Melanie Cole, MS (Host): While a visit with your OB-GYN can be awkward for some women, especially if you have questions regarding your vaginal health, it is a necessary step to ensure that you're getting the answers that you need. Whether you're visiting an OB-GYN for gynecologic or prenatal-related care, we are here to share what questions you should not be embarrassed to ask your OB-GYN.

Melanie Cole, MS: Welcome to Check-Up Chat with EvergreenHealth. I'm Melanie Cole. Joining me is Erin Kendall. She's a physician's assistant from EvergreenHealth OB-GYN. Erin, thank you so much for joining us. This is such a great topic to discuss because our health should never be something that we're embarrassed about or embarrassed to discuss. Is hesitancy regarding symptoms things that you see in healthcare or in your own practice? Do you see women that are embarrassed a little bit to ask you about things, whether it's vaginal health or intimacy issues, any of those sorts of things?

Erin Kendall: Yes, Melanie. Thank you so much for having me, by the way. I am so excited to be here talking to you and everyone listening. But yes, it can be very common. People do have a lot of concerns, and they're embarrassed to ask. But it's really important when you come to see us as providers. We do this a lot, so the question that you ask, we probably have heard it before, if not multiple times. And it's important for us to know so that we can help answer those questions, those concerns, reassure you and then, of course, treat you. So, it is important for sure.

Melanie Cole, MS: Well, I imagine, I mean, as somebody who was not really ever embarrassed to talk about, well, anything really, and certainly not my own symptoms. I know that some women have that hesitancy, so I'm so glad that you said that. And I'd like to outline some questions that your patients often initially might be hesitant to ask. So, let's start with some of these. When should our teenage daughters begin to see their OB-GYN? When do we bring them in for the first time?

Erin Kendall: Yeah. So Melanie, this is an excellent question. And I'll be honest, it's actually a little bit more difficult to answer, because OB-GYNs essentially are the specialists in women's health, right? And primary cares and pediatricians as well can do a lot of the basic things that we would do as well. For instance, like pediatricians ourselves and OB-GYN, we'll talk about birth control, heavy menses, STD screening, sex education, making sure vaccines are up-to-date. So, we all kind of do the same thing a little bit. So, you can honestly come to OB-GYN as soon as you need us. We have some patients who come because their parents have seen us. My youngest patient is probably 14. Other times, we get referrals from primary cares or pediatricians because of concerns that our patients have, and the pediatrician has tried certain things, and it's not working.

Other things specifically, something really to keep in mind, if you don't need to see an OB-GYN specifically or even, you know, you're nice and healthy, no problems with menses or concerns in general, we definitely say your first Pap smear, which essentially screens for cervical cancer, does need to start from majority of women at age 21. So, I'm kind of going back to the whole, if you've never seen a provider for anything besides an annual, that is definitely a time that you need to see a new primary care or OB-GYN to make sure that you're up-to-date on those very important screening tests that we can do.

And then, something I feel like I have to mention because I do work in OB-GYN and it is very close to my heart, is the importance of education regarding specifically HPV vaccines. These can be started at early as age nine, but definitely less than 15, and that's two doses. And then if you're older than 15, it's three doses. But we see through research this really, really can help decrease your risk of cervical cancers and sometimes even what new data is saying, throat, brain, neck cancers that we're seeing in this very large HPV family class. And really, the biggest thing is getting these vaccines on early before you're sexually active to help protect you before you ever see it.

Melanie Cole, MS: Well, I'm glad that you brought it up because I was going to ask you questions about HPV anyway. For our girls, and our boys are getting this vaccine, and it is one of those cancer preventive vaccines that is so rare today and so important. Now, just sticking for a minute with bringing our girls in for the first time, because I remember bringing my daughter in and she was so nervous and she asked me, "Am I going to get an examination?" And my doctor said, "I will only do what you are comfortable with." Erin, tell us a little bit about how you work with girls that young that may be so embarrassed, they're going through puberty, they're a little bit nervous about their bodies. You said about Pap smears, not until 21, but what about a breast exam? What about looking around down there, make sure everything's where it should be and doing what it's supposed to be doing? How does that all work with a new hesitant teen?

Erin Kendall: Yeah. And that's also really hard as well. The first thing I do, of course, I introduce myself. I think I'm kind of awesome, and I try and bring that bubbly, genuine, fun atmosphere with me. So, I hope that puts them a little bit of ease. And then really, I talk to them because it really depends why they're in here. Are they here for breast pain that is not correlated with their menses cycle? Are they here because of abnormal vaginal discharge or very painful menes, abnormal menses bleeding? Do I need to do a pelvic exam? And that's a discussion that I always do shared decision-making with my patients to kind of tell them what I can do and then what they're comfortable with. And if they're not comfortable with it, I of course would never do it. It is always your body. And if you aren't comfortable with an exam, that is okay. It's just very much dependent on how the patients and I connect, what they're comfortable with after we talk about the reason for certain exams and what they're really here at the appointment to do.

Melanie Cole, MS: Well, thank you. And I can tell that you do put your patients at ease and you do have a cool personality.

Melanie Cole (Host): And as we're getting ready to wrap up, what consists of a wellness exam? Please give us any final thoughts before we wrap up this episode of what you really want women to know because it's so important for us to be our own best health advocate and not to be embarrassed to ask those questions of our healthcare providers.

Erin Kendall: Yes, so great thing to end on is the wellness exam. Wellness exams are preventative appointments, okay, and insurance covers these once a year. a lot of women see their primary care providers for this and that is perfectly fine, but some women don't feel comfortable doing pelvic exams, sometimes breast exams, but they're primary care providers, which is where we can step in.

The wellness exam essentially consists of asking questions and then a physical exam. Specifically for me, in OB GYN, we tend to focus, again, on the breasts and the pelvis specifically. So we always start with questions regarding those things like any abnormal menses for you, vaginal discharge. Pain with intercourse, breast changes.

For my women 40, 45, and older, I also want to make sure, Do you have hot flashes? Do you have vaginal atrophy? Do you have vaginal dryness? Do you have new urinary symptoms that are bothersome to you? Because asking those questions will either take over that appointment and change it because we want to focus on that problem that you have, or we identify it and plan to have you follow up to discuss that specifically and treatments for those concerns.

but after that, we really do focus on overall health, wellness, exercise, diets. It's a time that we do birth control refills for women, if needed. The pap smear as well, if it's needed. we talk about screening guidelines. So if your, annual lab work is due and you haven't gotten it that year, we can do that for you.

We remind you of mammogram screenings as well as colonoscopies when those are due at a certain age. and then we also like to dig into family history a little bit. and like I said, OB GYN, we specifically are looking at breast cancers, ovarian cancers, uterine cancers in the family, as well as colon cancers.

Because these sometimes if you have them in your family, they are going to change the screening guidelines. So, it's important for us to identify those as well to see if we need earlier screening. For the physical exam specifically, every provider is going to be different. For myself specifically, I tend to do a thyroid exam, breast, abdominal, and a pelvic exam.

But, with both the breast and the pelvic exam, I do shared decision making with my patients. the reason is that the breast guidelines for exams have changed recently. so I talk to my patients about those new guidelines, and together we decide, do we do the breast exam today?

or not. Some women will decide they don't want it, they have no breast concerns, they either had a mammogram a couple months before, or they're going to be due in the next couple of months, and then we don't do it. Some women are like, nope, I'm here, I want to do it, and I love that, that is perfect, either or.

 So again, Very important for shared decision making with my patients. And we together decide what type of exam to do.

Erin Kendall: And really, the biggest things I have to leave everyone with is that, honestly, the best patient advocate for you is yourself. No one else can do it better, okay? So if you have questions, if you have concerns, please, please ask. You'll never have an answer unless you ask. And Google, as we know, can tell us everything that can go wrong, so please ask us. And then, we joke, because we live in the Pacific Northwest, if there's ever sunshine, you know in the area, please go outside, enjoy some sun and some fresh air. Thank you, Melanie, so much for having me.

Melanie Cole, MS: Thank you, Erin. What a great episode this was. You really speak to women and in such a passionate, compassionate way. I can hear that in your voice and thank you so much for joining us. The ability to even talk about this can really help women who might be hesitant to ask some of these questions. And the Women's Health Specialists at EvergreenHealth are available to address all health concerns that you may have regardless of sensitivity. To find a women's health specialist, please visit evergreenhealth.com/findadoctor. That concludes this episode of Check-Up Chat with EvergreenHealth. Thank you so much for joining us.