Tips for Talking to Your Doctor About Prolapse

Speaking to a health professional about the symptoms of your prolapse can be difficult. We are taught not to discuss bodily functions, sex, or our genitals, and it can be hard to overcome this even with a doctor. It can be particularly difficult have that first conversation where you disclose your symptoms.

 

The American Association of Urogynaecologists has created a really useful document to guide you through that first conversation: Tips for Talking with Your Doctor.

 

It has two parts.

 

On the first page, there is a questionnaire for you to fill in and take to your doctor's appointment. It covers most of the questions your doctor is likely to ask if you tell them you are experiencing symptoms that could be caused by a prolapse.

 

On the second page, there is a list of questions that you might like to ask your doctor in an initial meeting, to help you get a clear diagnosis, and a pathway towards further medical care.

 

It is really important to go into medical appointments as prepared as you can be, to make sure that your concerns are heard. If you are getting a friend or family member to act as an advocate, they might be able to help you fill in the questionnaire, or ask questions during the appointment.

 

Doctors, you may like to get your female patients to fill in the questionnaire on the first page in order to help you screen for women who are experiencing prolapse or other pelvic floor dysfunction. This is a great way to begin a conversation with your patients about a topic they might be desperate to discuss, but that they feel unable to talk about with you.

National Association for Continence "Tools for Patients"

The National Association for Continence is an American organisation that aims to help women and men with continence and pelvic floor problems.

 

They have put together a page of excellent resources for women with prolapse, both in America and around the world: Tools for Patients.

 

General resources that can be used by all women, and their advocates, include:

• Information on patients' rights and informed consent, including a clear list of the information you should be given as a patient
• A summary of the latest findings and FDA statements about the use of mesh in prolapse repair surgery
• The questions that your surgeon should ask you before recommending a particular type of surgery, and the information you should be given about your condition and the suggested treatment

One of the most important parts of managing your prolapse is knowing the right questions to ask when you are talking to a health professional. This resource will help you to go into important conversations well-informed. It is also useful to read this if you will be advocating for a woman with prolapse at medical appointments.

 

For women in America, there is information on the 'Centres of Excellence' program, which identifies clinics that are specialists in dealing with prolapse. This is very important, as it can be extremely difficult to find a surgeon or practitioner who is experienced in dealing with prolapse and in whom you are confident. This program aims to take the guess-work out of the process by identifying health professionals who meet certain standards in training and results. 

The Importance of Being Able to Discuss Your "Down There" Anatomy

Most readers of this blog will live in a culture where you are not meant to discuss your private parts - certainly not with a stranger, and in some cases not even with an intimate partner. This means that when we absolutely have to, we use generalisations (see if you can spot the two used so far in this article).

So what's wrong with this, and how does it relate to prolapse?

Embarrassment about discussing our genitals is a big reason why some women do not seek treatment for their prolapse. It also means that when women do seek treatment, they often use vague descriptions that may give medical practitioners  an unclear idea about the situation. Unless you have a GP with truly phenomenal people skills, you are much less likely to get examined if you say "Things have been a bit different down there since childbirth" than if you say "I have a lump at the entrance of my vagina and my perineum is very sore."

One of the diagrams from Scarlet Teen

 

 

Here is a great resource from Australian sex ed website Scarlet Teen that takes you on a guided tour of your genitals: The Vagina, Clitoris, Uterus and More. While you may not feel comfortable looking closely at your genitals or touching them in certain ways, the diagrams on this website will really help you to identify and name each of the parts of your anatomy.

 

The next step is to practise using this terminology. You could do this by saying the terms aloud to yourself, or talking to an intimate partner or trusted friend. If you find yourself really unable to say these terms, consider using them in a written explanation of your symptoms which you can then give to your doctor. You may even wish to show this page to someone acting as your advocate, and ask them to speak to the doctor on your behalf.

Being an Advocate for a Family Member or Friend

 

An 'advocate' is someone who supports a patient and helps to ensure their wishes are respected. An advocate is usually a friend or family member, although some hospitals do have professional patient advocates.

 

There are a few benefits of having someone to advocate for you at medical appointments. Your advocate can:

• Help you plan for an appointment by writing a list of questions you would like to ask, or a script for part of the conversation you are nervous about
• Attend the appointment with you, and help you talk about aspects of your condition that you find upsetting or embarrassing
• Prevent you from being (however unintentionally) steam-rolled by a over-confident or overly-busy health professional
• Provide emotional support if you are asked upsetting questions or required to undergo procedures you find distressing

If you would like to advocate for a loved one, here is a good resource from the American Urogynecologic Society about how to do so effectively: Tips for being a Health Advocate.