Going to see a urogynecologist can be intimidating.  It helps if you know what to expect during your first appointment.  Different doctors do things in different ways but there is a basic format. Here is an outline of what you can expect during your first urogynecology appointment.

Expect paperwork

You know you can always expect paperwork at the doctor’s office! Lots of the questions will feel familiar to you and will be like the paperwork at any doctor’s office. It would be nice if all of the different electronic medical records talked to each other but they don’t.  But most importantly, there will be lots of questions about your symptoms. 

Some of these questions may be part of  a standardized questionnaire (here is a link to one of the questionnaires that I use in my office). These questionaires have been well studied and are used to objectively measure your symptoms and give you a score.  This score is an objective way of determining the severity of your symptoms.  The questionnaire can be repeated after treatment and can show the degree of improvement. These questionnaires can feel a little clunky when you are filling them out.  And because they assess severity, there is a huge range of different questions. There will likely be questions about symptoms that don’t apply to you.  Don’t let this worry you. This doesn’t mean that your symptoms aren’t bothersome. And if it bothers you, it is worth addressing.

Expect talking

I like the questionnaires.  They help me assess severity and improvement and tell me if I am doing a good job. But I love to hear the personal story and you can expect lots of talking during your urogynecology appointment. While it may seem embarrassing, I always learn more by hearing you talk about what is happening to you.  The conversation helps us to get to know each other and trust each other.  And it tells me what bothers you the most and where to start.

I’ve done this part in different ways over the years.  The most efficient way is to have someone undressed and in an exam room.  This way, I can talk and then examine you.  But this is not the best way to have a conversation.  Everyone is more comfortable talking with their pants on.  Instead, I prefer to talk in a small office without medical equipment and then move to an exam room when we are done talking.  I find this makes you more relaxed and more comfortable with the questions. 

Since the pandemic started, I do telemedicine.  This means that I frequently do this whole talking part over a computer connection.  Perhaps not surprisingly, women are much more comfortable talking about these issues when they are in their own comfortable environment.  This remote connection is a great way to start talking about these intimate problems and a little less scary.

Expect an exam

During your urogynecology appointment, you can expect a full physicial including a pelvic exam.  First, I listen to your heart and lungs and examine the back and abdomen carefully, making sure that your surgical scars match the surgical history you gave me.  It is pretty common to forget about small surgeries like tubal ligations. Then, I look at your legs for swelling and bruising.  Next, I do a complete pelvic exam including testing nerve reflexes and evaluating your pelvic floor muscle fucntion and strength.  I look for pelvic organ prolapse and leaking.  Finally, a small belly ultrasound machine is used to make sure that you are emptying your bladder well and a urine sample is collected to look for signs of an infection, diabetes, or blood.  Some offices will look in your bladder at your first exam but I find that this is too much for one day.

Expect education

After a history and physical, I have enough information to make a plan with you and you can expect more talking. This is when I put it all together and tell you about your diagnosis, any testing you might need, and available treatments.  Sometimes this can be an overwhelming amount of information.  I usually give out lots of handouts to read.  Sometimes you some time to process and consider your options. In this case, I will schedule a follow up meeting or phone call just to review and answer questions.

Key points to remember

Now you know what to expect during your urogynecology appointment. Remeber, we’re a team. This is your health and wellness. Here are few things I want you to remember when you are preparing for your office visit. Because I think knowing what to expect is half the battle, then you need to prepare and organize to get the most out of your appointment.

Be proactive

•  If you just want to talk and don’t want to be examined, tell me at the start.  It limits what I can do but for some women, it can be a better place to start.
• If there is information you want, tell me at the start.  Maybe you want information about a surgery your friend had.  I can tell you about that procedure and why it may or may not be a good choice for you.
• If there is information that you want me to have, send it to me before your appointment.  Old records, especially surgery reports, are always helpful.

Don’t wait

• Some of these issues are hard to talk about.  It may take the whole visit for you to work up the courage to tell me what is really bothering you.  Tell me at the start so I can focus on your important issue.

Don’t worry

• I’ve heard it before.  You aren’t going to surprise me or shock me.  I can’t remember the last time this happened.  Women tell me their most secret secrets everyday. 
• You might leak urine in the office or fart.  This happens everyday.  It is why you are coming to see me and tells me how severe your leaking is.  I expect this to happen. Besides, I have really quick reflexes, can get out of the way, and I usually wear scrubs.  No worries.
• You don’t smell.  I promise.  Lots of women will apologize for odor or anatomy prior to an exam.  I’ve never had anyone who apologized for an odor actually smell.  It is more likely to be something you worry about than a reality.
• You don’t look weird.  I am an expert in pelvic anatomy.  I know what is normal and what can change with muscle injuries, nerve injuries, radiation treatment, deliveries, and various surgeries.  My goal is to figure out what parts work, what parts don’t work, how that correlates to what bothers you and what we can do to fix it.  Weird isn’t part of the evaluation.

Take your time and pick your path

• Everyone makes their decisions in different ways.  Some people need time to process and talk.  Some know exactly what they want.  You could pick to bee-line to surgery or you could work on conservative therapy.  You do you.  My job is to give you the options and guide you along the way.  But you get to pick the path.