Finally, A Man Who Really Knows Women

Meet Edward J. Gill, MD. By day, he’s Associate Professor of Obstetrics & Gynecology, Director of Urogynecology and Reconstructive Pelvic Surgery, and Program Director of fellowship training in female pelvic medicine and surgery at Virginia Commonwealth University Medical Center in Richmond, Virginia. Which is a long-winded way of saying that he’s really smart. By night, he practices yoga, swims, cooks, and builds furniture in his wood shop. Luckily for us, Dr. Gill will contribute regular posts to Blisstree and answer questions related to all of our “lady problems”.

Seriously, why do men become gynecologists? (Sorry, but we’ve seen “The Hand that Rocks the Cradle,” and just had to ask.)

That certainly comes up once in a while. In medical school, after moving through the main rotations (internal medicine, OB/GYN, surgery, pediatrics), students pick a specialty. For many, the joy and privilege of delivering babies is the catalyst for choosing OB/GYN. For others, the surgical challenges of treating women who have debilitating conditions like fibroid tumors or ovarian cancer are the deciding factors. I practiced family medicine for six years. But for me, no specialty other than OB/GYN offers such a rewarding and diverse practice combining surgery, caring for patients over the long haul, and of course, being a part of the childbirth process. That has universal appeal to all medical students, male and female.

Have you ever had patients refuse treatment from you because you’re a dude? What happened?

I’m sure patients have opted not to make or keep appointments with me simply because I’m male. In our clinic, where we supervise residents and treat a socioeconomically diverse walk-in patient population, we occasionally run into someone who refuses to be seen by a male physician. Fortunately, there are usually female providers, so we can honor those requests. A  2001 survey by ACOG reported that 47 percent of women preferred a female OB/GYN, 15 percent preferred a male, and 37 percent had no preference. Most women simply want a caring, competent physician who listens well.

As a medical expert, is there one thing you’ve encountered that women do or don’t do that could contribute to serious gynecological problems? (aside from not smoking, getting a pap smear every year, and regular self breast exams)

Don’t douche. About one-third of women in the U.S. douche regularly, many of them every week. Common reasons for douching are to feel clean, remove blood, eliminate odor, and to try to prevent infection or pregnancy (not to mention “my mother told me I should”). A healthy vagina has a delicate balance of bacteria and other organisms, which are maintained by keeping the vaginal pH acidic. Douching disrupts this balance and may lead to vaginal irritation, cause infections like bacterial vaginosis, and increase the risk of sexually transmitted infections (STIs) and Pelvic Inflammatory Disease. Douching has never been shown to prevent STIs or pregnancy. It will mask a bad odor, but not treat its cause. Early studies have shown that frequent douching can prolong the “trying” time for someone who wants to conceive, and may increase the risk of ectopic pregnancies. Most gynecologists and the American College of OB/GYN recommend against douching – even once.

Now for a little Pap chat. Do we really need to get one every year?

Maybe not. The goal of Pap smear is to prevent cervical cancer. It’s the most successful screening test, and has dramatically decreased the incidence of invasive cervical cancer. In the past, doctors recommended that all women get an annual Pap from the start of sexual activity (or by age 18), and continue that as long as they could amble into the office. Quite a burden and thoughtless, by today’s standards. We now know that cervical cancer is almost always caused by human papilloma virus (HPV), the most common STI in the U.S. In addition to the Pap, HPV testing is now a routine part of the screening process. These days, if you’ve had recent normal Paps, and don’t have HPV, it’s perfectly reasonable to do the Pap (sometimes combined with HPV testing) every two or three years. But remember: the Pap is only the test that gets sent to the lab. A pelvic exam may still be needed yearly; and prescription refills usually warrant an annual visit. Women should have their first Pap by age 21, or within three years of first sexual activity. Once you hit 65, or have had a hysterectomy for reasons other than cancer or Pap problems (and have no cervix), and you don’t have a history of abnormal Paps, you may not need another one – ever.

Are there more men or women already in or getting into the field today?

Interesting question. That’s certainly changing. According to a recent survey by the American College of Obstetricians and Gynecologists (ACOG), at least three quarters of practicing OB/GYNS over age 50 are male. This makes sense, since the majority of physicians over 50 are men. But in terms of current residents training in OB/GYN, more than 75 percent are women. In our residency program, the entire first-year class is female.

Craziest professional story? (honoring doctor/patient confidentiality, of course)

Well, recently, I heard a patient say, “I agree with Glenn Beck.”