Do I Need to See a Gynecologist?
An interview with Dr. Eugene Scioscia Jr., M.D.
Dr. Scioscia is the chairman of the Department of Obstetrics and Gynecology at Allegheny General Hospital. We asked Dr. Scioscia some of the questions that are frequently asked by our patients.
Why should women schedule an annual checkup with their gynecologist?
There are a number of reasons. Foremost is the fact that meicine and medical knowledge are not stagnant. There is always newer information that patients should learn, as it relates to their care and condition. Various media sources and the Internet have allowed women to be more informed of these changes, that was true a generation ago. But such sources cannot replace a patient’s relationship with her doctor. Only your personal physician can direct you to information that is both reliable and that has specific application to you.
A common misperception is that your gynecologist does little more than screen for cervical cancer with a Pap smear. In reality, a gynecologist screens a woman’s overall health and well being. Your gynecologist can discuss with you the HPV vaccine that has been demonstrated to decrease the incidence of abnormal Pap smears and cervical cancer. An annual gynecologic exam screens not just for cervical cancer, but also for cancer of the breast, uterus and colon.
A gynecologist can help a woman of menopausal age to sort through the controversial issues of managing symptoms ranging from hot flashes to issues with libido. A chronic issue facing women in this age bracket is osteoporosis. Part of a regular gynecologic exam includes assisting women to prevent or treat this condition. Preventative attention is also given to other health issues such as thyroid disease and cardiac disease.
Your gynecologist will also give attention to diagnosing and treating any pelvic floor disorders such as urinary incontinence. Urinary incontinence is not an uncommon condition. It is, nevertheless, an issue that patients find among the most embarrassing to discuss with their doctor. This underscores the need for building a relationship with your gynecologist so that these sensitive issues can be discussed. At Allegheny General Hospital, we have been able to help women suffering from issues like these. We offer proven non-invasive and minimally invasive approaches that can often be handled on an outpatient basis. These techniques also minimize blood loss.
Women of child bearing years will also benefit from a discussion with their gynecologist about birth control and pregnancy planning issues.
If a woman is thinking about becoming pregnant, when should she first see her gynecologist?
A woman should see her gynecologist even before she begins trying to become pregnant. During a pre-pregnancy evaluation, attention is given to chronic pre-existing medical issues such as low blood count. Consideration is also given to genetic or family issues. Increasingly, an issue that we discuss is advanced maternal age. The average age at which women first become pregnant has gradually risen to about 28 or 29. We have seen a large increase in women over 35 years old who are having their first pre-conception visit. We have learned from experience that there are some gynecologists who are not comfortable treating the patient who cannot accept a blood transfusion when she becomes pregnant. We have accepted the care of a number of such patients from other institutions and see them at our maternal/fetal medicine or high-risk obstetrics divisions. Physicians from these divisions are available to be consulted as needed.
A patient who is one of Jehovah’s Witnesses would be well served to inquire specifically if a doctor works with bloodless medicine patients, rather than discovering mid-pregnancy that a doctor is uncomfortable treating her.
What constitutes abnormal bleeding and when should it be evaluated by a gynecologist?
Abnormal bleeding is any bleeding that is heavier or more frequent than a normal cycle. Women who are uncertain about this are often provided with a menstrual calendar by their gynecologist. A normal cycle for most women is between 22 and 28 days in length with some variation. A heavier than normal menstrual period may be noted by needing to change sanitary pads more often than usual, by the development of clots when this has not been experienced previously, or by the onset of associated symptoms. These symptoms may include fatigue, frequent headaches or feeling faint. In deciding whether to contact your gynecologist, it is always better to err on the side of caution as heavier than usual menstrual bleeding may be a sign of a serious underlying condition.
What might such bleeding indicate?
There can be a number of reasons for heavier bleeding that can include benign changes to a woman’s cycle or reaction to medications. Anatomical explanations can include uterine fibroids, polyps and ovarian cysts. It may also be an indication of cancer. Whatever the underlying reason for heavier bleeding, early diagnosis is a key to more successful treatment. While this is important for all women, it is especially vital for women who cannot accept blood transfusions.
Does the treatment of conditions such as uterine fibroids always involve major surgery?
No. In the past, the methods available for treating such conditions often involved major surgery with the potential of large intra-operative blood loss. But now, we have a number of minimally invasive techniques for addressing such concerns.
For instance, uterine fibroids affect as many as 30 percent of all women. This may manifest itself in discomfort and bleeding that can be quite substantial. For some patients, uterine artery embolization is an appropriate therapy to treat this condition. This is performed by our radiology department an does not involve surgery. Uterine artery embolization blocks blood supply to fibroids, thus shrinking them and allowing for subsequent greater quality of life as the patient experiences less discomfort and less bleeding. This procedure can often be done on an outpatient basis.
For some conditions, major surgery may be necessary for effective treatment. At times, we have treated patients who are Jehovah’s Witnesses for whom either less effective treatment options or no treatment options were presented at other institutions due to concerns about surgical blood loss. Our Division of Gynecologic Oncology has successfully treated a number of such patients with the use of specialized surgical and anesthesia techniques.
How can a woman find more information or a gynecologist who works at Allegheny General Hospital?
The Department of Obstetrics and Gynecology can be reached by calling 412-359-3355.
Additional helpful information about physicians and services provided at
Allegheny General Hospital is available at www.wpahs.org/womenshealth/.
