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Fat discrimination& TTC/Advice for first ever gyn appt

post #1 of 29
Thread Starter 

I'm 29, my husband is 34. We've been TTC for 4 years, 3 months.

 

I've NEVER been to a gynecologist. I have extreme anxiety and severe body/self-esteem issues (I'm very obese), so I have always avoided the first visit. I didn't become really sexually active until I was 25, with my husband, and at that point, the years and years of anxiety had built up and just refused to think I needed to go.

 

Anyway, this Wednesday is my first ever appointment. I know to expect a pap smear, and uncomfortable conversation... but how do I bring up that the real reason I'm there is to get the conception ball rolling? How do I deal with the thought they're just going to laugh at me b/c of my weight, and thus think I'm not worthy enough to have children?  The dr I chose to see was recommended by my best friend, who is also overweight and infertile, and she swears that the dr is fantastic, but that doesn't really help calm my fears. I just read about so much subtle, and often blatant, fat discrimination.  I also have so many years of anxiety that's built up revolving around this issue.

 

Should I even bring up TTC on the first visit, or wait until maybe we can get my menstrual cycles straightened out?

 

Anyway, the point of this jumbled mess is that I'm basically looking for advice on how to deal with my first ever gyn visit, and advice on dealing with fat discrimination in the TTC process.

post #2 of 29

hug2.gif

 

First, I hope *you're* not thinking you're unworthy of children because of your weight issues. 

 

I think getting a recommendation from a friend who is also overweight was a good idea.  I think most reproductive specialists have experience with obese patients, so especially with the referral I would try to assume the best.

 

What type of appointment did you make?  If you just scheduled time for a pap smear there might not be a lot of time, but I would go in with all  your information (have you been charting?  do you have information about your cycles, how often you are dtd, etc...). 

 

Lastly, what are *you* hoping for from this appointment?  Are you ready to investigate medications or technological solutions?  I think the doctor needs to know that your ultimate goal is pregnancy because his/her suggestions will be dependent upon your goals (why try to encourage ovulation if pregnany is a non-goal, etc...).

 

Is your DH going with you?  If not, can you take your friend along for moral support?  Do you know exactly what will be happening in a gynelogical exam?  Have you ever practiced deep breathing excercises (I find they help, I also like to chat while uncomfortable, lol).

 

Good luck. 

post #3 of 29
Thread Starter 

Oh, no. I definitely don't think that. I think I'm just as worthy as anyone to have a child. I just see a lot of that underlying prejudice.

 

I just asked for a new patient appointment. I assume that's just general get acquainted conversationand pap smear, but then I really don't know. I have charted a few times, for various lengths of time in the past, but after a while it just got to be pointless. I get discouraged with month after month of erratic temps and no real ovulation signs/symptoms. I keep up with my cycles with an app on my phone, so I should have all that info ready.

 

Honestly, what I want out of the appt is a sense that *something* can be done. I'm ready to do what it takes. I just don't want to hear "lose weight and it'll all straighten itself out" like other people have said to me so many times. But my cycles have been abnormal up for 5+ years, when I was 100lbs lighter.

 

My DH is going with me, but I'm worried they won't let him in the room when they do the pap smear. That's what I'm most anxious/scared about. I know I sound like a big baby! I guess I'm just trying to think it to death before it happens, so that I'll be like, "oh that wasn't so bad!" when it does.


Thank you for your reply!

 

post #4 of 29

I can't see why they wouldn't let your DH in the room when they do the pap. I haven't tried it, personally, but DH has come to prenatal appts when they've done vaginal exams, and it hasn't been a problem. They *might* want to talk with you when he isn't in the room during part of the new patient intake. If they're being thorough, they might ask you about whether you are safe in your relationship, whether you feel safe, if you've been abused...they shouldn't have DH in the room for those questions (for fairly obvious reasons, I would think). But they might not be THAT thorough in your initial appt. I believe my midwife asked those types of questions with my first appt with her (I wasn't pregnant, just establishing well-woman care with their practice).

 

If you have any charts, bring them with you. There might not be time to go over them, but pulling them out can demonstrate, at a minimum, that you're serious about keeping track of things. And if there IS time to go over them, great. If not, ask if you can have another appointment to go over them, and if the appt is another month away, say, "Great, that will give us another's month worth of data to look at."

 

Best wishes for a smooth appointment.

post #5 of 29
Quote:
Originally Posted by AmandaTN View Post

My DH is going with me, but I'm worried they won't let him in the room when they do the pap smear. That's what I'm most anxious/scared about. I know I sound like a big baby! I guess I'm just trying to think it to death before it happens, so that I'll be like, "oh that wasn't so bad!" when it does.

 


Totally forum crashing, but I just wanted to say: I've had several different close friends come with me to various gyn appointments over the years, even for pap smears. I have major social anxiety and never go out without a support person. It has never been a problem. I've always been given the option to have my friend leave when it is time to get under the paper gown and prior to being asked really personal questions, but it has never been pushed even a little after I've said they should stay. I can't imagine them not allowing your DH in the room. There's one point you can relax about. Good luck.

 

post #6 of 29
Quote:
Originally Posted by AmandaTN View Post

 

My DH is going with me, but I'm worried they won't let him in the room when they do the pap smear. That's what I'm most anxious/scared about. I know I sound like a big baby! I guess I'm just trying to think it to death before it happens, so that I'll be like, "oh that wasn't so bad!" when it does.

 


It's a good idea to think everything through.

 

As the PPs mentioned, there may be a part of the appointment that the doctor will want to talk to you privately. When it is time to undress, they will probably say something like, "Do you want your husband to leave?' or the like.  It is *best* if you say "I'd like him to stay" instead of HIM saying "I'd like to stay" because some people take the 2nd situation as an example of the man trying to control his partner.
 

 

Quote:

Originally Posted by ASusan View Post

 

If you have any charts, bring them with you. There might not be time to go over them, but pulling them out can demonstrate, at a minimum, that you're serious about keeping track of things. And if there IS time to go over them, great. If not, ask if you can have another appointment to go over them, and if the appt is another month away, say, "Great, that will give us another's month worth of data to look at."

 

 

ITA with this.  Otherwise, their first suggestion will probably be, "Why don't you chart for a while and then we'll meet."  If you can pull your charts out already, they will know that you are not "imagining" the infertility issues and take your situation much more seriously.

 

Good luck!!!
 

 

post #7 of 29

Fat discrimination is real unfortunately. I left a Dr who said I was too fat to get pregnant again and that I needed to wait to loose weight (I was 200lbs) Well I got pregnant anyways. I was 238lbs when I gave birth to DD and I was at a birth center that treated me fine but during my birth I had a different MW (it was all whoever is on call there) and I felt fat discrimination....She even said I *had* to lie on my back to give birth so she could see everything :/

 

That being said if you don't like them just fire them! You can see a MW for gyno care instead of an OB if you want.

post #8 of 29
Thread Starter 

Thanks everyone. I don't have a problem with making DH leave if they need to ask DV screening questions. I just really want him there to hold my hand during the vag exam.

 

I will definitely print off the past charts I have. They aren't consistent, but I have some starting from 3.5 years ago, so that shows a timeline of the problem anyway.

 

I haven't had a period since late September, and it's taken so much courage to even make the phone call to set up the appointment... and I started my period today. I just feel like crying. I don't want to cancel, because it'll take forever for me to have the courage to do it again. I want to just go anyway, but everyone (read: the Internet) say they won't be able to do the exam and it's pointless to go.

post #9 of 29
Quote:
Originally Posted by ASusan View Post

They *might* want to talk with you when he isn't in the room during part of the new patient intake. If they're being thorough, they might ask you about whether you are safe in your relationship, whether you feel safe, if you've been abused...they shouldn't have DH in the room for those questions (for fairly obvious reasons, I would think).

 


(Barge and sidetrack, sorry.)

 

I have never heard of these questions being asked at an ob/gyn. I'm 47 and I've been to a dozen different ob/gyns.

 

Have others had this experience? I'm really curious. That kind of questioning would really really bother me.

post #10 of 29

First, big hugs to you hug2.gif  I have had anxiety over the same thing. I have a BMI of 32 so I am classified as obese and I was very worried about how I would be accepted at my RE's office because of it. My doctor doesn`t mention my weight much, but she has suggested that if I were to lose weight, my problems would get better. Please know that many big women do get good help from specialists and go on to have healthy pregnancies and babies. I know that the discrimintation is out there, but I`m hoping your gyn is sensitive and listens to all of what you have to say. I would bring up your hopes for conception during your first appointment. It`s good for your gyn to know who you are and what you are hoping for, and I`m sure he or she will be able to give you some advice and help to go forward with it. I also don`t see a problem with your DH being there with you. I`ve brought my partner with me several times. I hope things go well!

post #11 of 29

I can definitely relate to this. I'm over 250 lbs and have been trying to conceive for a year. Even though I'm well versed in Fat Acceptance, I still don't do a very good job of advocating for myself with medical professionals. If the topic comes up and I don't want to get into my FA beliefs, I simply tell the doctor, "Okay, fine, but even if I did everything right, I won't lose weight tomorrow and I"ll never be thin, so what can we do RIGHT NOW to help me?" If I get a negative response to that, I know it's a professional I don't want caring for me.

 

Here's a link to Fat Friendly Health Professionals. I don't know how up-to-date it is, but it's a start. Here's a link to a sample letter you can write introducing yourself to your doctor and explaining how you'd like to be treated. Obviously, the details are specific to the person who wrote the letter and you'd have to change it to fit you (for example, I'm not completely opposed to being weighed since sudden weight loss or gain can be signs of illness) but it's a place to start. I think being honest about your anxiety is important, too.

 

I have my annual on Monday and I'm SO not looking forward to it. We just need to keep reminding ourselves that no matter what, we have a right to be treated like human beings and the right to expect doctors to treat our condition, not your size.

 

Good luck and let us know how it goes!

post #12 of 29
Thread Starter 

It went well! Well, except for the mini-breakdown and panic I had in front of the doctor. bag.gif I swear, I was very nervous and anxious, but still keeping myself together, until she asked what I was most scared about: the actual exam or finding out something could be wrong. And I don't even know, but that question just opened the gates. I flailed around and weeped and gnashed for a couple of minutes, and then I was (relatively) okay.

 

But that sucker hurt! Everyone says is just a little uncomfortable, or whatever. Liars! I guess being nervous and tense made it worse, but sheesh! It felt like someone was shoving a stick up there. And then when she palpated my ovaries, or whatever it was she doing pressing on my belly... ouch!

 

The doctor herself was absolutely wonderful. She was very friendly and good-natured and funny. I did not feel at all uncomfortable with her. We had a good discussion about weight, in that she understood my concerns, but she didn't think weight had that much to do with it. She said how upset it made her that so many docs would turn away overweight/obese patients. We had a good rant/rave session about fat discrimination and pregnancy. Actually, she did most of the ranting, because I was still in my anxiety/what just happened haze.

 

As for diagnosis, she said I was a textbook case of PCOS (which I've long suspected). She said there were 4 fertility specialists/REs in town, and 3 of them wouldn't touch me d/t the weight issue. But the fourth one she highly recommended and said she sends all of her overweight pts there that are having trouble conceiving. She swears he is very open and would not refuse us help, or even make weight much of an issue at all. Also, that the last three fat patients she sent him ended up pg.

 

So I'm very hopeful he can help us, starting with getting my cycles straightened out and beginning to ovulate again. I'm glad I went, even though I hated it, and dread doing it again.

 

 

Femmeknitzi, I am very into the Fat Acceptance movement, too. I have so much confidence about almost every other issue regarding FA, and don't ever hesitate to speak out... but for some reason, this whole gyn and TTC thing has triggered every insecurity and doubt I've ever had. It's dumb, because I can even advocate for myself with my regular MD and anyone other health professional I come across. But this one issue... I just fall apart.

post #13 of 29

I also left a gyn practice because the nurse practitioner was extremely judgmental, part of which was her opinion about my weight. By the way, I am well under 200 lbs. I switched both gyn and PCP and am much happier. Make sure you express your fears/emotions. Most of the time that really helps. I'm glad your appointment went well. Weight issues can definitely be a big component of PCOS, so hope that is a bit of a comfort to you. I don't have PCOS, but have heard that. I also hope it is comforting to you that I got PG on my first IVF try and I am expecting identical twins in July.

post #14 of 29

I'm so glad to hear it went so well.  I hope you have good luck with the specialist!

post #15 of 29

Just saw this now and I wanted also to say I'm so glad your appointment went well! I also wanted to mention that the speculum has always been extremely uncomfortable for me. It is the worst part of most procedures I've had, including biopsies and an HSG. One thing I learned is you can ask for a small speculum. Who knew they had sizes? Not me, until my mom clued me in. I wanted to pass that along for next time, in case you want to try it out!

post #16 of 29

Gozal- That's a good point. 

post #17 of 29
Quote:
Originally Posted by Buzzer Beater View Post


(Barge and sidetrack, sorry.)

 

I have never heard of these questions being asked at an ob/gyn. I'm 47 and I've been to a dozen different ob/gyns.

 

Have others had this experience? I'm really curious. That kind of questioning would really really bother me.

I've always had them asked. I've lived in several states, so I don't think it's a regional trend. There's no reason for them to bother you. A lot of women will open up in women's health settings if they won't elsewhere. I do know that when I worked summers at an OB/GYN office, there were women who would admit to abuse and not knowing what to do during those questions, so there's immense value in them.

post #18 of 29
Quote:
Originally Posted by AmandaTN View Post
As for diagnosis, she said I was a textbook case of PCOS (which I've long suspected). She said there were 4 fertility specialists/REs in town, and 3 of them wouldn't touch me d/t the weight issue. But the fourth one she highly recommended and said she sends all of her overweight pts there that are having trouble conceiving. She swears he is very open and would not refuse us help, or even make weight much of an issue at all. Also, that the last three fat patients she sent him ended up pg.


Ask for ultrasounds to confirm ovarian scarring. PCOS is a diagnosis of exclusion. You can't get that diagnosis with one pap smear. I had a doctor (who really didn't like that I am overweight) who insisted the same - "textbook case" - though I wasn't. When I asked for an ultrasound, it came back with "perfect" ovaries - absolutely no evidence of past cysts (they almost always cause scars in PCOS patients) and certainly no current cysts. It was not PCOS but a significant hormone imbalance combined with uterine fibroids that I've treated through Chinese medicine. 

post #19 of 29

As to the pain of the exam vs the "discomfort" some people have... that may be your tension, or it may be your sensitivity.  And in fact, they are shoving a stick up there.  It's actually a little bristle brush or a tiny spatula (depends on the doc, I've seen both used).  I find it to be painful enough to jump - definitely more than "discomfort", but not extremely so.  As for the pain on palpation, if you're cystic or have fibroids, that can cause pain.  I pretty much always find those painful though, more painful right around my cycle, but painful regardless, and I don't have cysts or fibroids. 

 

Quote:
Originally Posted by VisionaryMom View Post

Ask for ultrasounds to confirm ovarian scarring. PCOS is a diagnosis of exclusion. You can't get that diagnosis with one pap smear. I had a doctor (who really didn't like that I am overweight) who insisted the same - "textbook case" - though I wasn't. When I asked for an ultrasound, it came back with "perfect" ovaries - absolutely no evidence of past cysts (they almost always cause scars in PCOS patients) and certainly no current cysts. It was not PCOS but a significant hormone imbalance combined with uterine fibroids that I've treated through Chinese medicine. 


Ovarian scarring has nothing to do with PCOS.  PCOS is a concatenation of symptoms.  If you have more than X# of symptoms from a big long list, then you fall under the heading of PCOS.  Cysts on/in your ovaries are only 1 possible symptom.  And it can in fact be diagnosed fairly easily with a good history and careful observation (weight distribution, hirsutism and acne are fairly easily observed).  Most docs do order hormone testing just to see what's going on, but if your OB is sending you to an RE, that's one of the first things the RE is going to do.

 

And I'm glad that your OB had a good RE to refer you to.  A fat-friendly RE is such a blessing.  I know mine never made me feel badly about my weight, and that was such a blessing.  I can't say the same for the OB practice when I got pregnant the first time, though.

 

A couple questions for you though:

Have you been TTC, or are you skipping straight to seeing the RE?  We didn't even try before starting with the RE, and as it turns out we probably should have, since #2 and #3 were spontaneous. [ETA - sorry, missed that on first reading.]

Have you done anything to attempt to regulate your cycles?  Some people find acupuncture or Chinese medicine to be very helpful.  Personally I found diet to be very helpful with regulating my cycle (as in what I was eating, not as in losing weight).  Insulin Resistance (IR) is a very common symptom of PCOS, and since you say you've seen significant weight gain in the last few years, that would be my first thought, unless your eating habits changed drastically.  Finding the right (and wrong) foods for your body can be huge when dealing with IR.  Regular exercise can also be really helpful in regulating your cycles - it doesn't have to be anything strenuous, but even a regular long walk a few times a week can make a difference for some people. 

 

Personally, I never found temperature charting to be at all helpful for me, but tracking my cycles and learning my body were both extremely helpful in knowing what was going on.  I'd suggest picking up a copy of Taking Charge of Your Fertility.  Even if you don't use most of the information in the book, there are parts of it that you may find quite useful as you go along.  

 

There is a Plus Size Mamas/TTC group in the Social Groups section, if you'd like to join in there. 


Edited by cristeen - 1/25/12 at 7:51am
post #20 of 29

I have 2 friends with PCOS. One entered a clinical trial for Byeta and lost the weight she wanted to loose. Her blood tests imrpoved as well.

 

Another one started taking Metformin and entered exersise clinical trial.  He blood work and weight improved. So did her ovulation. She was able to get pregnant without any additional treatment. 2 healthy babies

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