Four top gynaecologists - three male (gasp!) and one female - help us to dispel the stigma of genital health (latex gloves and all).
Introduction: Susan Riley / Interviews: Georgie Lane-Godfrey
Photography: Pixie Leyes
Featuring in many women’s ‘top 10 things in life they don’t enjoy’ will be the following: Andy McNab books, eating spaghetti al pomodoro in a white shirt, being asked to freestyle during a hen-do dance class and a gynae exam.
Dress it up as a smear, scan, transvaginal ultrasound, colposcopy or a simple gloved hand having an investigative poke around, the gynaecologist remains a mythical character dancing at the edge of our subconscious like Michael Flatley on a bungee.
Yes, we know they have an impressive skill set; we’d just rather not publicly acknowledge it. This is odd on many fronts. For one, we all have vaginas that we want to be healthy. That's not embarrassing. For another, many of us are usually shameless hypochondriacs (I once went to the doctors with ‘blue hands’ only to be told my worrisome circulation was down to the dye of my new indigo jeans).
But that seems only to apply to body parts positioned above the waist and below the knee. Develop an issue in between the two and we suddenly take on the role of Switzerland: more than happy to hang back and wait and see what happens.
It’s a stance that sees us delaying the most basic of check-ups. In the UK, women aged 25 to 29 currently wait, on average, 15 months before attending their recommended cervical smear. Why? How did gynaecologists become the only professionals with a female bias that we actively try to avoid? Anyone else who dedicates their working day to the protection or promotion of women receives our applause. Not our Out Of Office.
Our reluctance to engage also seems a waste considering ob/gyns are trained specifically for us; our own special ops ninja of reproductive health.
Their quest is to fix our most personal of problems, from the inconvenient (heavy periods) and embarrassing (STIs) to the inconceivable (tears) and distressing (infertility). They are the agony aunts of our cervixes and wombs. We should want to engage with them more. Especially when one in two UK women will suffer from a reproductive or gynaecological health problem in their lifetime.
So how far away are we from welcoming them with open, er, legs? After all, our American sisters do. Everyone has a gynaecologist (well, everyone with medical insurance). Friends of mine who live in New York tell me women recommend gynaes like they’re great hair stylists.
To not have one is a social sin, tantamount to letting your roots grow out and your ends split; the wanton neglect of something that should be maintained, and often. And why not? In an age where we volunteer to get our chakras opened and colons irrigated, our vaginas are most likely getting a raw deal.
OK, a vaginal exam isn’t the most cushty thing – the paper towel mop up, the jelly-laden probing, the leaving your pants and shoes in a puddle on the floor like you’ve just been beamed up to Mars. Hell, you don’t even get a lollipop after. But it should be treated as normally and as unashamedly as any other check-up, eye exam or ear test.
Indeed, why not just think of it as you would a trip to the dentist. Yes, you might have to prep a bit. Yes, only those with perfect teeth will truly look forward to it. And granted it might be a bit awkward when they shove their hand down your throat. But you’re not going to be slapped with a filling every time; prevention is so much better than cure.
So lets start to lie back, make ourselves comfortable and open wide. Ours is a generation of fearless, agenda-setting, business-launching women. We should be laughing in the face of vaginal exams. And saving a few warm smiles for our gynaecologists while we’re at it...
Why do men become gynaes?
The only thing worse than a speculum encounter? A man on the other end of it. Stylist dispels the myths...
Mr Hugh Byrne 40, consultant obstetrician and gynaecologist at St George’s Hospital, London
“I’m often asked why, as a man, I became a gynaecologist. They always seem slightly mystified. It’s strange, because I don’t think people would ask a woman why she became a urologist.
I decided to go into the field because it’s so varied. Gynaecology covers a huge spectrum of disorders, where you’ll act as radiologist, physician and surgeon. We all have specialist areas, like cancer or infertility or menopause.
I specialise in keyhole surgery to treat conditions such as fibroids, endometriosis and polycystic ovaries, but I also deal with menstrual disorders and abdominal pain. I don’t think there is any other branch of medicine that is so diverse.
One of the problems we face is that people tend to over-sexualise it. It’s hugely frustrating because there really is nothing sexual about the situation. It’s very clinical and almost business-like, not in a brusque way, but in that you’re there to fix a problem. To me it’s just a job, but the perception of it definitely creates some obstacles.
Personally, I think there are more male gynaecologists because there are more male doctors. It wouldn’t be right to ask women to become gynaecologists simply because they are women. In countries like Pakistan, for instance, women are quite often side-lined into it because of their gender, which is unfair.
I don’t think my patients are bothered that I’m a man. The important thing is to be a good communicator so you can put the patient at ease, and gender doesn’t matter for that.
I don’t do any aesthetic gynaecology. It’s a personal and professional decision because when a woman wants to change the appearance of her genitals, the pathology is often in her mind. Fixing prolapses that occur with age or childbirth isn’t a problem, but I think there’s a fine line between making something aesthetically pleasing and mutilation.
Pornography has had a huge influence on our perceptions of genital appearance. Many of the women I meet are upset because all they see, or all their partner sees, are these unrealistic expectations. Sometimes the only genitalia a woman has seen is her own, so I have to tell her to trust me when I say that hers is perfectly normal, because I’ve seen thousands. Everyone looks slightly different, just as our hands and feet aren’t the same. We’re all just at different places on a spectrum of normal.”
Mr Mike Bowen 52, consultant obstetrician and gynaecologist at the London Wellwoman clinic
“One of the most amazing things I’ve learned since being a gynaecologist is how a person’s self-esteem can really lie in their genitals. I do some cosmetic surgery for women, like vaginal tightening and labia reshaping, and the change in a woman’s confidence after a successful procedure never fails to astound me. You do have to make a judgment call though about whether a woman really needs a procedure as often the problem is psychological.
The most interesting part of my job is the women’s personalities. Yes, the technical aspects can be challenging and rewarding, but there comes a point where it’s all very familiar. The one thing that is never the same is the women – they never fail to cheer me up. It’s often a joy to see a former patient as a lot of the time it’s like seeing an old friend. I’ll get calls about everything, from boyfriend troubles to fashion advice.
Invariably the one question I get asked is whether I’m put off sex by examining women all the time. The answer is you compartmentalise it – there is a world of difference between what goes on in your private life and what goes on in a bright consulting room. I challenge any normal individual to find anything vaguely seductive about it.
You might think that getting people to feel comfortable enough to show you their genitals is the hardest thing, but getting them to expose their soul is a much bigger hurdle. It always strikes me when a patient I’ve known for years suddenly reveals something, like the fact that they’ve been abused. You can’t underestimate how long it takes to build up that trust.
I wouldn’t say I’m ever shocked by anything I see, but there are times when you get pulled up sharply, like when you suddenly come across an invasive tumour you weren’t expecting. You don’t want to say anything, because the woman is already vulnerable and you need to do lots of tests before anything is confirmed, but deep down you think, ‘Sh*t, I’m about to turn this person’s life upside down.’ You just have to remain completely neutral and professional.
Women are very perceptive and any change in your mannerisms can make someone suddenly panic.
As to being a male gynaecologist, my view is that if I had a serious problem, I wouldn’t care if I were treated by an alien from the planet Zog as long as they were going to fix it. That’s all that matters. There’s no point gambling on your health because you’re embarrassed, so just get it checked.
Putting the patients at ease really is the most important thing. For example, with urinary incontinence, usually I try and explain what’s going on in their bladders by filling a rubber glove with water. One time the glove burst and water went all over my crotch. That was one occasion where the doctor was more embarrassed than the patient! Luckily she laughed, so hopefully it worked as an icebreaker.”
Dr Ed Prosser-Snelling 34, specialist registrar in obstetrics and gynaecology at The Royal College of Obstetricians and Gynaecologists
“What I think a lot of people don’t understand about gynaecology is that it’s a dual speciality. You don’t become a gynaecologist without becoming an obstetrician as well, as the two are intrinsically linked.
Half of my job is delivering babies, but people don't realise this because the birth conversation is so dominated by midwives. In fact, obstetrics monopolises the majority of my out-of-hours work as there are so many emergency situations during labour.
Some people do express a preference for a female obstetrician when they’re giving birth, but I think it really depends on what stage they are at in their labour. For example, at the start the couple might ask for a woman, but obstetricians only get involved when there are complications, by which point they usually don’t care. All they want is someone who can get their baby out safely, no matter what their gender.
Whenever I tell people what I do, they immediately share their birthing stories with me, but I actually quite enjoy hearing them. Labour can be a very stressful and intense experience, in more ways than one. I had one patient who had an orgasmic birth during an instrumental delivery, which is when the woman climaxes as the baby comes out because the stretching sensation is so intensely stimulating. It’s an incredibly rare phenomenon. It was a little awkward though, mainly because her mum was also in the room.
Personally, what I really like about gynaecology is that it is a life course approach to medicine as you can help women at every stage in their lives. The fact that it focuses on an intimate part of the female body does make it a challenge, just like it would if you were a colorectal surgeon or working in a sexual health clinic.
People find examinations embarrassing regardless of whether you’re a male or a female doctor, so you have to be sensitive to this. But the thing is you see thousands of women a year, and although the appearance of a vagina is variable, they all end up looking the same after a while. To us, it’s just another anatomical part.
Gynaecology is changing a lot. Twenty years ago, it was mostly grey-haired men in suits, but now 60% of the workforce is female. Chances are if you go to a clinic now you’ll be treated by a woman, but don’t be shocked if it is a man – there are still a few of us hanging on.”
Inside the mind of a gynae
One female gynaecologist honestly reveals what’s on her mind while she’s examining you…
“A lot of people find it hard to believe, but intimate examinations just don’t bother me. To be honest, I’d probably be more grossed out having to examine someone’s eye rather than their genitals.
Sometimes I worry that patients think I’m judgemental because I’m really not. If my expression is dead-pan, it’s just because I don’t want to transpose any of my fears onto the patient – as you see some truly horrific things. For example, some of the tears I have had to fix after a traumatic birth look like a grenade has gone off in the woman’s vagina. But I don’t want to worry the patient by the look on my face, because I’ve never come across a tear we couldn’t fix.
In my career I’ve seen some strange things, but nothing shocks me any more. Extracting foreign objects inserted during sex is quite common, especially on a Saturday night. They tend to be things that people have found lying around the house – bottles, brushes, even pet toys. I remember seeing one woman who’d put a cat’s toy ball in her vagina and then couldn’t get it out. I think my overriding sentiment was one of confusion rather than judgement.
A lot of the women I meet worry about what they look like down there, but they really shouldn’t. In the whole of my career, I’ve only ever seen one lady who had grossly abnormal labia and she needed surgery because it was causing her significant discomfort. But that is very rare. The majority of us are just a variant of normal.
I often get asked whether women should get a wax before an examination. Hair doesn’t bother me in the slightest, but it can make some procedures tricky. For example, repairing a ripped perineum (the bit between the vagina and the anus) can be difficult if a woman is very hairy. In the past, women were asked to shave beforehand but now it’s not seen as socially acceptable.
I always think it’s a bit odd when a woman doesn’t have a wash beforehand though – you wouldn’t go to the dentist without brushing your teeth first, so why is this any different? Of course, if the woman has a malodorous discharge then it’s understandable. Or if the patient is an older lady who struggles with washing, that’s fine too. But with younger woman? Well, you do wonder.
I once saw a lady who had lost a tampon, which created the most offensive stench. You could smell her outside the door before you even entered the room. The problem was that she had continued to have sex with the tampon still in situ because she thought it would eventually come out naturally. She waited three weeks before coming into A&E, after both her mum and her best friend had failed to fish it out. It took us under 30 seconds to retrieve it.
A lot of the time it’s hard to remain emotionless, but you get better at it as you get older. The first time I saw a severe female genital mutilation case, I cried and had to leave the cubicle. I was just so upset for that poor woman.
I do find my patients tend to confide in me too, for example telling me who the real father of their child is when they’ve told no-one else. I think the barriers come down when you’re already exposing yourself so intimately, but I consider that level of confidence a privilege. Trust is a gift.”