Listeners asked, we answered! From mismatched socks at a gynecologic exam to UTIs after sex - here is a Q&A episode just for you. Thank you for listening and asking!
DM @gynandtonicpodcast or email gynandtonicpodcast@gmail.com with more questions and we'll get back to you soon.
*This is not intended to be personal medical advice but general information. We always advise speaking with your provider to find out what's best for you*
Listeners asked, we answered! From mismatched socks at a gynecologic exam to UTIs after sex - here is a Q&A episode just for you. Thank you for listening and asking!
DM @gynandtonicpodcast or email gynandtonicpodcast@gmail.com with more questions and we'll get back to you soon.
*This is not intended to be personal medical advice but general information. We always advise speaking with your provider to find out what's best for you*
Hi, i'm Sarah, And I'm Sarah, ja, and this is Gin and Tonic.
Speaker 2:Welcome back to Intamin Convos with your besties. You're okay. What are you doing now?
Speaker 1:There's my orange wine. My only French I've retained is how to say certain words with a French accent. No, please, sarah is not fluent in Italian. If everyone was wondering, she's a prodigy.
Speaker 2:I can say ten words in Italian, but I'm one week less than a week four.
Speaker 1:Yeah, you're such a diligent student, you're actually very inspiring.
Speaker 1:You get something in your head and you just go right at it. I love that about you. I'm trying to find happiness. How's it going for you, though? I'm still figuring it out, i'm just kidding, i'm happy Me, too. I spontaneously cried at work today. It was like having a perfectly pleasant conversation with people that I love and then cried for their reasons. So it's one of those days, guys, but we are going to answer questions. Woo, woo. I actually really love when you say woo in our episodes. It's my favorite.
Speaker 2:Did I ever tell you the best compliment a guy ever gave me? What was it? That I could be a cartoon voice? You are a cartoon, but I was so flattered I was like this is better than anything any man has ever said.
Speaker 1:And somebody's like what the I'm like that's really cute.
Speaker 2:I could be a cartoon voice.
Speaker 1:That's very novel, especially when you're talking that voice for your joking and you'll say things really fast. It's very fun and funny. You'll be like, oh my God, i'm so sorry, what are you doing? I love your cartoon voice. Okay, this is going to be a shorter episode so you can go back and listen to the last one if you needed more of a fix. But you all wrote in some great questions and we want to answer them.
Speaker 2:Okay, shall we do it. Pregunta número 1.
Speaker 1:Shall we go for it, yeah.
Speaker 2:Alright. So my OV advised against fertility testing before trying to conceive. I want to know my clock.
Speaker 1:Okay, love this question because I feel like there's so much information and all these new resources out there about getting fertility testing. There's all these new companies that have like home testing or this kind of startup mentality around initial testing of things, and I think that, in general, more information is better, but talking to someone who can help you interpret that information is the best. So when people talk about fertility testing, i think they mean different things, but the truth is we just like don't have great information to predict someone's fertility, like we actually don't know how to tell you how long you have to get pregnant by being exposed to sperm. We just don't know that You know.
Speaker 1:What we do know is how your body might react if you had to do IVF or things like that. We have better means of predicting how your body might respond to that. So I think that your doctor probably didn't want you to do it, because maybe you're in an age range where we have no good ways of predicting it. But for some people it does make sense, like, depending on what your family planning goals are and what your other medical history is, that you might be someone we're having some of that information sooner might push your hand in terms of doing something more. So I don't know. Did I answer the question?
Speaker 2:Yeah, well, essentially it's like I think a lot of these online companies can be empowering, but I think they have to be interpreted with a grain of salt because they can be falsely reassuring. So it's like you have to interpret them carefully and, like Supra just said, the numbers are actually more helpful in understanding how well you'll respond to IVF treatments if you need it. That's what they really help with, which is kind of seems ironic. And why are we getting it for fertility testing?
Speaker 1:Yeah, i feel like the lab that has gotten the most attention is something called an AMH or an anti-malarian hormone, and people use that kind of as a substitute for fertility. but really like, just like you said, sarah, all it's really been tested to show is how someone who suffers from infertility reacts to IVF medication, like how well your ovaries can be stimulated in that very specific scenario and it also has to be interpreted based on your age.
Speaker 1:I had a friend who did one of these modern fertility tests and then was told it was all normal and didn't worry about it for a few years and it showed me her test results later and I was like that wasn't normal. You know you should have been counseled that you needed to have a conversation with the doctor. So I think they're just. They're good in some cases, but definitely helpful to have a doctor relationship that you can have you at with or like hopefully you can have a conversation with the doctor where they understand your goals and you guys can come to a decision about whether or not it's meaningful.
Speaker 2:Yeah, i had a friend whose number was low and she had no problem conceiving it as two children, so I think it can be, can swing either way of the pen, whatever that pendulum swing.
Speaker 1:Sarah and I were both in the war elite today so we're trying to answer your questions, but also, we are tired, and so good luck to you for listening. Okay, sarah, out of my annuals, a listener wrote in do you judge me for wearing mismatched socks? Oh my god, i would be judged all day, every day of my life. How prepared does my huja need to be at an annual exam? What do you think, sarah?
Speaker 2:People apologize all the time, like as we're getting to that, like I'm just so sorry, i haven't shaved. It sounds like neither have I since New Year's. I'm not part of her. I haven't shaved.
Speaker 1:I am partner and he said he loves me anyway. So there we go.
Speaker 2:But people apologize all the time, like I actually don't care at all.
Speaker 1:Also, i cannot remember, like I do not register it. Like I could not tell you what anyone's huja looks like unless I documented it in a note. is like an abnormal finding. Yeah, like, do not comment on hair, like nothing of the sort.
Speaker 2:Yeah, we don't care about grooming status at all. And more people will say like oh, you know, i didn't shave my legs, or even like we don't. I don't bitch that stuff at all.
Speaker 1:Okay, i'm laughing because we took notes on these questions and Sarah wrote maybe don't go four to five days without shower right, yeah, well, people like I did shower this morning I was like that's okay, but like is it been a few?
Speaker 2:like been in shower yesterday, yeah.
Speaker 1:I mean, you don't have access to shower, it's totally fine. But I think the general concept is like overall, good hygiene is good, you just don't need to do it for us.
Speaker 2:And we've literally seen everything. There's very little that can surprise us. Like you know, we've had visits for moving foreign bodies from the vagina.
Speaker 1:Which is also one of my greatest fears that I left in a tampon. Really, yeah, you never have that fear.
Speaker 2:No.
Speaker 1:Oh, i'm constantly afraid I have something.
Speaker 2:I'm just like so psychotic about it.
Speaker 1:What do you mean? What does that mean? like every night you like feel around me and turn on things there.
Speaker 2:You have like a journal.
Speaker 1:I tampon in tampon out, but I'm not sure it does have a journal. Well, i know probably.
Speaker 2:Well, i know I have an IUD, so I have been using tampon in like nine years. That's true, but those visits are really fun actually Finding it?
Speaker 1:Yeah, because you're like hurry The patient's so mortified, but I'm like this is fun. Because it's like quick tricks. You're like oh, we got you. We're like our picture comes in all the way.
Speaker 2:My discharge has been smelling abnormal for weeks. Something's wrong.
Speaker 1:That is satisfying Where you're like. well, this is it. This is it. Now we won't have a problem anymore.
Speaker 2:It's because you left your diva cup in for three weeks. I have you had that.
Speaker 1:Yeah, i went to A diva cup too. I gotta try out this diva cup stitch. It hurt. Oh, you tried it. Yeah, whatever Like, just sit in the back. Maybe I need to see a blower specialist.
Speaker 2:It's because Eric and my cousin swears like that. I was like mm-hmm, i even looped it up. Okay, you did, yeah You're looping everything. It's because I have pelvic floor dyslexia. I can't relax.
Speaker 1:We'll work out later.
Speaker 2:I'm too high, strong, okay, you want to loop?
Speaker 1:Okay, where are we with our specialist? Okay, so yeah, we don't care, be comfortable.
Speaker 2:We've had, you know, humans like stool on us, pee on us, bleed on us retreat for an outtakes.
Speaker 1:Last time I peed in my mouth.
Speaker 2:Oh god, yep, it's happened On labor delivery, not at a GYN visit, oh No.
Speaker 1:Well, the labor delivery was like into my mouth, but otherwise it was on my face.
Speaker 2:Really Yeah, but you know what?
Speaker 1:I couldn't even tell you who. Like I don't remember who I just remember the sweet nurse walking over and like patting my face Which is how much we associate these things with you specifically like literally zero.
Speaker 2:Okay does it matter if I?
Speaker 1:have my period on my pap Sarah.
Speaker 2:Someone wants to know In general, no, i will let the patient know. there is a possibility that when we do the pap smear, that there will be too much blood, obscuring them from seeing the cervical cells.
Speaker 2:So remember pap smear is the cervix at the end of the vagina. So if you think of the vagina like a tunnel, at the very end of the tunnel is like a donut shaped organ. We use a brush literally to just brush the cervix. Like this I'll brush it in my forehead Just to pick up cells. We swirl them in a little jar of fluid and then the pathologist like identifies the cells. But if there's too many red blood cells they don't have a harder time. But in all honesty, when somebody's on their period we just brush the blood away and then do the pap smear, but on occasion a handful, like literally just a handful of times a year. It will say insufficient or obscuring blood.
Speaker 1:It's very uncommon And then you just have to do it again. Yeah, and also at the cytology lab where they read it, they have a reagent they put on it to get rid of the blood. So they also try to minimize any effect that has. But my, i have my friends who told me there are doctors automatically canceled their appointments because they were on their period, which I would never do. That I wouldn't do that either.
Speaker 2:That's odd. Okay, am I too old to freeze my eggs? When does the age interval for egg freezing Guys?
Speaker 1:Did you?
Speaker 2:This is such a sad question. You guys do we not answer this on episode one? Come on.
Speaker 1:But it's sad so we should answer again One I always I had a big problem with using the word old because you're not old. Our bodies just do different things at different times.
Speaker 2:Normal Sarah's old, but the rest.
Speaker 1:Sarah's young. Sarah has young, beautiful body, including your eggs. But yeah, our bodies just do different things at different times. So We also live longer than we used to. We do things at a different time in our lives and our reproductive systems have not caught up. So, like I hate like the word Geriatric or I refuse to write advanced internally, but I'm like it's not advanced. It's not advanced. Being 35 is not advanced.
Speaker 2:That's like. anyway, I won't write per Stereolization oh, I hate that.
Speaker 1:I hate what. Am I? a cow, Yeah what?
Speaker 2:Yeah, I'm a contraception.
Speaker 1:Anyway. So you're not old, regardless of what I'm about to say, but I will say that Ideally you would do it before 37 and really, if you're thinking far ahead, i'd say like 33, 34 is a great time, but before 37, at 37, our fertility really does decline a good bit. After 40 declines a lot. So many REI doctors, who are the ones who do freeze your eggs, won't do it after 40. There are always exceptions, so it might be worth having a conversation if you're after 40 and that's something that's still of interest to you. That doesn't mean there are options like you can. If you really do want to have a baby and be pregnant, you can do donor egg. There are other things that you definitely can do, but I would say, because just 40 is the number to be thinking ahead too, Remember as we get older.
Speaker 2:Well, no, sorry advance. As we become geriatric as my phone talks, wears off. You three Minds extends to six, seven months.
Speaker 1:Sarah, it's been a year.
Speaker 2:Yeah, it just people how your forehead won't move. I think it's. I think it's because I've been using my robot. Monotone face with more you have. Oh.
Speaker 1:You like, trained yourself not to use your forehead. I just give people dead face. I've been doing that too, like this is how I smile now.
Speaker 2:I don't even smile. I can't risk the wrinkles.
Speaker 1:I'm just kidding, i'm not kidding, we're doing well with this aging process. Hey, we're with you. Oh god, like kept talking about Botox. And then Adam, which I've had Botox once. No shame, though I honestly really want it again. I've had it multiple times. Um, and Adam, poor Adam, who's like, looks very young for his age. My fiance was like I think I'm talking like no, i don't have my craziness from off my face. It's perfect.
Speaker 2:Okay, oh, wait questions. But I just want to say, and the reason we don't recommend doing it too, too much later in life, like late 30s, is because remember, you have fewer eggs and the eggs that remain are Generally less like like higher chance of being genetically abnormal, abnormal. So it's just you're gonna end up doing more cycles if you're not gonna be as successful and retrieve as many good, healthy eggs late.
Speaker 2:Later on, later on versus a 33, 34 year old or somebody younger, then that's the reason behind it and those eggs that are Genetically abnormal or less likely to form an embryo implants.
Speaker 1:You're just less likely to get pregnant. Yeah, okay, okay, yes. So this these are listeners who clearly listen to our lecture called an electric Young person.
Speaker 2:Yes young woman who submitted.
Speaker 1:I'm just kidding This person wants to know what are things that can go wrong with egg freezing. Can I lose my ovaries?
Speaker 2:Well, So remember, when you're doing your egg freeze, you're essentially, essentially when you're having a regular cycle, not egg freezing your body is sending hormones to your ovaries to make one Super egg that you ovulate most, most people just ovulate See my hands.
Speaker 1:I'm like People just saw my armpit hair. I don't know. Provence, when I'm really our Peruvian tearless.
Speaker 2:We are like minimal hair.
Speaker 1:Oh, indians are all about it. I love you know. I don't know why, cuz it's hot there, but we didn't not for lack of hair. I'm barely shave, anyways, that's true. Anyways, okay, what was the question?
Speaker 2:Oh, yeah, so remember, every month you literally just you know Superproduce one egg. But when you're going through an egg freeze cycle or IVF, they're trying to super produce many eggs at one time, and so your ovaries, you know, grow in size by 10 times. They get to the size of grapefruits. And so the risks in this is you end up producing a lot of fluid in your belly And your eggs are so big that they could accidentally turn on themselves. That's called ovarian torsion, and so that could be an uncommon risk, but a theoretical risk, and that's a surgical emergency, you would know, because you'd be in a lot of pain, you'd be in a lot of discomfort, you'd be crouching over, very uncomfortable. So that is theoretically a risk and if it did happen it's a surgical emergency.
Speaker 2:Other things You know during your procedure, when they're actually retrieving the eggs, they put a vaginal probe, while you're asleep, into the vagina And then the probe has a needle attached to it, a very small needle that Punctures the the top of the vagina and enters into the abdomen and then punctures the ovary to kind of aspirate, suck out The eggs. In doing so there's some bleeding. That happens. In general, the bleeding is minimal and you'll feel a little discomfort, but in some cases it can be a lot, and then you can have bleeding in your abdomen and that might require surgery or a procedure.
Speaker 1:These are uncommon. Yeah, i'd say, all these things are super rare And the past.
Speaker 2:They would really pump up the hormones and people would get admitted for being too hyper stimulated. This doesn't happen as much as before, it's just super uncommon.
Speaker 1:Now There's so much more like careful decision making, better understanding of how much medication everyone needs We're just better at medicine, basically. So, everything comes with risk, but in general, egg freezing is really safe.
Speaker 2:Okay, okay, so I had no issues conceiving the first time and couldn't, but now can't get pregnant the second time. Why?
Speaker 1:So crappy. It's so tough when you're trying to get pregnant and you have trouble, especially when it's unexpected. We would call that secondary infertility. So, and again, i hate the word infertility Really. I write like fertility concerns.
Speaker 2:I write difficulty conceiving. I do that too, actually. I write difficulty conceiving. I just feel like it's so cruel. Or it's kind of like when people write they failed their glucose test and pregnancy. It is failed. I don't write for it, i just say did not pass.
Speaker 1:But okay, so we call it technically, called it secondary infertility, although if Sarah and I are not there we'll probably try not to say that word to you. But that's basically when you had one pregnancy where you got pregnant spontaneously And the second pregnancy you weren't able to for over a year, or in some cases, six months, depending on the situation. And there are a lot of reasons that can happen, although often we're just not sure. So reasons can be issues with the structures in your body, so scarring in the uterus, scarring on the tubes that don't allow either the egg to get into the uterus via the tube or don't allow for implantation, don't allow for the sperm to join the egg. So that can be it. Some people experience what we call premature ovarian failure, which basically is kind of like an early menopause, like your eggs and ovaries just start acting like they're going through menopause in an age period, in your 30s.
Speaker 2:That's super, uncommon Super rare.
Speaker 1:And then there are genetic abnormalities. So some people have genetic abnormalities in the mom and the dad if it's a cisgender couple and the combination of those genes together predisposes them to things like miscarriages, So that's possible too. also really rare. And then some people just have unexplained infertility. In general, about 10 to 20% of people who have infertility have unexplained infertility, which basically means all of your testing is normal, We don't know why. We just have trouble getting pregnant And in those cases they have the most success doing IVF.
Speaker 2:And your doctor can do some of this work up for you. but if you're having regular cycles and you're still not able to get pregnant, with regular cycles meaning you're ovulating, your ovulation predictor kits are positive and all your testing is normal, there's very little your OBGYN is actually going to be able to do for you. So I tell my patients that this is happening. We can either do your work up at a fertility center I can do it for you but again, we'll get to the fertility center, it's just there's not anything I can do for you.
Speaker 1:And when Sarah says nothing I can do for you. She just means in general is like not the world but just we would refer you to someone who did three more years of training than we did in fertility science. Okay, so someone wants to know, sarah, how long they have to wait after getting their ID removed to get pregnant?
Speaker 2:Um nothing, it's just get it popping.
Speaker 1:Yeah.
Speaker 2:Because, remember, when you have the IUD, the way it works is it's a local effect, meaning it's just really having hormonal effects in your uterus. It's not like the pill or depot or the implant where it's tricking your brain and affecting all of your hormones. It's really a local effect. And so what? most people are still ovulating when they're on the IUD actually. So when you remove the IUD, you may have a delay in your period coming back, but it's usually not because you're not ovulating, but it's because the IUD has really thinned out the lining of the uterus And that's why people don't bleed while they have an IUD. But I've had people get pregnant without even having a period because they're still ovulating.
Speaker 1:Yeah, There's no hard and past guidance about it. I often recommend people wait until one period only because we date pregnancies from your last menstrual period, so if you get pregnant before that period, it's hard to know when your pregnancy started, but not dangerous to get pregnant sooner.
Speaker 2:And some people do stop ovulating when they're on the IUD, usually in the first few years after insertion, but so those people might have a little bit of delay in return of, you know, population and fertility. But in general most people can conceive the same way as the general population without an IUD does.
Speaker 1:Okay, And this leads to another question via listener Can an IUD affect my fertility? And the answer is no, it does not affect your ability to appropriate at all. Get the IUD out, have your babies get at it.
Speaker 1:Yeah, the only thing I would say is that, because a lot of people stop having a menstrual period when they have an IUD, sometimes you're not as aware of like natural changes in your cycle. So if you are someone with really irregular bleeding or if you're just going through other changes, you might not be keyed into that as quickly because the IUD is masking what you would be doing without hormones, but that's still really rare.
Speaker 2:And then do I have to urinate after sex?
Speaker 1:Sarah says yes, she says she has to urinate immediately, otherwise she's UTI central.
Speaker 2:But nine UTIs in my early 20s.
Speaker 1:Nine. Oh my God, that's so rough, Sarah. Wait, how do you know nine You counted.
Speaker 2:Yeah.
Speaker 1:So you kept again a journal or what. You counted only, so I was like, today was UTI number five.
Speaker 2:I was like does my urgent care? was like oh God. I was like I just went to bed after I couldn't get on no-transcript.
Speaker 1:Okay. So basically the concern is for having recurrent UTIs, which means you either had two UTIs or more in six months or three or more in a year, and some people are really prone to this, other people not as much. When you look at big studies, actually peeing after sex was not a consistent thing. That stopped UTIs. But some people it matters more than others And I'd say the risk is low, like it's not that hard to pee after sex. So we often encourage it, especially for people who are prone to UTIs. But evidence is out whether it really makes a difference. Sarah doesn't believe me.
Speaker 2:Okay, because think about this When you're being intimate with somebody, you know all the fluids you produce lubrication and that fluid you know your vaginal opening is literally right next to your urethral opening.
Speaker 1:Okay, sarah's going to do another study, another. Okay, she's not biased at all on what the results will be, but so far the studies don't agree. Well, that matters for everybody.
Speaker 2:The anus is really close, to you know.
Speaker 1:I'm just saying the holes are close. Okay, yeah, so this is another thing. a lot of people talk about direction, of wiping front to back to what you were doing back to front, were you really? I actually I've like recently messed it up and I tried to counsel someone to do it back to front and they were like wait, you mean front to back? And I was like yeah, i do mean front, i don't think I even wiped.
Speaker 2:I just like blot. Now I'm afraid I'm messed up.
Speaker 1:You're right. That's why you blot, i blot, okay, i support you, okay, but so front to back is better. But again, the research is out, whether or not it really affects your. UTI risk. The big controlled studies don't really show that it makes a difference, but no harm in doing it And it could make a difference for you, things that do matter, that have been proven. You're crying? No, i just whatever evidence based whatever is.
Speaker 1:Drink lots and lots of water, like two to three liters of water. Avoid things like spermicide reliant, other methods of birth control. It's like those are like two things that matter. And then if you are someone who repeatedly gets infection, sometimes your doctor might put you on an antibiotic for right after sex. That can help. Or if you're someone after menopause, sometimes things like estrogen crink can matter.
Speaker 2:Big fan of that Okay good We're on, the sir and I are aligned.
Speaker 1:Okay, Sarah, who needs an anal pap? I actually want to know this because I don't know. Okay, okay.
Speaker 2:So anal pap smears are, in reference to screening for anal, pre cancer, kind of like cervical. The reason we get pap smears it's of our cervix. We're screening it for cervical cancer. So there are certain parts of our bodies that we can fortunately screen for cancer, meaning we can do things to detect it early, like breast cancer, colon cancer, cervical cancer. So for things that are caused by HPV or affected by HPV the cervix, the vagina, the vulva and the anus you can sometimes detect those early with certain tests, like cervical cancer screening with pap smears.
Speaker 2:And so if somebody has a history of abnormal pap smears and there's different degrees, there's low grade abnormalities and high grade abnormalities if you have a high grade abnormality of the cervix, you should get an anal pap smear. Or if you had a high grade abnormality of the vulva or the vagina a lot of people the screening for that is a little bit different. It's mostly oh, i saw a mole or something abnormal on the vulva, biopsie it Okay. so it's really only diagnosed in the moment. But if you had high grade of the vulva, of the vagina or the cervix you should be doing an anal pap smear.
Speaker 1:And it's okay, and we were talking about how often men, which there are a billion different societies, a billion different suggestions, but no one has really agreed upon anything But probably, if you do fall under one of those categories that you mentioned, you should start yearly and then have a discussion with how often.
Speaker 2:Yeah, And there's so many different societies and they're going to finally come up with one standard census And actually an anal pap smear is easier than a cervical pap smear.
Speaker 1:Because you don't have to have anything stuck in the anus. Well, a brush Except for the brush, but the brush is different Device.
Speaker 2:It's a Q tip. It's not the brush that they use for the pap smear, that's cervical pap smear And you don't have to put an instrument in the anus. It's literally just you moisten a Q tip, you put it into the anus about four, seven, like four to five centimeters. It's really not that bad.
Speaker 1:I was laughing because of your hand.
Speaker 2:I'm sure It's really not that bad. And then you just go, you know a little into the anus and then you swirl it out. It's really not that bad, swirl it out.
Speaker 1:Yeah, i hear it, you hear it. Okay. And then what all do I need swab for STDs. You got to swab every hole you're using Yep, mouth, vagina, anus, all of it Okay. And then there's also blood testing that you can do, so But do you swap all the other? holes Like I should, but I don't always, but sometimes I do. There's a lot of oral chlamydia, like a lot.
Speaker 1:I know, yeah, and no one ever swaps for it. So, yeah, you should get it all swabbed. If you're, you know, putting things in your mouth, then put this brush in your mouth too. Well, okay, i got to go swab myself. Then you want me to swab you? To be decided, we'll decide later. All right, those are all the questions. So if anyone has more questions, feel free to DM us on Instagram. We're at Jin and Tonic podcast. Jin's spell GYN. You can comment in our YouTube same name And that's all. We'll get back to you. Thanks for the questions, love you. I'll see you in the next G.