Selected Podcast
Embarrassing Questions Before an OBGYN Appointment
Dr. Kara Geoghegan de-stigmatizes "embarrassing" questions you may have before an OBGYN appointment.
Featuring:
Learn more about Kara Geoghegan, MD, FACOG
Kara Geoghegan, MD, FACOG
Dr. Geoghegan set her sights on becoming an OB/GYN in high school after seeing the birth of a baby for the first time at a nearby hospital. Fifteen years later, as a practicing OB/GYN, she is still in awe of the birth of a child and finds it an honor to share the experience with families. “Relationships are what life is all about, and I truly enjoy building relationships with my patients and their families,” she says. Dr. Geoghegan is interested in adolescent gynecology and especially interested in infertility care because she herself was once an infertility patient.Learn more about Kara Geoghegan, MD, FACOG
Transcription:
Deborah Howell: So your annual trip to the OB-GYN is coming up or maybe it's the first one ever. Let's get some answers for some of those embarrassing questions before your OB-GYN appointment. This is the podcast series from Deaconess, The Women's Hospital, a place for all your life. I'm Deborah Howell. And our guest today is Dr. Kara Geoghegan, an OB-GYN at Deaconess, The Women's Hospital. Welcome.
Dr. Kara Geoghegan: Thanks. Thanks for having me.
Deborah Howell: So glad to have you here so we can ask those questions we really don't want to ask when we get there.
Dr. Kara Geoghegan: Which I think is so funny, because lots of times you all think that these questions are embarrassing when actually I hear them all day long every day. And so when I hear the word embarrassing, I'm always wondering what that means to somebody, because to me it's not embarrassing at all.
Deborah Howell: I think it's shyness more than anything, especially your first time.
Dr. Kara Geoghegan: Right. Absolutely.
Deborah Howell: So at what age should I start seeing an OB-GYN?
Dr. Kara Geoghegan: That's a good question. So I usually tell patients or their mothers, depending on who I have in my office, that usually when someone either starts to have issues with their cycles. So for young girls, I always say your periods, your cycles, should not affect your lives, right? If you are playing basketball and you're a girl, I want you busting your butt on that floor to get that ball and not worry about your periods. Or if you're a cheerleader and you want to be thrown up in the air, I don't want you to worry about your bleeding ever affecting your goals in a life. So if a cycle or a period is why you're missing school or not able to be the best version of you, you need to come in and be seen. Otherwise, I typically say before you go to college, because that's typically when you're in relationships and we want to have those conversations before they get too serious.
Deborah Howell: Perfect. Sounds exactly right. Now, how often should I get a pelvic exam and a Pap test?
Dr. Kara Geoghegan: Great question. So less than 21, no pelvic, no Pap smear, all right? So really the key there is we want to build a relationship. So obviously, your OB-GYN is one of your most intimate conversations, appointments. And we really want to build that relationship before we ask you to undress below the waist and get naked in front of us. But 21 typically is your first Pap smear, regardless of when you become sexually active. And sometimes if you're 21 and you're not sexually active, I will wait to even do a pelvic exam at that time. Again, we want to build a relationship and make sure that someone feels comfortable with us before undress all the way.
Deborah Howell: Now, especially for our younger girls, they always wonder, does it hurt to go to the OB-GYN?
Dr. Kara Geoghegan: I'm not going to tell you it's the most pleasant experience, because it's not. But, you know, normally, we try to make it again the most comfortable. We try to do it as fast as we can, but obviously the least pain. You feel pressure whenever you're having a pelvic exam. We'll use a speculum, which is the instrument that we have to use in order to visualize the cervix. We try to keep them in the heaters and warm them up a little bit, so they're not these cold metal instruments that we're using.
Again, we're trying to make this as best as it can be in the situation that we're in, right? We don't want to hang out there any longer than we have to. And we don't want to obviously cause you any pain or discomfort, but I'm not going to lie either and tell you that it's themost pleasant thing because it's not. And then someone who's had these exams myself, I can tell you pressure, but it shouldn't pinch, it shouldn't hurt. Again, I think also it's just an uncomfortable thing too. And the more that patients try to bring their knees together, it makes it just all worse for everybody. So again, we're trying to make you comfortable in this situation.
Deborah Howell: What I do is I just kind of do some deep breathing and I say, "Okay, this is 30 seconds of your life."
Dr. Kara Geoghegan: Right. Yeah. And I'm really good at distracting. Like, I will ask all kinds of questions about your dog and what movies you've seen lately and what books you read. Again, we try to have relationships and talk with our patients and get to know them during this situation and distract them from exactly what we're doing.
Deborah Howell: Good tactic. Okay. So what can I do so I'm not so nervous about stripping my clothes off?
Dr. Kara Geoghegan: Well, I try to tell patients, "Listen, I see 30 cervixes a day." You know, I see so many that I know people feel like, "Oh my gosh." I can not remember what it looks like. And I walk out there, if I don't document in the computer right then what I see, I do not remember what your vagina or vulva looks like.
So try to remember that this is everyday for us, as I know it's not for you. It's every day for us. And again, we don't think anything about it. So, that's one thing. I mean, obviously if you're nervous, let us know, because sometimes, you know, we're trying to read people too, and some people are more comfortable than others and that's okay. But obviously, if you're not comfortable or you're having anxiety about it, I love it when patients say, "Listen. Hey, Geoghegan, you know I don't like this." And I'm like, "Yes. I know you don't and we're going to walk through it as fast as we can. Okay?" But again, just being open about the situation is I think the best thing to do.
Deborah Howell: Perfect. Now, can I see my OB-GYN if I'm on my period?
Dr. Kara Geoghegan: Good question. So usually, we say as long as it's not really heavy flow. Usually everybody has a couple heavy days. Not probably the best time to come in at that time. But otherwise, yes, if you're spotting or having light bleeding, and again, that's something that patients get embarrassed about. "Oh my gosh. I'm so sorry. I didn't know 'til I got here and I started my period." That's something we see every day. I mean, that's why most of us don't wear nice clothes in the office because we're getting blood and amniotic fluid and all kinds of things on us on a daily basis. So right, for you getting an exam on your period, you think that's just gross or disgusting. For us, that's normal and we'd go out and have lunch right after we do it, the exam. So it's nothing.
Deborah Howell: You are hardy, I got to say. Okay. Now, here's another one. Should I shave or wax before my first appointment?
Dr. Kara Geoghegan: You know, the trends of vulvas over the years has definitely changed.
Deborah Howell: No kidding.
Dr. Kara Geoghegan: And we are definitely In a hairless trend right now, and I could give a whole lecture on that in and of itself. So, my best advice is that shaving is not the best thing to do because it actually nicks your skin when you shave and we have bacteria down there and it gets into your skin. You can get all kinds of like folliculitis and infections and abscesses and stuff. So I prefer or I recommend waxing is better or obviously laser hair removal, definitely cost differences, or actually your best option is a beard trimmer. So a beard trimmer is not going to cut as close sometimes as a shave, but it doesn't nick your skin as much. So it's typically better for your own vulvar health.
Deborah Howell: But you can also go au naturale to your OB-GYN.
Dr. Kara Geoghegan: You can go au naturale. You can do whatever you want. Like, you don't have to shave for us. I mean, it's not for us.
Deborah Howell: Exactly. Okay. Well, that's good to know. And my producer, Scott, is really going to love this next question. So all ears, Scott. Should my vagina smell?
Dr. Kara Geoghegan: They all have a smell. If it doesn't smell, you're in trouble. I think people get worried that they have a smell, but really they only smell themselves and nobody else can smell it. So people will come in all the time, patients will say, "I think I have an odor, but we don't smell anything." So that's a very common question. I do also think people get obsessed with their vagina smells and that leads to all kinds of problems. I think the vagina is like a self-cleaning oven. It takes care of itself. You don't have to worry about anything.
Deborah Howell: Isn't that a miracle? There would be maybe one exception. Sometimes if a foreign object becomes lodged there, there would be an odor that would be, I mean, really severe.
Dr. Kara Geoghegan: Oh, yeah. Retained tampons kind of happens. It happens, and people forget about them and we can definitely smell that when you come in and get undressed. We know we got a problem there, so yes.
Deborah Howell: And you can take care of that for the patient, right?
Dr. Kara Geoghegan: Absolutely. Absolutely.
Deborah Howell: All right. How about this, is my discharge normal?
Dr. Kara Geoghegan: So everybody has vaginal discharge and that is normal. So in the vagina, you've got good and bad bacteria and they live in harmony. If the bad bacteria takes over, that's when you get something called BV or bacterial vaginosis, and that can give you like a fishy odor. And you can have an abnormal discharge.
Obviously, we're in the summertime right now. Heat causes yeast infections. Moist heat leads to yeast in which you can get like a cottage cheese sticky discharge. So those are common things. We see them all the time. I always say though if you feel like something's not right, we're more than happy to take a look and check it out for you.
Deborah Howell: Oh, so, so reasonable. Now, should I get tested for STI at my appointment?
Dr. Kara Geoghegan: Yes. Yes. I think in this line, field that I'm in, I don't really trust anybody. Most people don't come in here thinking that they have an infection, but I find them, right? So I always say, anytime you have a new partner, I think it's always great that you get tested prior to having intercourse. And that way, you know, that you're good and you don't have anything. But unfortunately, people will trust partners and don't get tested and we do find things. But yes, that's a conversation that we typically have at your annual exams about what tests we should order and what is most common.
Deborah Howell: And when did STI replace STD?
Dr. Kara Geoghegan: I don't know. I think that's just kind of nomenclature. I think some people still say STDs and some people say STIs. Basically means the same thing.
Deborah Howell: Okay. All right. Thanks for clearing that up. Should I get an HPV vaccine while I'm with you?
Dr. Kara Geoghegan: Absolutely. I'll tell you what, in the short time that I've been doing this 12 years, I've really seen a dramatic difference in cervical cancer. So HPV, the vaccine that came out, Gardasil, that protects against the HPV variance, some that lead to genitals warts and some that we know lead to cervical cancer. So, that came out, I think right around 2000, maybe a little after 2000. And I have not seen a cervical cancer patient in my practice. So really has drastically changed the outcomes. Cervical cancer we often see now in patients who don't come in for their annuals. So patient who disappears for 10, 15 years, had a baby, never comes back. That is who I remember as cervical cancer patients when I was in residency.
Patients, as long as you do your Pap smears and do what we ask you to do, you typically are not going to get cervical cancer. Not saying it can't happen and just super uncommon. But the HPV vaccine has really changed that. Even with abnormal Pap smears, we used to have so many abnormal Pap smears and we would do all these procedures, colposcopies and LEEP procedures on young girls. And really, we're not doing any of that anymore.
Deborah Howell: Oh, that is a wonderful thing to hear. Now, we've kind of focused on your younger clients, but what about your patients over 50 and should we still be going to you and how long should that last.
Dr. Kara Geoghegan: Absolutely. So you still need a pelvic exam every year. You still need a breast exam every year. Now, there are some patients who can go to their family doctor and feel comfortable with them doing that exam or they can continue to come here and see us.
The most common obviously issues for over 50 are, one, menopause, right? Average age of menopause is 50-1/2. You have urinary issues. So urinary incontinence, you have urgency, those kind of things, "Got to go. Got to go right now" or "Man, I can't jump on that trampoline anymore. I'm leaking like a faucet," right? You also have, "Okay. Maybe I have some prolapse after having babies. And in life and as is, maybe something might be falling out of my vagina." Or, "Hey, my sex life has changed. It's not what it used to be. Is this normal?" So, I mean, there's still issues that arise even over 50, and we're more than happy to help you in that area of your life as well.
Deborah Howell: Perfect. What's the best part about your job?
Dr. Kara Geoghegan: Man, I tell you what, I really love my job. And the best part of it I think is that I get to sometimes start seeing patients when they're teenagers, follow them through college, they get married, they have a baby. I get to deliver that baby. Have another baby, I get to deliver that baby. And then continue on to take care of them hopefully until menopause. I think the reason why I do this job is obviously I like relationships. And I like being a part of their life in some of the most intimate moments. I mean, delivering a baby is the crème de la crème. I get to do that day after day.
Deborah Howell: You know, my dad was what they call a specialized GP back in the day. And he said every time he delivered a baby, it was a true certified miracle.
Dr. Kara Geoghegan: It never gets old, man. Never gets old. Never old.
Deborah Howell: Well, this is some really good information, Dr. Geoghegan. Thank you so much for all your expertise and for being with us today.
Dr. Kara Geoghegan: Hey, anytime. Thanks for having me.
Deborah Howell: This is The Women's Hospital, a place for all your life. To schedule an appointment or to learn more, call (812) 471-0045 or visit whcpc.com to get connected with one of our providers. I'm Deborah Howell. Thanks for listening and have yourself a great day.
Deborah Howell: So your annual trip to the OB-GYN is coming up or maybe it's the first one ever. Let's get some answers for some of those embarrassing questions before your OB-GYN appointment. This is the podcast series from Deaconess, The Women's Hospital, a place for all your life. I'm Deborah Howell. And our guest today is Dr. Kara Geoghegan, an OB-GYN at Deaconess, The Women's Hospital. Welcome.
Dr. Kara Geoghegan: Thanks. Thanks for having me.
Deborah Howell: So glad to have you here so we can ask those questions we really don't want to ask when we get there.
Dr. Kara Geoghegan: Which I think is so funny, because lots of times you all think that these questions are embarrassing when actually I hear them all day long every day. And so when I hear the word embarrassing, I'm always wondering what that means to somebody, because to me it's not embarrassing at all.
Deborah Howell: I think it's shyness more than anything, especially your first time.
Dr. Kara Geoghegan: Right. Absolutely.
Deborah Howell: So at what age should I start seeing an OB-GYN?
Dr. Kara Geoghegan: That's a good question. So I usually tell patients or their mothers, depending on who I have in my office, that usually when someone either starts to have issues with their cycles. So for young girls, I always say your periods, your cycles, should not affect your lives, right? If you are playing basketball and you're a girl, I want you busting your butt on that floor to get that ball and not worry about your periods. Or if you're a cheerleader and you want to be thrown up in the air, I don't want you to worry about your bleeding ever affecting your goals in a life. So if a cycle or a period is why you're missing school or not able to be the best version of you, you need to come in and be seen. Otherwise, I typically say before you go to college, because that's typically when you're in relationships and we want to have those conversations before they get too serious.
Deborah Howell: Perfect. Sounds exactly right. Now, how often should I get a pelvic exam and a Pap test?
Dr. Kara Geoghegan: Great question. So less than 21, no pelvic, no Pap smear, all right? So really the key there is we want to build a relationship. So obviously, your OB-GYN is one of your most intimate conversations, appointments. And we really want to build that relationship before we ask you to undress below the waist and get naked in front of us. But 21 typically is your first Pap smear, regardless of when you become sexually active. And sometimes if you're 21 and you're not sexually active, I will wait to even do a pelvic exam at that time. Again, we want to build a relationship and make sure that someone feels comfortable with us before undress all the way.
Deborah Howell: Now, especially for our younger girls, they always wonder, does it hurt to go to the OB-GYN?
Dr. Kara Geoghegan: I'm not going to tell you it's the most pleasant experience, because it's not. But, you know, normally, we try to make it again the most comfortable. We try to do it as fast as we can, but obviously the least pain. You feel pressure whenever you're having a pelvic exam. We'll use a speculum, which is the instrument that we have to use in order to visualize the cervix. We try to keep them in the heaters and warm them up a little bit, so they're not these cold metal instruments that we're using.
Again, we're trying to make this as best as it can be in the situation that we're in, right? We don't want to hang out there any longer than we have to. And we don't want to obviously cause you any pain or discomfort, but I'm not going to lie either and tell you that it's themost pleasant thing because it's not. And then someone who's had these exams myself, I can tell you pressure, but it shouldn't pinch, it shouldn't hurt. Again, I think also it's just an uncomfortable thing too. And the more that patients try to bring their knees together, it makes it just all worse for everybody. So again, we're trying to make you comfortable in this situation.
Deborah Howell: What I do is I just kind of do some deep breathing and I say, "Okay, this is 30 seconds of your life."
Dr. Kara Geoghegan: Right. Yeah. And I'm really good at distracting. Like, I will ask all kinds of questions about your dog and what movies you've seen lately and what books you read. Again, we try to have relationships and talk with our patients and get to know them during this situation and distract them from exactly what we're doing.
Deborah Howell: Good tactic. Okay. So what can I do so I'm not so nervous about stripping my clothes off?
Dr. Kara Geoghegan: Well, I try to tell patients, "Listen, I see 30 cervixes a day." You know, I see so many that I know people feel like, "Oh my gosh." I can not remember what it looks like. And I walk out there, if I don't document in the computer right then what I see, I do not remember what your vagina or vulva looks like.
So try to remember that this is everyday for us, as I know it's not for you. It's every day for us. And again, we don't think anything about it. So, that's one thing. I mean, obviously if you're nervous, let us know, because sometimes, you know, we're trying to read people too, and some people are more comfortable than others and that's okay. But obviously, if you're not comfortable or you're having anxiety about it, I love it when patients say, "Listen. Hey, Geoghegan, you know I don't like this." And I'm like, "Yes. I know you don't and we're going to walk through it as fast as we can. Okay?" But again, just being open about the situation is I think the best thing to do.
Deborah Howell: Perfect. Now, can I see my OB-GYN if I'm on my period?
Dr. Kara Geoghegan: Good question. So usually, we say as long as it's not really heavy flow. Usually everybody has a couple heavy days. Not probably the best time to come in at that time. But otherwise, yes, if you're spotting or having light bleeding, and again, that's something that patients get embarrassed about. "Oh my gosh. I'm so sorry. I didn't know 'til I got here and I started my period." That's something we see every day. I mean, that's why most of us don't wear nice clothes in the office because we're getting blood and amniotic fluid and all kinds of things on us on a daily basis. So right, for you getting an exam on your period, you think that's just gross or disgusting. For us, that's normal and we'd go out and have lunch right after we do it, the exam. So it's nothing.
Deborah Howell: You are hardy, I got to say. Okay. Now, here's another one. Should I shave or wax before my first appointment?
Dr. Kara Geoghegan: You know, the trends of vulvas over the years has definitely changed.
Deborah Howell: No kidding.
Dr. Kara Geoghegan: And we are definitely In a hairless trend right now, and I could give a whole lecture on that in and of itself. So, my best advice is that shaving is not the best thing to do because it actually nicks your skin when you shave and we have bacteria down there and it gets into your skin. You can get all kinds of like folliculitis and infections and abscesses and stuff. So I prefer or I recommend waxing is better or obviously laser hair removal, definitely cost differences, or actually your best option is a beard trimmer. So a beard trimmer is not going to cut as close sometimes as a shave, but it doesn't nick your skin as much. So it's typically better for your own vulvar health.
Deborah Howell: But you can also go au naturale to your OB-GYN.
Dr. Kara Geoghegan: You can go au naturale. You can do whatever you want. Like, you don't have to shave for us. I mean, it's not for us.
Deborah Howell: Exactly. Okay. Well, that's good to know. And my producer, Scott, is really going to love this next question. So all ears, Scott. Should my vagina smell?
Dr. Kara Geoghegan: They all have a smell. If it doesn't smell, you're in trouble. I think people get worried that they have a smell, but really they only smell themselves and nobody else can smell it. So people will come in all the time, patients will say, "I think I have an odor, but we don't smell anything." So that's a very common question. I do also think people get obsessed with their vagina smells and that leads to all kinds of problems. I think the vagina is like a self-cleaning oven. It takes care of itself. You don't have to worry about anything.
Deborah Howell: Isn't that a miracle? There would be maybe one exception. Sometimes if a foreign object becomes lodged there, there would be an odor that would be, I mean, really severe.
Dr. Kara Geoghegan: Oh, yeah. Retained tampons kind of happens. It happens, and people forget about them and we can definitely smell that when you come in and get undressed. We know we got a problem there, so yes.
Deborah Howell: And you can take care of that for the patient, right?
Dr. Kara Geoghegan: Absolutely. Absolutely.
Deborah Howell: All right. How about this, is my discharge normal?
Dr. Kara Geoghegan: So everybody has vaginal discharge and that is normal. So in the vagina, you've got good and bad bacteria and they live in harmony. If the bad bacteria takes over, that's when you get something called BV or bacterial vaginosis, and that can give you like a fishy odor. And you can have an abnormal discharge.
Obviously, we're in the summertime right now. Heat causes yeast infections. Moist heat leads to yeast in which you can get like a cottage cheese sticky discharge. So those are common things. We see them all the time. I always say though if you feel like something's not right, we're more than happy to take a look and check it out for you.
Deborah Howell: Oh, so, so reasonable. Now, should I get tested for STI at my appointment?
Dr. Kara Geoghegan: Yes. Yes. I think in this line, field that I'm in, I don't really trust anybody. Most people don't come in here thinking that they have an infection, but I find them, right? So I always say, anytime you have a new partner, I think it's always great that you get tested prior to having intercourse. And that way, you know, that you're good and you don't have anything. But unfortunately, people will trust partners and don't get tested and we do find things. But yes, that's a conversation that we typically have at your annual exams about what tests we should order and what is most common.
Deborah Howell: And when did STI replace STD?
Dr. Kara Geoghegan: I don't know. I think that's just kind of nomenclature. I think some people still say STDs and some people say STIs. Basically means the same thing.
Deborah Howell: Okay. All right. Thanks for clearing that up. Should I get an HPV vaccine while I'm with you?
Dr. Kara Geoghegan: Absolutely. I'll tell you what, in the short time that I've been doing this 12 years, I've really seen a dramatic difference in cervical cancer. So HPV, the vaccine that came out, Gardasil, that protects against the HPV variance, some that lead to genitals warts and some that we know lead to cervical cancer. So, that came out, I think right around 2000, maybe a little after 2000. And I have not seen a cervical cancer patient in my practice. So really has drastically changed the outcomes. Cervical cancer we often see now in patients who don't come in for their annuals. So patient who disappears for 10, 15 years, had a baby, never comes back. That is who I remember as cervical cancer patients when I was in residency.
Patients, as long as you do your Pap smears and do what we ask you to do, you typically are not going to get cervical cancer. Not saying it can't happen and just super uncommon. But the HPV vaccine has really changed that. Even with abnormal Pap smears, we used to have so many abnormal Pap smears and we would do all these procedures, colposcopies and LEEP procedures on young girls. And really, we're not doing any of that anymore.
Deborah Howell: Oh, that is a wonderful thing to hear. Now, we've kind of focused on your younger clients, but what about your patients over 50 and should we still be going to you and how long should that last.
Dr. Kara Geoghegan: Absolutely. So you still need a pelvic exam every year. You still need a breast exam every year. Now, there are some patients who can go to their family doctor and feel comfortable with them doing that exam or they can continue to come here and see us.
The most common obviously issues for over 50 are, one, menopause, right? Average age of menopause is 50-1/2. You have urinary issues. So urinary incontinence, you have urgency, those kind of things, "Got to go. Got to go right now" or "Man, I can't jump on that trampoline anymore. I'm leaking like a faucet," right? You also have, "Okay. Maybe I have some prolapse after having babies. And in life and as is, maybe something might be falling out of my vagina." Or, "Hey, my sex life has changed. It's not what it used to be. Is this normal?" So, I mean, there's still issues that arise even over 50, and we're more than happy to help you in that area of your life as well.
Deborah Howell: Perfect. What's the best part about your job?
Dr. Kara Geoghegan: Man, I tell you what, I really love my job. And the best part of it I think is that I get to sometimes start seeing patients when they're teenagers, follow them through college, they get married, they have a baby. I get to deliver that baby. Have another baby, I get to deliver that baby. And then continue on to take care of them hopefully until menopause. I think the reason why I do this job is obviously I like relationships. And I like being a part of their life in some of the most intimate moments. I mean, delivering a baby is the crème de la crème. I get to do that day after day.
Deborah Howell: You know, my dad was what they call a specialized GP back in the day. And he said every time he delivered a baby, it was a true certified miracle.
Dr. Kara Geoghegan: It never gets old, man. Never gets old. Never old.
Deborah Howell: Well, this is some really good information, Dr. Geoghegan. Thank you so much for all your expertise and for being with us today.
Dr. Kara Geoghegan: Hey, anytime. Thanks for having me.
Deborah Howell: This is The Women's Hospital, a place for all your life. To schedule an appointment or to learn more, call (812) 471-0045 or visit whcpc.com to get connected with one of our providers. I'm Deborah Howell. Thanks for listening and have yourself a great day.