myself." "What, do you want to get pregnant?" "No". It turns out to be a paradoxical situation. In this regard, I want to say: before starting sex life, in order to make a step into adulthood correctly and without sad consequences, you need to think that sex life is, on the one hand, beautiful, good and adult , on the other hand, it is a step that entails certain problems. These problems need to be solved the way adults can solve them. Therefore, it is best to think about a method of contraception for the first time even before the onset of sexual activity.
And what problems can be associated with the onset of sexual activity?
These are sexually transmitted diseases and unwanted pregnancies. Unfortunately, there are really a lot of these diseases now. Everyone knows about AIDS, syphilis, and gonorrhea; now, perhaps, it is not even interesting anymore. But there is also the same hepatitis, which can be sexually transmitted, chlamydia, mycoplasma and others. The most annoying thing is that these are such diseases that, once infected, you will not immediately understand that you are really sick. This is revealed much later - after 2 years, after 3, after 5, and can manifest itself in the adhesive process, which then you do not understand where it came from. Where did these chlamydiae come from? When did you catch them?
Therefore, so that later these problems do not arise, as well as in order to properly protect against unwanted pregnancy, it is better to first consult a doctor, and only then start having sex.
Of course, love is such a romantic concept that does not imply an offer to your young man to undergo a preliminary examination and be examined by herself. Therefore, this option for the onset of sexual activity is rare. But in principle, this is the ideal option.
If both sexual partners are healthy, you can use hormonal contraceptives. If one or both partners have not been examined, or one of them has a sexually transmitted disease, then it is better to give preference to condoms, just as in the case of accidental sexual contact with an unfamiliar person.
What is the best method of contraception?
This is not the way to put the question. There are patients for whom one thing is suitable, and for others it is completely different. Therefore, not a single doctor will categorically answer this question. For a woman who has one regular sexual partner, an intrauterine device (IUD), for example, may be the best option. But you need to know that this method of contraception has both its pros and cons, and even contraindications. The intrauterine device has an advantage that no other method of contraception has - it is the most “hassle-free” method of preventing unwanted pregnancy. That is, putting it once, you can forget about the problem of contraception for a certain period of time. The disadvantages of this method are more profuse and more painful periods. Can spiral and provoke or maintain inflammatory diseases of the female genital organs. Therefore, it is impossible to say unequivocally that the spiral is good or bad. There is a specific person with his specific problems, and only considering them, you can make the right decision. First, you need to decide which methods of contraception are more suitable for a woman, and only then, based on her wishes, decide what is right for her and what is not.
What is the effectiveness of various contraceptive methods?
According to statistics, 2 women out of 100 cannot wear intrauterine devices due to individual intolerance or because of contraindications; and in 2 out of a hundred, with the presence of an IUD, pregnancy develops. Unfortunately, one hundred percent contraception does not exist at all. The IUD is believed to be 96% effective; the effectiveness of hormonal contraception - 99%; effectiveness of condoms - 92 - 94%.
Hormonal contraception, in addition to being highly effective, has another plus - regular, like clockwork, menstruation. Moreover, menstruation is very short in time and painless. I must say that today, hormonal contraception can be selected for almost any woman, but they certainly have their own contraindications, and there are side effects. Most often it is nausea. In such cases, I recommend that women take the pill not in the morning, but in the evening before going to bed. This does not affect the effectiveness of the drug, and, falling asleep, the woman does not experience any unpleasant sensations. Sometimes there are painful sensations in the mammary glands. This happens when the dose of hormonal substances contained in the preparation is not suitable for a woman. In this case, the drug can be replaced with another with a slightly higher or lower hormone content. But it should be noted that even if there are some unpleasant sensations when taking hormonal contraceptives, after 3 months, in most cases, they all disappear by themselves.
Is it true that hormonal contraception makes women very fat and their facial hair begins to grow?
The myth that a woman can recover very much while taking hormonal contraceptives, or her hair will grow in unwanted places, unfortunately, cannot be completely destroyed. Indeed, there are a small number of women who may experience some kind of side effects of hormonal contraceptives. But this is typical for contraceptives, which were produced 20-30 years ago, which contained large doses of hormones and hormonal substances with an androgenic effect. This does not generally apply to modern contraceptives, on the contrary, now contraceptives are prescribed even for the treatment of excessive hair growth. The only thing that is needed is to select the drug very carefully.
How to Prepare for Pregnancy?
Natalya Mikhailovna, please tell us what a woman needs to do if she wants to prepare in advance for pregnancy?
With pregnancy in general, the question is interesting. Doctors are constantly fighting to ensure that women are registered before 12 weeks of pregnancy. Unfortunately, our women, and especially young girls, do not understand what this is for, and often do not know about such a need. It is necessary to register early in order to be able to carry out the necessary examination and decide whether it is possible to continue this pregnancy, or maybe not; are you healthy or not; what generally happens to your body; is there enough hemoglobin; whether the kidneys are healthy, etc. In general, it would be better to determine these issues even before pregnancy, at the planning stage. If you are planning a pregnancy, go to your doctor and get tested. If you are healthy, you will be sure that you can conceive, carry and give birth to a healthy baby. If you have any problems, it is better to solve them in a non-pregnant state, and only then think about the child.
What tests need to be taken to make sure that everything is in order with health and that you can plan a pregnancy?
It is often unnecessary to carry out some kind of global and expensive surveys. It is enough to pass the simplest tests, which, in principle, are important for any person interested in their health. These are general blood and urine tests, blood glucose, fluorography, examination by a gynecologist, who will determine how healthy a woman's genitals are. It would be nice if the future dad was also examined, at least, he passed blood and urine tests. You can also be tested for syphilis and AIDS, of which there are quite a few now.
If the doctor thinks that not everything is good in the body, then you may have to undergo additional examinations. Often in women, chronic inflammatory diseases are detected: chronic pyelonephritis, chronic adnexitis - inflammation of the appendages. Such a focus of chronic infection can be dangerous for both a pregnant woman and her unborn child. If it cannot be completely eliminated, then you can at least choose the moment for pregnancy when this inflammatory process is in remission, calm, the body is relatively healthy, and it is possible to become pregnant and give birth.
According to existing standards, it is recommended to start taking folic acid three months before the planned pregnancy, which reduces the risk of developing fetal malformations of the nervous system. In this regard, it is also worth consulting your doctor.
If a woman was protected from pregnancy with hormonal contraceptives or an intrauterine device, then it is advisable to consult with a doctor about what kind of break should be taken between stopping the use of this method of contraception and conceiving a child. In particular, it is recommended to stop taking contraceptive drugs three months before the planned pregnancy. At the same time, it is desirable to remove the spiral.
Now there is a lot of talk about diseases such as chlamydia, mycoplasmosis and others. Who needs to be tested for this infection?
It is necessary for those who have problems, in particular, chronic inflammatory and adhesions in the uterine appendages. If the cause of this inflammation cannot be identified by conventional methods, an additional examination is required. Because with such diseases, pregnancy may either not occur at all, or proceed with complications and even an unfavorable outcome.
So, fallopian tubes and ovaries affected by chlamydia pose a danger to the unborn child, as they can become a source of infection for him.
Mycoplasmas are microorganisms that live in the genital area and in the urinary tract. Most often, mycoplasma does not create problems by itself, but in conjunction with other microorganisms. They provoke the development of chronic cystitis, pyelonephritis, which, exacerbating during pregnancy, firstly, require treatment, which can be quite difficult against the background of pregnancy. Secondly, these diseases contribute to the development of preeclampsia - toxicosis in the second half of pregnancy (edema, increased pressure), which pose a danger to the health and life of both the mother and the child. And thirdly, they provoke congenital infectious and inflammatory diseases in a child.
It is possible to decide whether it is necessary to be examined for these infections or not only after the basic tests have been passed and the gynecologist has been examined. This approach will save you both time and decent cash, since examination for chlamydia, mycoplasma, etc. is not cheap.
Much is now being said about cytomegalovirus. It is believed that 90% of the population is infected with it. But worst case- not become pregnant while infected with it, but become infected with it during pregnancy.
Tampons or pads?
In letters, we are often asked the question, what is the best way to use during menstruation: tampons or pads?
There is evidence that women who use tampons are more likely to develop inflammatory diseases of the female genital organs. I believe that tampons should be preferred in those cases where they cannot be done without them: in the summer in the heat, when wearing tight-fitting clothes, while on vacation and swimming in ponds, and in other similar situations. But, using tampons, you need to change them in a timely manner! There are always some microorganisms in the vagina, including pathogens. And blood is an excellent breeding ground for their reproduction. And against this background, inflammatory processes with an untimely change of a tampon can occur.
In all other cases, as well as if it is not possible to change tampons in a timely manner, I recommend using pads. The advantage of pads is that there is no foreign body in the vagina. Although it is more correct to talk not about the advantages of pads, but about the disadvantages of tampons.
Where do bad tests come from?
Here is another frequently asked question: if a woman has a bad smear result, fungi, coccal flora, leukocytes are found in it, is her sexual partner to blame for this?
As a rule, not, unless, of course, we are talking about sexually transmitted diseases. The vagina is non-sterile. It is believed that a newborn girl's vagina is sterile from 3 hours to a day after childbirth. And then the vagina is colonized by various microorganisms. Normally, a specific beneficial microflora, the so-called Doderlein sticks, should prevail in the vagina, which maintains an acidic environment and prevents the active growth of pathogenic bacteria and fungi. But other microorganisms are also present in small quantities in the vagina. For a number of different reasons - hypothermia, some kind of illness, anemia, etc. - an imbalance can occur, as a result of which there is less protective, useful microflora, and conditions are created for the reproduction of other microorganisms. Then symptoms such as itching, genitals, irritation, and discharge appear. In such cases, you do not need to self-medicate, but you need to come to the doctor and try to find the cause of the disease and choose the drug necessary for treatment.
Such symptoms can appear after unprotected intercourse, even with a healthy man, because there is an exchange of infection between sexual partners. At the same time, if the male genital organs are located outside, and it is easy to implement their full-fledged toilet, then the female genital organs are not so accessible, and it is much more difficult to implement their toilet. If a woman, for example, has a slightly reduced immunity, foreign microflora can easily cause an inflammatory process in the vagina.
Do both partners need to be treated in such cases?
It's pretty controversial issue... The prevailing trend is that if the second sexual partner is not worried about anything, he does not have clinical signs of the disease, then he does not need to be treated. But, if the problem recurs, the question of treating the sexual partner should still be raised. It is advisable in these cases to undergo a more in-depth examination, to pass additional tests for bacterial culture in order to determine the pathogen and choose the right treatment.
What wishes would you like to give to our readers?
The main thing is health. If there is health, there will be everything else. And love yourself!
