Many of us would agree that going to the gyno is probably one of the more uncomfortable doctor’s visits we have to make. From awkward conversations about going on the pill, to rapidly stripping down to a paper gown, to cold metal contraptions going up our you-know-whats, the gynecologist’s office tends to be an intimidating space (and it honestly doesn’t seem to get any easier with age). In a now-viral tweet from this past Sunday, Indianapolis-based urogynecologist Ryan Stewart took to the Twitter-sphere to get feedback from people who need gynecological care on the “problems, frustrations, and solutions” in the gynecology office. Twitter users didn’t hold back, and with over 3,000 responses later, the collective discomfort with our OB/GYNs is pretty evident.
I have the opportunity to design my office from scratch.
I’m asking women. How would you design/optimize a visit to the gynecologist’s office?
No detail is too small.
If I’ve ever had a tweet worthy of virality, it’s this one. ?? RT.
— Ryan Stewart (@stuboo) December 5, 2021
One concern that drew a wide range of responses: ways to achieve a more comfortable experience. There’s no denying that lying half-naked with your feet up in the air and a doctor you just shook hands with for the first time staring at your cervix isn’t the most pleasant encounter. Not to mention there’s something so cold and sterile about the doctor’s office, especially with all that metal equipment staring right back at you. One user, @BlingSing, stresses, “Comfort & WARMTH – pillows, warm blankets, warm the ultrasound gel & the lube (please use lube).” Although stripping down is part of the gig, many Twitter users expressed distaste for the paper napkin gowns. “I hate paper gowns for exams. It makes me feel so exposed. My Gyn recently changed to spa-style robes. What a difference! (@thenotoriusMDB). Beyond what patients have to wear, undressing with the fear of the door swinging wide open at any moment or haphazardly dumping your undies on the nearest chair is quite honestly a mess. The biggest joke of all is the stirrups. In a tweet from @PhabPharmaDoc, the office placed hilarious feet warmers over the mechanical feet:
My OBGYN has hilarious warmers over the stirrups, which always make me laugh. There’s another room that says “I Hate” & “This Part”. They also make me feel like the office understands how awkward and uncomfortable these appointments can be, despite their best efforts. pic.twitter.com/UidkvHjrR3
— Dr. Jay Phab, PharmD, BCPS (@PhabPharmaDoc) December 5, 2021
Discussions around comfort quickly lead to that of pain management. We may have friends who have gotten an IUD and equate the pain to a minor period cramp, while others complain they almost passed out on the table. While individual pain tolerance differs from person to person (although I don’t know how getting an IUD is a walk in the park), doctors seem to downplay the pain of IUD insertion as “uncomfortable,” and popping a couple of ibuprofen beforehand is practically pointless. Twitter user @theemptypockets expressed what we’re all thinking: “IUD Insertion needs anesthesia.” Many patients elicit similar sentiments for Stewart about doctors encouraging pain relief or management before procedures. “Offer painkillers. Don’t make people ask/have to know to ask,” says Hairy Seldon (@eschatomaton). And whether it be biopsies, pap smears, IUD insertions, patients want a no-bullshit play-by-play for what they’re going to be in for.
It’s crucial to recognize that experiences at the gyno are not universal. When it comes to approaching triggering, heavy topics like infertility, parenthood, or sexual assault, patients want doctors that care about their individual situations. Twitter user @Anneredmond13 said, “Rather than asking a direct question such as “Have you ever been assaulted?’, a physician should try, “Have you ever had any unwanted sexual experiences?” Ask: What can I do to make your visit and exam easier?” While many patients indicated a preference for having a female doctor, many users revealed that they had been put on the spot at appointments with observing male interns or last-minute changes to practitioners. “Please consider: not asking the patient if an intern can be in the room in the presence of the intern- it’s hard to say no in front of them; not changing practitioner between the time of appt. and the actual appt. expecting the patient to be comfortable with someone else.” (@KCooperGrifin). Out of the fear of being labeled “difficult,” many patients just go along with these uncomfortable scenarios, but prioritizing patient preferences is a necessary improvement.
Equal representation and staff training are essential elements of proper physician care. Gynecology has a dark history of experimentations on enslaved Black women—as was done by Dr. James Marion Sims, “the father of modern gynecology.” Sims performed surgical techniques on these women without anesthesia, reinforcing long-standing racial stereotypes that Black patients have higher pain tolerances than White patients. Black representation in physician’s offices and medical illustrations are discussed in the Twitter thread as well: “Please have images of Black women in the office. I haven’t visited a gynecologist office yet with this type of representation” (@KimEMPA2019). Gynecological care is also not just limited to “women’s health,” as not every person with a uterus identifies as a woman. This understanding transcends patient care and encompasses office staff. One Twitter user, @HannahntheWolf, posts, “Have marginalized folks on your staff and support them. Let us see people like us in your office.”
While Twitter can trend some pretty ridiculous content, it can also spark some pretty remarkable offline change. Patients want to enter the gynecology office feeling respected, included, and heard when it comes to their health concerns. Dr. Stewart has revealed plans to incorporate the responses from his Twitter thread into an employee handbook for his new OB/GYN office. Fingers crossed that we can retire those paper gowns once and for all!
Top Photo: Julio César Velásquez Mejía / Pixbay