In the past year, I’ve seen a lot of doctors. PCPs, therapists, psychiatrists, GI specialists, radiologists, anesthesiologists….I’ve met them all. In fact, I’m even dating one: my boyfriend David will graduate from medical school this May! (I promise this is a coincidence, not a ploy to get free medical care. Though, now that I’m thinking of it — wouldn’t that make a pretty great movie plot?!)
As a result, I’ve learned a thing or two about how to converse with doctors about uncomfortable topics. The number one lesson I’ve learned? Don’t be afraid to talk about the taboo. There’s no such thing as oversharing about bodily fluids, sexual activity or bodily pain if it’s something of concern to your doc.
I know, because over the past year of suffering with IBS, David has become completely desensitized to any mention of my bowel habits. And we still have a sex life, believe it or not!
Doctors are regular people like you and me — but they’re unique in that they’ve been trained to know what to look for in patients who are suffering. Not to put too fine a point on it, but most doctors have had eight years of higher education and anywhere from three-to-seven years of on-the-job training.
After spending that much time in hospitals, doctors see a lot of sh*t, literally and figuratively. So, you don’t have to be afraid to talk to them about anything concerning your health. And I do mean anything.
I understand why talking about things like poop, sex and drugs feels uncomfortable for many patients — but I also hear the frustration in David’s voice when he can only get an incomplete medical history from a patient. Doctors he’s worked under have told him to double or triple the number of alcoholic drinks a patient reports, assuming they’re being dishonest about their drinking habits. He’s even been told to disregard patients’ pain scale ratings, since doctors view these self-reports as “inaccurate.”
That’s all pretty damn scary, when you think about it! Lying to your doctor, or omitting important information, not only prevents your doctor from making an accurate diagnosis, but it also affects the medical care they provide to other patients.
We owe it to everyone to be honest about our health, even when it’s uncomfortable or embarrassing. That may sound daunting at first, but I promise you: the long-term outcome of being honest with your doctor will be better than any relief you get from telling a lie.
So, here’s my guide to talking to your doc about sex, drugs, pee, poop and everything in-between. I’ll share the things you should never be afraid to talk about with your doctor, as well as the alarm signs that signify a serious health condition may be underway. I am, of course, not a doctor, so please consult your PCP or an ER if you are suffering from any of these symptoms!
Pee & Poop
Ah, bodily fluids. Once upon a time, I, too, felt shy discussing my bladder and bowel habits with my PCP. So, what changed, you ask? IBS! Having chronic constipation, alternated with diarrhea and stomach cramps, forced me out of my shell. Suddenly, I had to closely monitor and report on my bowel habits — which is a speedy and successful way to shed the stigma around waste products!
You might be wondering why, exactly, these nasty little fluids matter so much to our doctors in the first place. Well, pee and poop may be gross to us, but they’re also key indicators of your health. In fact, from just one urine sample, your doctor can test for sugar, protein and blood in the urine: biomarkers for a variety of medical conditions!
Talk about it: You should be able to talk comfortably about the consistency, frequency, color and smell of your pee and poop. If you visit the gastroenterologist (GI), be prepared to go into even deeper detail about your bowel habits — use a smartphone app like Cara to track your food, mood and poop in advance.
Alarm signs: See your doctor ASAP if you notice blood in your pee or poop, experience pain during either a bladder or bowel movement or notice anything else is “off” for longer than a few days. You may be referred to a GI doc if your PCP suspects something is up, but don’t worry: many GI conditions are not as big a deal as you may think!
Alcohol & Drugs
Rule #1 of visiting your PCP: always be honest, even when the truth hurts. Trust me when I say, your doctor needs to know the truth about your alcohol and drug consumption. Even if you aren’t a heavy drinker, lying to save face helps no one — and certainly harms your health.
Even if you are consuming illegal drugs or drinking below the legal age of 21, your doctor’s number one concern is your health. As long as you present no violent harm to yourself or others, your doctor must keep such matters confidential — even if you are not a legal adult.
If your doctor suspects you have a problem with illicit drugs or alcohol, they will likely refer you for treatment. However, your doctor cannot force you to go to treatment (though we will both highly recommend it!), nor will they turn you into the authorities — even if you refuse treatment.
Talk about it: Tell the truth when asked how often you consume alcohol, how much alcohol you consume — and the same for marijuana or other drugs.
Alarm signs: If you feel dependent on drugs or alcohol, feel that drugs or alcohol interfere with your daily functioning or experience withdrawal symptoms when you don’t use drugs or alcohol, it’s time for a visit to your PCP or mental healthcare provider.
Periods & PMS
We’re taught at an early age to subscribe to stereotypes about women’s periods. For example, a cycle must last the perfect 28 days to be healthy, or excruciating cramps during your period are perfectly normal. In reality, many of the things we think are “normal” are cause for concern, and vice-versa.
Most of us probably don’t pay much attention to our monthly periods, beyond knowing when to buy tampons or marking the date on our calendars. Yet it’s important to pay attention to these things! Know what your “normal” is, because anything from the color to the heaviness of your flow can signify a change in your health.
While we’re at it, let’s also talk about cramps. You also should never be bedridden by painful cramps, no matter what the media tells us in movies or on TV. This symptom can be a sign of ovarian cysts, endometriosis or another important-to-know medical condition! If you’re not sure if your period pain is something to worry about, consult your gynecologist, or any doctor whom you trust to take your pain seriously.
Talk about it: Always know the date of your last period whenever you visit the doctor’s office. At the OB-GYN, be prepared to discuss regularity, flow and PMS. My advice? Track your period symptoms in a smartphone app — I like Spot On by Planned Parenthood — for easy reference.
Alarm signs: Any significant change in your period’s color, texture, flow or frequency should be run by your doctor. When it comes to flow, see your doctor if you soak through more than one regular pad or tampon per hour, or if you pass a blood clot larger than the size of a quarter. Excruciating pain that forces you to lie down or stop daily activities is not “just cramps” — and neither is any cramping that can’t be controlled by OTC pain relievers.
Oh, and when it comes to PMS? You should never have debilitating mood swings that interfere with your functioning or relationships. This could signify a disorder known as Premenstrual Dysphoric Disorder (PMDD), a form of depression in which its onset is linked to a particular point in a woman’s menstrual cycle.
Sex & Birth Control
Let’s talk about sex, baby! Let’s talk about you and me…. All jokes and song lyrics aside, your doctor cares about your sex life — and not just because they’re curious. Your sex life keys your doctor into important clues about your health. For example, a recently-onset lack of interest in sex may signify depression or anxiety, while a history of unprotected sex may indicate it’s time for a pregnancy and/or STI test.
As for birth control, you should always feel comfortable discussing your options before making a decision. Never accept a form of birth control you don’t want, or go without birth control if you want it, without receiving complete information about your options. See this link for an in-depth description of different types of birth control — and the pros and cons of each.
If you’re under 18, you should know that laws vary from state to state. However, generally speaking, your doctor cannot disclose to your parents that you want to take or are taking birth control. Just call to make sure your insurance company does not send an explanation of benefits to your home if you’re still on your parents’ health insurance — the customer service number should be on the back of your insurance card, if you have it.
And, a word about abortion: it’s controversial, but regardless of how you feel about it, your doctor should not impose their political or religious beliefs on you. Your doc should never pressure you to have an abortion if you don’t want one, nor should they make you feel like abortion is not an option if you do.
Avoid crisis pregnancy centers, which do not provide abortions and will instead trick you into carrying a pregnancy to term. Many workers there are not even healthcare professionals, as you do not need a license to provide an ultrasound in many states! Instead, visit this link to find the closest Planned Parenthood — their experienced providers will be happy to talk to you about all of your options, rather than promoting pregnancy or abortion. (And watch this amazing John Oliver segment on crisis pregnancy centers for more information.)
Talk about it: Be prepared to tell your doc if you’re sexually active, the number of partners you’ve had, the types of activity you’ve engaged in (no need to go into detail!) and if you’re using birth control or STI protection. Take the time to find a PCP or gynecologist who will answer your questions about birth control and abortion honestly, without judgment or bias.
Alarm signs: Keep an eye out for missed periods, abnormal discharge, pain during or after sex and irregular bleeding (though be aware that these symptoms can also be side effects of certain types of birth control). If you’ve had an abortion and experience any concerning symptoms — such as prolonged bleeding — give your doc a call or visit your nearest emergency room.
STIs & Problems “Down There”
Say it with me: vagina. Again, louder: VAGINA! Good. Now that we’ve broken the ice, let’s talk about discharge and pain as they relate to your vag.
The pill, IUDs and other forms of hormonal birth control can have great benefits. They’re also highly effective in preventing pregnancy — but not necessarily in preventing STIs. Abstinence-only sex ed got one thing right: abstinence is the only way to 100% guarantee you will not get an STI. (You cannot, as many of us have heard as children, contract an STI from a dirty toilet seat in a public restroom!) Since most of us are not abstinent, however, the only way to prevent STIs while having sex is by using barrier methods such as condoms or dental dams.
But never fear! Clear, whitish or yellowish discharge in your panties doesn’t mean you have an STI — it is, in fact, perfectly normal to experience these fluctuations in discharge throughout your menstrual cycle. Pain during sex, pain while urinating and any unusual change in your discharge’s consistency or color are not normal, and should prompt a visit to your PCP.
If you’re sexually active and experiencing these symptoms, you could have an STI — but, more likely, you could also have a yeast infection, bacterial vaginosis or another infection of the vagina. Regardless, both STIs and vaginal infections require prompt treatment, as their spread could lead to Pelvic Inflammatory Disease (PID) — and eventually infertility, if PID is left untreated. The only way to know for sure is to visit your doc. They will perform a pelvic exam and a swab of your discharge to send into the lab for testing.
Talk about it: Know what your normal discharge looks like throughout your menstrual cycle. You may even want to keep track of the changes, since your discharge can say a lot about your fertility throughout your cycle.
Alarm signs: Pain during urination or sex is never normal — and should always warrant a visit to the doctor’s office. As for thick or watery, grayish or cheesy and/or smelly discharge, see your doc, the OB-GYN or even an urgent care to ensure you don’t have a vaginal infection. Following unprotected sex, when having sex with a new partner or after experiencing a sexual assault, you should always seek an STI test to ensure your status. It’s both responsible for your health — and responsible for your relationship, whether that’s a one-night stand or a committed partnership!
Pain (as a Woman)
If you’re a woman seeing a doctor, chances are you’ve learned to dread that horrible question: “Rate your pain on a scale of 1-10.” All of us women with chronic illness know that talking to doctors about pain is 1000x harder without a Y chromosome.
Studies show doctors are less likely to take women’s pain seriously than men’s. In Sweden, one study showed female visitors to the emergency room (A&E) frequently waited longer to see a doctor and were classified as less “urgent” cases. The BBC calls it “pain bias,” which is the perfect name for something that’s as scary as it is sexist. And it can have detrimental health consequences for the women who suffer from it. For example, women are slightly less likely to display the classic symptoms of a heart attack — so their chest pain may be dismissed by doctors, or they may not think to see one at all.
And let’s not even talk about period pain. Growing up, I thought debilitating menstrual cramps were “normal.” There’s even a medical diagnosis for painful periods: dysmenorrhea. When I saw my doctor for my cramps, my doctor diagnosed me with this and sent me on my way with a note telling me I could keep painkillers at the school nurse’s office.
Because we normalize women’s period pain, however, we may be grossly underdiagnosing underlying conditions like endometriosis. If you’re interested in learning more about the misdiagnosis and maltreatment of endo, I recommend the book The Doctor Will See You Now by Dr. Tamer Seckin, who happens to be Padma Lakshmi’s endometriosis doc.
At the end of the day, you should NEVER be made to feel like your pain is all in your head or not as bad as you’re reporting it. You may need to see multiple doctors before you find one who really “gets” it, but if you have a chronic health condition, I can promise you: taking the time to find the right doc is so worth it.
Talk about it: Learn to advocate for yourself at the doctor’s office. Be prepared to explain your pain beyond the numerical rating scale: is it sharp and stabbing, or dull and achy? Where in the body is it located? If it’s in the abdomen, for example, specify which quadrant. Be sure to mention if the pain feels generalized to an entire area, or localized in one distinct spot.
Alarm signs: Pain so severe you cannot breathe, speak or stand should always warrant a visit to the emergency room, while less severe, yet persistent pain is still worth a visit to your doc.