Start Visiting the Gynecologist

When is the right time to start visiting the gynecologist?

All women should have a pelvic exam and Pap smear by the age of 18 -- and sooner if they're sexually active. Unfortunately, 50 percent of teenagers have their first pelvic exam after they have become sexually active. Many women would greatly benefit from a discussion of sexuality, safe sex, and contraception before they become intimate. As you can see, it is perfectly reasonable for you to let your mother know that you would like to see a gynecologist. In fact, I'm sure that your mother would be pleased to have you suggest it. A visit to your gynecologist should be part of your regular health maintenance program. It is always best, whenever possible, to establish a rapport with your physician before a problem exists.

During your visit, your gynecologist will ask you specific questions about your medical and sexual history. If these are issues that you do not wish to discuss openly with your mother present, you may ask her to wait in the reception area during the interview. I encourage a policy of honesty between my patients and their mothers, yet the decision is yours. You may both feel best if you are able to discuss these matters openly.

A visit with your gynecologist is a confidential matter; however, many young ladies prefer to have their mothers present during the interview and/or exam. The choice is yours. I think it's always best to have a little time with the doctor alone so that any particular issues may be addressed confidentially. This is also the time to establish yourself as the patient and let your gynecologist know that you want to be able to seek advice when the need arises.

Remember, gynecologists have chosen a specialty that involves establishing long-standing relationships with their patients. Now is the perfect time to start that relationship!

Will getting a flu shot affect my pregnancy?

Medications or procedures that pose a risk to the fetus should be avoided during pregnancy. The benefits of immunization during pregnancy must outweigh the potential risks. In determining the appropriateness of vaccination during pregnancy, the risk of the disease to both the pregnant woman and her fetus must be weighed against the risk of the vaccine to both the pregnant woman and her fetus. Previously, the influenza vaccine was recommended only for those pregnant women with serious underlying diseases. The recommendations have now changed to include a much broader group of women.

Pregnant women who contract the flu during an epidemic of a new antigenic strain have a greater risk of death from the disease. Additionally, pregnancy increases the risk of serious medical complications from the flu. In fact, women at the end of their pregnancy have nearly five times the risk of hospitalization for flu complications. Flu infection in the fetus may increase the miscarriage rate, but no birth defects have been documented. The flu vaccine is an inactivated virus vaccine that is considered safe for all pregnant women with no confirmed risks to the fetus.

Because influenza poses the greatest risk to pregnant women in their second and third trimesters, the U.S. Department of Health and Human Services (HHS) and the Centers for Disease Control (CDC) recommend that women who will be more than 13 weeks pregnant during the flu season receive the vaccine. Pregnant women who have medical conditions that increase their risk of complications from the flu should be vaccinated before the flu season, regardless of their gestational age. This includes women with chronic cardiovascular, pulmonary, or metabolic diseases, such as asthma or diabetes.

While the vaccine is generally safe at any gestational age, vaccination during the first trimester should generally be avoided. This is because of concern about the coincidental association of the vaccine with early miscarriage.

What's the best way to deal with rude responses to pregnancy?

You have been blessed with a happy marriage and wonderful family. Congratulations to you and yours!

I understand your situation. It has become more and more common for friends, family, and even total strangers to comment on one's pregnancy. And unfortunately, the comments that are shared are not necessarily in anyone's best interest.

I've had patients relate the most atrocious stories. One woman was greeted in the elevator with, "I'm glad to finally see that you are pregnant -- your breasts have gotten so enormous, I was worried." And another favorite is one of my own. I was leaving the playground with my two boys, then 1 and 2 years old, and visibly 40 weeks pregnant with my third son, when two women stopped me. "Be sure to talk to your doctor about birth control after you have this one," one of them remarked. I smiled and said, "Thank you. You know what's even harder to believe is that I'm an obstetrician!" It's great to have a quick comeback!

Family size is a personal matter. In this day and age, it is often one of choice, and we all make choices. Some choose to limit the size of their families for personal or economic reasons. Others choose not to limit the number of children they have because of personal or religious reasons. Some feel complete with two children, while others long for many more. And still others may become surprised when their chosen method of contraception fails.

Unfortunately, people are curious and want to know -- was it a mistake, was it an accident, was it a surprise? You don't have to answer these questions.