Shy about talking to your gynecologist? Here are some answers to difficult questions

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A visit to the gynecologist isn't just an essential part of your health routine. It's an opportunity for anyone who has a cervix, vagina or ovaries to ask questions about their reproductive health, from painful periods to a decreased libido.

If talking to your provider about this kind of stuff makes you feel shy or squeamish, you're not alone, says Dr. Rachel Bervell. She's a physician with training in obstetrics and gynecology and the co-founder of The Black OBGYN Project.

"I come from a strict immigrant household," she says. "I never had the birds and the bees talk. I never had any of those types of conversations."

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Take charge of your gyno visit

Take charge of your gyno visit

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Today, Bervell is much more outspoken about this topic &#; in fact, there'sa viral video on Instagram of her talking about what happens during a pap smear ... at her family's Thanksgiving dinner.

You shouldn't be afraid to speak up, either &#; especially when your health is on the line, says Bervell. To give you an idea of what kinds of questions you can ask your provider, Bervell answers queries from our listeners. Whether you're a woman, trans or non-binary, this story is for you. This interview has been edited for length and clarity.

I have terrible anxiety surrounding pap smears. Are there any changes I can make during a routine exam that gynecologists would be willing to accommodate?

Sometimes anxiety is because of a bad experience, whether that's conditions like vaginismus [an involuntary tensing of the vagina] or other pain, or because of prior [sexual] assault.

There are things you can do to make the pap smear easier for you. Think of your provider as a partner in your care. If you feel like there will be a concern with pain or discomfort, ask the provider to use a smaller speculum. Ask them to use more lubrication. And [get them to help you] understand why you're doing this exam. At the end of the day, it's to prevent cancer. But it can be done in a way that prioritizes your needs and comfort.

I have intense period pain. How do I know when my pain isn't normal?

Excessive pain during or outside your cycle can be noteworthy because it can indicate an underlying health issue &#; something isn't "quite right" and is contributing to the subsequent pain/discomfort. In that case, it's important to seek medical attention to identify the source of that issue, diagnose the underlying cause and receive treatment. The last thing we want to do is wait for worsening conditions or complications.

Conditions like endometriosis, when [endometrial-like] tissue that's supposed to be within the womb [grows] outside the womb, can cause debilitating pain and discomfort for patients.

If you're having intense period pain andyou can't get relief from an over-the-counter medication like Tylenol or ibuprofen, consider talking to your physician or your provider about other ways to ease that pain.

I'm a post-menopausal woman with both ovaries removed and I am not taking any hormone replacement therapy. How do I get my libido back?

When we stop our ovarian function, which is really what menopause is all about, you are no longer releasing eggs. You're no longer able to have those eggs fertilized. And there will be a decrease in estrogen. Estrogen is needed to maintain the lubrication, elasticity and blood flow in the vagina. When estrogen drops, vaginal dryness occurs.

I recommend an open honest conversation with your health provider. They might suggest hormone replacement therapy, vaginal estrogen, lubricants and moisturizers or meds to address sexual dysfunction. They may ensure you are maintaining positive health habits and assessing stress/psychological factors overall. Enjoying sex and having a libido is not just biological, it's also lifestyle and behavioral.

I deal with multiple sclerosis, which causes severe spasticity. In order for me to get a simple gynecological exam, two people must support my knees and keep them open. But most doctors' offices have said they cannot accommodate me. As a result, I do not see a gynecologist as often as I should, simply because it's uncomfortable and embarrassing when my foot kicks the doctor without my control. What should you do if you're struggling to find a gynecologist who can meet your needs?

This isn't the best answer, because it's telling the patient they have to do the work for themselves. But No. 1 is, you know what you need. And you know providers are supposed to take care of your needs as a patient that has a disability [it is also the law].

Making sure the clinic is accessible to you should be your priority, and the clinic should be able to respect that and respond accordingly, because that's our duty. So speak up, send a message ahead of time.

If your provider cannot accommodate you, find someone else who will respect how you are coming to the provider and ensure you are getting the care that is necessary.

How should I talk to a gynecologist about birth control?

The first question is to figure out what your goals are. Is it because you don't want to get pregnant and you're not ready to start a family at the moment? Are you concerned that your periods are not regular and you want some consistency? Or is it to help with other health conditions like acne or heavy bleeding [during your period]?

Once you figure that out, your provider can talk to you about the full scope of options. One of the organizations I always refer to is Bedsider.org. They've done a wonderful job of listing all the birth control types with their effectiveness and what it does, what's included, what it looks like, where it goes.

The digital story was edited by Margaret Cirino and Meghan Keane. The visual editor is Beck Harlan. We'd love to hear from you. Leave us a voicemail at 202-216-, or us at .

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Going to the gynecologist for the first or 10th time can be awkward, but it doesn&#;t have to be a bad experience. To help cast away your fears, here are answers to 20 questions you might be too embarrassed to ask before your visit.

Questions About My Visit

1. I&#;m nervous about having to strip down for my visit. What can I do to feel more at ease?

This is a normal concern. Exposing yourself in front of other people, including doctors, can be uncomfortable. Remind yourself that gynecologists see thousands of bodies of all shapes and sizes, and this is just another day for them. In turn, they are also mindful that this isn&#;t the most comfortable part of the visit for you. You can always ask to talk to the doctor first and then get undressed after your initial conversation. This can help you feel more at ease, especially if it&#;s your first time meeting your doctor.

2. I&#;m on my period. Can I see my OB/GYN, or should I wait?

If you&#;re embarrassed about the bleeding, don&#;t be! We deal with vaginal bleeding pretty much every day; however, sometimes, menstrual blood can affect the results of a pap smear. In a perfect world, you would not get a pap smear on your menstrual cycle, but usually, this is not a big deal. If you are having problems, don&#;t delay your visit just because you are on your cycle.

3. Should I shave or wax before my visit?

Unless you are worried that your pubic hair might be concealing a concerning spot, leave it however you feel most comfortable.

For more gynecological exam tableinformation, please contact us. We will provide professional answers.

4. What is my vulva supposed to look like? I feel like it must be abnormal.

Vulvas are like people, and they come in all different shapes and sizes and with different characteristics. Like many things regarding the female body, there are unrealistic beauty standards that tend to make women feel self-conscious or different. However, if you notice abnormal growths or changes, please let your gynecologist know so they can perform an examination.

5. I don&#;t like the smell of the vagina. Is there anything I can do to fix that?

This is somewhat complicated. A vagina will never be completely odorless. Like our digestive tract and other parts of the body, the vagina is a complex ecosystem with various bacteria, as well as different secretions. Things like diet, activity, weather and undergarment material can have an effect.

It&#;s important to understand what is normal and what is not normal, and you can always ask your gynecologist if you have concerns.

6. I have a lot of vaginal discharge. Is daily discharge normal?

Discharge is normal! The color and consistency of your discharge can change throughout your menstrual cycle, and it increases during pregnancy due to changes in hormone levels. Other changes in quantity or odor, or association with pain, burning or itching, may indicate an underlying problem like an infection and should be evaluated if you are concerned.

7. I feel some bumps down there. What is normal, and what should concern me?

The vulva/vagina is rarely perfectly smooth, and there are plenty of reasons you might feel small bumps such as hair follicles, Fordyce spots (normal tiny bumps on the vagina) and ingrown hairs. However, you should alert your gynecologist to anything that is newly discovered, especially if it&#;s painful or enlarging, as that could be a sign of something more serious.

8. I sometimes experience itching down there. Should I be alarmed?

Itching can be caused by various reasons, from yeast infections to sensitivities to detergents and/or bath soaps or inflammatory skin conditions. It&#;s rarely a sign of something very serious in pre-menopausal patients. If it&#;s just occasional, make sure to wear breathable cotton undergarments and avoid scented soaps &#;down there.&#;&#; And if it becomes bothersome, alert your doctor, especially if it doesn&#;t go away or if you are post-menopausal.

Questions About Sex

9. Why is sex painful for me?

Sex could be painful for any number of reasons: muscle spasms, ovarian cysts, endometriosis, vaginal atrophy, lack of adequate lubrication, or even more complicated psychological reasons. It is something that warrants an exam and a discussion with your doctor.

10. Is it safe to have sex during my period?

If your cycles are regular and predictable (occurring every 28-35 days) then there shouldn&#;t be a risk of pregnancy during this time.

11. Is there less risk of getting pregnant if I have sex a few days after my period?

Normal cycles last 21-35 days, with an average cycle length of 28 days. If your cycle falls within this range and is consistent (e.g. always 27 days or always 31 days), then you should not be ovulating during the first few days after your cycle. Those with shorter cycles (e.g. 21 days) should be more careful. Use a menstrual tracking app to help you identify (and possibly avoid) your &#;fertile window.&#;

Just remember, this method of contraception is less effective than most other methods. Ask your doctor if you have questions, especially if it is your main method of birth control.

12. Can I have sex during pregnancy?

Yes, but certain pregnancy conditions prohibit sexual intercourse, including placenta previa (the placenta lies low in the uterus and partially covers the cervix), preterm labor or cervical insufficiency (premature shortening/thinning or dilation of the cervix early in pregnancy). If you are experiencing vaginal bleeding in pregnancy, ask your doctor before resuming sexual intercourse.

13. What should I do if I had unprotected sex with someone and haven&#;t gotten tested yet?

Tell your OB/GYN and get tested, especially if you are not on birth control. If there is a concern for exposure to STDs or HIV, there are preventative treatments that can be started before the results.

14. I don&#;t seem to ever be in the mood anymore. Why is my libido low?

There could be any number of reasons. Usually, low libido isn&#;t just from one cause. Certain medications, medical conditions, stress, relationship dynamics, sexual function, life stressors and many other things can affect libido.

Questions on Reproductive Health

15. How often should a woman get a pelvic exam and a Pap test?

Starting at the age of 21, a woman should undergo a routine annual pelvic exam. However, if there are any problems or concerns, a pelvic exam might be needed at an earlier age. A pap smear is a specific swab that collects cells from your cervix that are tested for pre-cancer, or &#;dysplasia.&#; Not every pelvic exam includes a pap smear. Pap smears are typically performed every three years (if the prior result was normal). A Pap smear with testing for HPV can be performed every five years starting at age 30. Although the Pap smear test is only every three to five years, your gynecologist is still performing a visual inspection of your cervix at your yearly visit.

16. I&#;ve been experiencing premenstrual syndrome. How can I tell the difference between what is normal and what is more serious?

If your premenstrual syndrome is interfering with personal relationships or your ability to perform functions at your job or school, it should be evaluated. There is a syndrome known as pre-menstrual distress disorder that can cause substantial mood changes, and this can be screened for at your physician&#;s office.

17. How many weeks need to pass before I will be able to know if I&#;m pregnant?

Some commercial urine tests offer results as soon as six days before your first missed period.

18. How often should I be tested for sexually transmitted infections (STI)? Which ones?

Most STIs do not cause symptoms and can go undiagnosed unless you get a routine screening. All women younger than 25 should get annual testing for gonorrhea and chlamydia. Those older than 25 in a new sexual relationship should consider routine screening as well. Also, consider annual screening for trichomonas, HIV, syphilis and hepatitis B and C, especially if you think you are high risk or are unsure of your partner&#;s status. It&#;s important to remember that Louisiana has among the highest rates of HIV and syphilis in the nation. If you have more than one sexual partner or you don&#;t regularly use condoms, opt for more frequent screening .

Herpes (HSV-1 and HSV-2) testing presents a bigger challenge. It is difficult to screen for herpes in someone who is not having symptoms, such as a painful rash. Just because you or your partner may have been &#;checked for everything,&#; this usually doesn&#;t include herpes testing. If you&#;re not sure what exactly you or a partner were tested for, ask for a copy of your records. The most useful herpes tests are done at the time of an outbreak, so if you are having pain or see a genital sore, call your doctor for urgent testing and avoid sexual intercourse. If you are concerned that this has happened to you, but the symptoms are now gone, discuss it with your doctor. Herpes is extremely common and can be transmitted even when you are not having an outbreak. Talk to your doctor if you are concerned about passing the virus to an unaffected partner or vice versa.

19. What&#;s the best way to protect myself from sexually transmitted infections?

Barrier methods (male or female condoms, dental dams) and regular STI testing for both yourself and your partners. Honesty is the best policy! Being truthful about your sexual health from the outset will open the door for your partner to be honest with you in return. It could prevent you from transmitting or receiving an STI.

20. How can I talk to my partner about STIs?

This can be hard for people to talk about due to stigma, but it shouldn&#;t be! Try to normalize the conversation as much as possible. For example, you can say something like, &#;I try to make a habit of asking new partners about past infections. I just got tested (or have an appointment to get tested) and was hoping you would do the same.&#; You could offer to go with him/her if that&#;s something you&#;re comfortable with. Offering your testing history will make your partner feel less judged and more likely to be honest.

You shouldn&#;t feel the need to disclose a history of treatable STI&#;s that have been treated (such as gonorrhea, chlamydia, trichomonas), but chronic STIs that may infect your partner need to be disclosed (such as herpes or HIV). You should always discuss when you were both last checked. Remember, herpes may not have been included, so always ask about what tests were done. Many STIs cause no symptoms, so you could be transmitting or catching infections that you don&#;t know about. These infections are often easy to treat, and for those that aren&#;t, there are often ways you and your doctor can help decrease the risk of passing the infection to an unaffected partner.

Editor's note: This blog was originally published on Jan. 7, and has since been updated. 

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