Frequently Asked Questions About Gynecology Visits
What is the difference between going to the gynecologist and your primary care provider? Can’t they just do the same thing? Do I need to go to the gynecologist as soon as I am sexually active? I’m not pregnant so I don’t need to go to the gyn.
There are many questions surrounding the gynecologist and I figure, why not set the record straight.
The Basics
Let’s differentiate. An OB/GYN is technically two separate specialties. An OB or obstetrician specializes in pregnancy which includes postpartum care and birth. A GYN or gynecologist specializes in women’s health and treating conditions such as endometriosis or polycystic ovarian syndrome (PCOS). MDs are board certified as OB/GYNs. As a nurse practitioner, you can reach this path a few ways. You can become board certified as a Women’s Health Nurse Practitioner (WHNP), become a Certified Nurse Midwife (CNM) if you are interested in delivering babies, and/or you could become a Family Nurse Practitioner (FNP) who practices in women’s health (like me).
A family practice provider or internal medicine provider specializes in the whole body and chronic conditions. It is not uncommon to have a family provider that has interest in specialties like dermatology or even women’s health. Technically a family provider does not HAVE to see you for the specialty issue, but you can certainly start at the family provider until you are guided to the right specialty, especially since some insurances require this referral from your primary care. When in doubt, start at family or internal medicine because your concern may be able to be addressed there especially if your provider is knowledgeable and comfortable with the specific specialty.
When To Go
Contrary to popular belief you don’t have to go to the GYN just because you are sexually active. There is nothing different that will be done at the GYN vs. your regular provider. In the past (many, many years ago) people thought that if you wanted to get birth control or have any testing for sexually transmitted disease that you had to go to the GYN for this. If you are comfortable with your primary care provider (PCP) you can stick with them for these types of visits. I would recommend sticking with your PCP especially if you are younger and have never been seen by a GYN before (under 21). There was also thought that if you are sexually active you must have a pap smear (screening for cervical cancer), we will go into detail about this testing at a later time, but this is inaccurate.
So, when do you go?
- If you have an abnormal pap smear and need additional testing.
- If you have abnormal bleeding for more than three months. Abnormal meaning heavier bleeding or skipped periods. Remember it is not uncommon to have one or two back-to-back abnormal periods, depending on stressors, infection, or weight gain/loss for example, but having three or more periods that you skip or have a change should be evaluated.
- Extremely painful periods that are not helped with medication, lifestyle changes, or conservative measures. These are the types of periods that you would need to miss work or school because you are so uncomfortable. This is not normal even if it is normal for you.
- Pregnancy and postpartum care.
- Personal preference. Sometimes you just feel more comfortable discussing certain things with a GYN and that is okay.
What Can You Expect at the Visit?
It depends on the type of visit:
Well Woman Exam
For this exam, if you are over the age of 21 you will get a breast exam and a pap smear. If you are already up to date on your pap smear, you will always get a breast exam. In addition to this you will discuss your period and whether you want any STI testing or birth control. The difference between this exam and a physical with your PCP is that we will not routinely order cholesterol or annual physical labs. That would still need to be obtained at your PCP. If you are under the age of 21, it depends on the provider, but you would not have a pelvic exam unless there was a concern.
Remember, this is a wellness exam which means you are stating you are well. If you have a concern, this will need to be schedule as a separate visit (a GYN problem visit).
Initial Prenatal Visit or Confirmation of Pregnancy Visit
This visit is a lot of questions, for this visit we are gathering all of your medical history as well as your family medical history and genetic family history. Then the visit will be like the well woman exam, but with blood work. Depending on the clinic, you may either have an ultrasound in the office confirming the pregnancy or you will be sent out for an ultrasound.
Preconception Visit
This is a talking visit to figure out your health history. When you are planning to conceive or if you are already trying, how long you have been trying, etc. Depending on what you tell your provider, you may or may not have a physical exam (meaning you may or may not get undressed).
GYN Problem Visit
If you are experiencing a problem, such as irregular bleeding, painful periods, etc. You will have an exam depending on what your concern is. If you want to change or discuss starting birth control it would also fall under this visit.
How Often Should You See the GYN?
Your well woman exam should be once a year. If you start a new birth control you should be seen after the first 3-4 months to be sure it is working well for you and then yearly. Otherwise as needed, or if you have had an abnormal pap smear and have recently had a LEEP procedure, every 6 months at least twice for a repeat pap smear.
Why the GYN Should Not Refill Your Prescriptions or Place a New Referral for You
If the GYN did not prescribe the original prescription, they really should not fill a prescription for you. Some (me included) will give a short-term refill (30 days) to help you have time to make your appointment with your primary care or other specialist. However, this can’t be a routine thing. We aren’t monitoring you for that prescription/condition and you really should check in with the provider that gave it to you.
The same goes for referrals. We are a specialty and technically we should not be referring you to another specialty (insurance wise), unless we have actually seen you for the condition. For example, if we see someone that has a breast abscess, we SHOULD be the ones referring you to a breast specialist. Or bladder leakage, the referral to uroGYN (urologist specializing in gynecology) should come from us. But if you misplaced your hip physical therapy order, we really shouldn’t be ordering that. All the reports and adjustments to your care for physical therapy would be sent to us since we ordered the physical therapy and the original person who ordered this would not have the updated information on your progress. The original person should be the one to re-send your order since we aren’t monitoring you for that condition. Hope that makes sense.
I hope you take away some things from this post and will be prepared to go into your next GYN visit! Next week we will dive into pap smears!
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