This post discusses sexual assault, traumatic birth and internal examinations.  Please read on with caution.

In my post A Beginner’s Guide to Endometriosis, I talked about getting a referral to a gynaecologist and some of the diagnostic tools they have.  Today I want to explore that a little further and talk about what to expect and do at your first appointment.

First things first, I want to talk about what to wear.  That probably sounds a little fashion-obsessed – is style really the important thing here? – but there is a practical element to it that will become clear.  My go-to gynae outfit is a comfy midi-skirt and long top (tucked in).  This allows you a little bit of modesty for pelvic exams and gives the doctor easy access without you needing to strip down to your birthday suit.  For that reason, avoid jumpsuits or tight dresses that you can’t easily pull up and out of the way.  Looser dresses are ok, as are trousers, but trousers will almost certainly have to come off, and I never feel terribly secure or dignified with a bare bottom.

The appointment itself will generally follow the same formula.  The gynaecologist will discuss your symptoms with you.  They may then proceed to a pelvic exam, which may involve some pressing on your pelvis externally, and possibly them inserting their fingers into your vagina to feel for any obvious abnormalities.  This may be followed by both an external and internal ultrasound (the usual jelly-on-the-belly ultrasound followed by the rather uncomfortable experience of having the wand inserted into your vagina to provide a better view of the uterus and ovaries).  Having concluded their work, the gynaecologist will then have a talk with you about a possible diagnosis and treatment options.

Because of what occurs in an appointment, it is important to think about a couple of things before booking in with your gynaecologist.

1. Would you prefer a male or female gynaecologist?  Some women may not feel comfortable with the rather invasive diagnostic techniques above being conducted by a man.
2. Can you cope with the internal examination?  If you have previous had a traumatic sexual or birth experience, you should let your doctor know that having an internal examination may be very uncomfortable for you and could induce a panic attack or flashback, or physical pain.  You do not have to undergo an internal exam if you cannot deal with it.  It will only pick up obvious abnormalities and will generally not show endometriosis.
3. Is your gynaecologist an expert in endometriosis?  Gynaecology is a very wide field and covers pretty much all pelvic health issues.  All gynaecologists should know about and be able to give you an initial diagnosis for endometriosis, but for ongoing care you want to make sure that you are in the most experienced hands possible.
4. Do you have other concerns?  For instance, are you trying to get pregnant as well?  Many endometriosis experts also specialise in fertility as the two are linked.  When in doubt, research the doctor to make sure you are getting the best care you can for your specific needs.
5. What is the cost and can you afford it?  In Australia you will almost certainly get something back on medicare, but there is usually an upfront cost and the medicare goes back into your bank account after you have paid the total.  If you are struggling financially, speak to your gynaecologist about a payment plan.  It is also worth seeing if you are eligible for the NDIS (although that comes with its own massive variety of problems which I will discuss in a later post).  See this excellent post by Kylie Travers on medical costs and how to make them more affordable.
6. Is the gynaecologist recommended by other patients?  Whilst not everyone is the same and we all have different preferences for our medical practitioners, I find reviews by other sufferers to be a huge factor in choosing my specialist.  If other sufferers are saying that a particular doctor is rude, rough, old-fashioned or difficult, I would generally not waste time going to them (unless that’s what you really like in a doctor, I suppose).  If people are saying a doctor is kind, caring, understanding and pro-active, that’s someone I’d be interested in seeing.

During the appointment, there are a few things you should definitely remember to do.

1. Be completely honest.  Your gynaecologist cannot give you accurate advice if they do not know all your symptoms.  Even if you are embarrassed by something, you can assume that they have heard far worse.  This is not personal to them – it is their job and they have seen all the weird, gross and icky things our reproductive systems can do dozens of times before.  Likewise, if something is causing you pain, tell them.  Don’t do what I, and many other women, do, which is to hide pain or downplay our pain because we are used to doing so in our everyday lives.  If you don’t know if you can be honest, consider taking along someone who witnesses your pain regularly and can describe for the doctor the effects they see it having on you.
2. Take notes.  Before you go in, write out your own history and all your symptoms, and a list of questions you want to ask.  Write down the answers.  I always find when I get out of the appointment that I am not 100% sure what was said, usually due to information overload.  Writing it down can help combat that.  Even better, have someone else with you who can also take notes, if you have someone you can trust with all that information.
3. Ask questions.  If there is anything you didn’t understand or weren’t sure about, question it.  It is your health and it is important that you understand it.
4. Have a plan.  Get your gynaecologist to confirm what the next steps are, whether they need to see you again, and commit to following it up.

That pretty much sums up my tips and tricks for getting through your first appointment.  Do you have anything you wish you had known before seeing your first gynaecologist?

My next post will be related to this – I’ll be writing on how to advocate for yourself when doctors get difficult.  See you tomorrow!