with Dr. Jillian Lopiano of Betty's Co.
Nyssa's Mia Clarke recently chatted on Instagram Live with Dr. Jillian Lopiano of Betty's Co, a Texas-based organization taking a new approach to wellbeing an OBGYN care for teens and young adults. Betty's Co is dedicated to empowering young women when it comes to managing their own wellness whether with gynecological care, nutrition, or mental health--essentially all of the areas where they might have been afraid to ask someone.
Mia & Dr. Lopiano talked about how to raise empowered teen girls as well as tips for women of any age who dread trips to they gynecologist. Here are our Seven Top Takeaways from that conversation.
Transcript edited for length and clarity.
We asked: what age would you generally recommend that somebody start going to see a Gynecologist? Is there a specific marker for that, for example starting your period?
That’s a great question! And I think the answer to that is not very widely known.
ACOG (the American College of Obstetricians & Gynecologists, the governing body for the profession in the US) recommends that young women start to seek gynecological care in some capacity around the age of 13 to 15.
Actually getting your period is absolutely not a marker for having to go. Neither is sexual activity. That’s another popular myth that that’s when you should go. Really the time to go is before you have started sexual activity, even before you’ve started having your period just to really get to know about these topics, right?
Ideally you want to be educated on sex and educated on your period before it happens so that when it does happen you are more empowered and more informed. That’s philosophy behind that age group recommendation.
The other component is that if there are any medical issues or anatomical abnormalities that can come up and cause issues, those things can be addressed early, often and quickly and you don’t have a lingering diagnosis that you don’t know about that you find out when your 20.
So there’s a two-fold philosophy towards seeing a gynecologist early.
It’s really kind of mind-blowing how much women are suffering for so long before we can get to them and before we can see them. Where, a lot of this can be addressed early on in life. The right amount of education and empowerment can really change the course of someone’s well being.
We asked: what are some of the biggest challenges you’ve seen in getting preteens and teens to feel comfortable going to a Gyno for the first time?
Also, the assumption that it’s going to be painful applies to adult too, what would you recommend to help people in general feel more at ease?
The first thing they can do is really research your provider and get to know them. You can schedule a visit just to go meet your provider and get to know them. You may get some pushback on that that’s not the accepted standard at this point.
At Betty’s that’s really where we’re trying to revolutionize and break the mold: if you want to just come in and see what we’re about, we’ll just talk to you. So that is absolutely your right and your prerogative to make sure you’re comfortable with a given provider.
Dr Lopiano continued in answer to the previous question:
The second component to that is if you’re not comfortable, if you don’t feel connected to this person who’s going to be intimately taking care of you. You don’t have to stay. You are not required to do anything
If someone is making you uncomfortable, if you just don’t like the vibe, if it’s not working for you or you don’t feel seen or heard. You don’t have to stay. There’s no requirement. This health care visit is about you. This is about you and what we can do for you.
Moving towards the exam, there are a couple of things you can ask for. If it’s freezing in the room and you’re shivering, you can ask to turn the temperature up. If you want someone else in the room with you, whether that’s a nurse or medical assistant or your support system, so your mom, your sister, your best friend.
There are a couple of medical scenarios where a support person really isn’t a safe thing to do, but in the office, usually you can ask for that. You can ask, ‘is someone else going to be in the room with you?’ In this country it’s kind of the standard, but if it’s not happening, you can ask for that and if someone says no you can leave. If something’s making you uncomfortable you don’t have to stay there.
Now, there are some patients who have experienced trauma who just can’t do it. They have involuntary muscle spasms and things. There are a couple of tricks of the trade that we can offer women.
Some women find it helpful to place their own speculum and work with the provider, sometimes we go had over hand. Sometimes the exam is limited. And those things are all okay. Really there are a lot of little things at each step that women can ask for and that we can do on our end to help make it more comfortable.
I always recommend physicians that are board-certified, and that’s for anything, dermatologists, whatever, you really want someone to be board-certified because in this country that says that they’re annually doing CME’s and being reviewed by their governing bodies that practice evidence-based medicine, so that’s always a good place to start. Look at the letters after the last name--for gynecologists in this country that’s FACOG so that’s a Fellow of ACOG. You can’t be an ACOG Fellow without passing your boards and re-upping every year.
Look for the language that they use, look at the images they use: are they making an effort to be inclusive or diverse or are they not? Those are little flags you can look at that may be helpful before you go in the door, but really it’s going to be so driven by what you need as a patient and how you feel when you get in there.
I know some wonderful doctors that just don’t connect with various patients. You have to connect with them and that’s just driven on such a personal level. I think the main thing is to know that it’s for you to say I feel comfortable or I don’t and to feel empowered to say ‘I don’t’.
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what tips would you have for someone to support someone younger in their lives, whether it’s a child or younger sibling how can parents and caretakers best support young people during that time–not just in terms of getting them prepared to see a doctor, but also starting up their period and just having a healthy and positive practice?
The first thing I would say is being comfortable with language. You have to use the right terms. It is not a ‘kitty,’ a ‘purse’ -- there are a lot of colorful names for vaginas and vulvas out there. Just using that anatomical terminology and using it with them and often.
If your children are at home and your eight, nine, ten year old or even pre-teen is talking about their vulva, their vagina, their period, their bleeding, the best way to support them is to not say ‘Shh, don’t talk about that.’ It’s to stop and to listen. And it does take some effort.
You have to be prepared to talk about something in public or in front of friends. My children will use the words penis and vagina in mixed company and part of the learning curve is teaching them when to kind of shout things and (laughs) but to not bristle and not teach them that that’s a bad word. It’s not a bad word! We don’t come up with weird words for your nose or your ears.
Really working with them and not bristling and not freaking out when they say things either at home or in public. Just being that anchor. Really normalizing it. Betty’s [is about] normalizing it. It’s not dirty and it’s not shameful and it has a purpose and it has a use and in an age-appropriate way explaining that to them.
At Nyssa we talk a lot about the importance of self-check and the power of intimately getting to know your own body. We created this VieVision Between Legs Mirror so people can look at their vulvas.
Do you think it’s Important for young people to start getting comfortable doing that by themselves, outside of the gynecological visit?
If you know the right words to say and that they’re not shameful, the next piece to that is knowing what it looks like and what is what. And, interestingly, it’s sort of the only part of our body that we can’t see casually, right? It takes some effort to look at it. But it’s like any other part of your body. Like your hands, if you saw a mole or a rash or something you’d be like ‘what is that?’
We want not only to know the language of what things are, but also what your normal is. There’s a huge variation of ‘typical’ anatomy and so getting to know what your normal is along with the language of how to speak about it, I think, is incredibly empowering.
That’s the first piece, The second piece is for older women–or not even older, but young adults, like early twenties. Follows the same logic that I tell patients about a self breast exam: when I tell a patient to do a self breast exam it's not for you to diagnose anything. The goal is to know your normal.
So size, shape, quality, skin, moles, markings, freckles, texture, consistency, all of that in a breast exam is not intended for any one person to diagnose anything, it’s just for you to get to know what your typical breast tissue looks like.
The same goes for any kind of vulvar exam or view. You’re not looking for anything, but maybe there’s a mole there, maybe there’s a red mark, maybe there’s a freckle that you didn’t notice and you’re like, ‘hmm. I don’t know what that is, I should ask about that.’ That’s really what the purpose is and if you don’t look, you don’t know.
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