What's Up Down There?

Questions You'd Only Ask Your Gynecologist If She Was Your Best Friend

Lissa Rankin, M.D., with an Introduction by Dr. Christiane Northrup, M.D.

St. Martin's Griffin

CHAPTER 1
Being a Gynecologist
ALL WOMEN HAVE STRADDLED THE stirrups, but few have the opportunity to see things from the other side. My patient Lita always brought her boyfriend, who was fascinated with what went on between the stirrups. Lita would undress, lie on the examining table, and mount her feet into the padded pink stirrups. Her boyfriend would hustle over to where I was sitting between her legs on my rolling stool, eye-level with her coochie, and he would beg me to let him take a look.
I always deferred to Lita, who didn't seem bothered by having her boyfriend watch. He would pull up a chair, with his eyes glued to her crotch like he was watching the tie-breaking pass in the last minutes of the Superbowl. I would insert the speculum into her vagina, pull out my cytobrush and spatula to do her Pap smear, and he would sit behind me, resting his chin on my shoulder as I worked. He would pepper me with questions and even asked if he could pull out the speculum when I was done.
It always weirded me out a little bit. I mean, who wants their boyfriend getting all clinical on them? Don't you want him to think of sex, not speculums, when he's staring with rapt attention at your hooha? But this guy's fascination with what goes on between the stirrups is not uncommon.
When I was an OB/GYN resident, I briefly dated this baby-cakes of a boy, who we'll call Adonis, since I honestly can't remember his name. I'm pretty sure he was legal, but only barely, and when he and his buddies found out I was a gynecologist they were riveted. They made up a drinking game they called Gyno Guzzling in my honor. As the star of this game, I was supposed to tell gynecology stories, and every time I said the word vagina or speculum, they would drink. While the feminist in me found this game a tad offensive, the narcissist in me couldn't resist the attention, and a roomful of hunky college boys egged me on for hours, as I told story after story, until we were all hammered. Gyno Guzzling went something like this:
LISSA: So Jolene comes into the clinic and I'm about to do a Pap smear when the nurse says to me, “Oh, you gotta be careful when you go in there, you know. Jolene's vagina has teeth.”
BOYS: Drink!
LISSA: So I'm thinking the nurse means she's got chops, like her vagina’s got bite.
BOYS: Drink!
LISSA: So I go about my business, but when I pull out my speculum …
BOYS: Drink!
LISSA: I find Jolene's va jay jay stuffed with those plastic teeth you wear when you're pretending to be a vampire on Halloween.
BOYS: No way!
LISSA: Yes, way!
BOYS: More! More!
LISSA (COYLY, BATTING EYES): Well, okay. So the ER calls and says, “We've got a lady with purple pee. Can you come see her?” So I take a look at the pee and, sure enough, it's as purple as Violet in Charlie and the Chocolate Factory.
ADONIS: What's Charlie and the Chocolate Factory?
LISSA (SIGHING, THINKING, I'VE GOTTA DATE OLDER GUYS): Never mind, sweetie. Anyway, I ask her, “Did you eat anything unusual? Have you had purple pee in the past?” And she shakes her head. I say, “You put anything purple up your vagina?”
BOYS: Drink!
LISSA: And she says, “No, ma'am. I ain't.” So finally, I stick a speculum in there …
BOYS: Drink!
LISSA: And her vagina is filled with this skanky, gelatinous purple goo.
BOYS: Eeeeee www … . Drink!
LISSA: So I scoop some out with my glove and show it to her, and say, “Then what's this?” And she says, “Oh, that. Well, my mammy told me I should always use jelly when the boys put on them condoms, so I do what my mammy says and use Welch's.”
BOYS: Ha Ha Ha Ha Ha …
ADONIS (LOOKING MORE GOD-LIKE THAN EVER): One more, Lissa? Please?
LISSA (THINKING, “ANYTHING FOR YOU, GORGEOUS!”):
Okay. So I'm examining this woman with a plastic speculum …
BOYS: Drink!
LISSA: And she asks me if she can take home the speculum so she can look for her G-spot!
BOYS: Drink!
ADONIS: You must get some great pickup lines when guys find out you're a gynecologist. What's the best one?
LISSA: You mean what's the worst? “Will you be my doctor?”
ADONIS: What do you say?
LISSA (GRINNING): I don't do men. That one always shuts them up.
So if you're curious what it's like to be a gynecologist, you're not alone. When I go to dinner parties with people I don't know well, the conversation invariably winds up going down there. Gynecologists evoke a sort of morbid fascination from others, much as morticians must. Like a rubbernecker at a gruesome car wreck on the highway, you can't help being fascinated.
Really, we gynecologists are not so different from accountants, lawyers, car mechanics, or firemen. We all just focus on what we do best. What sets us apart is that what we know best happens to be what makes the world go round.
Why in the world would anyone ever want to be a gynecologist?
I know what you're thinking. We spend all day looking at naked women, so we must be a bunch of perverts, right? Does a woman do it because she's a closeted lesbo? Does a man do it because he's a sex fiend? But it's not like that. I swear. Nobody chooses this field because we get to stare at naked ladies all day long.
My call to medicine came early. I was only seven when I first started nurturing injured baby squirrels back to health, feeding them dog's milk with an eye dropper every two hours throughout long nights. Plus, my father was a doctor, so I grew up in hospitals. By the time I was twelve, I scrubbed in on my first surgery, a hysterectomy performed by one of my dad's friends, who graciously let me, little punk that I was, don a pair of surgical scrubs and stand back with the anesthesiologist with my washed and gloved hands. When the uterus came out, the surgeon handed me the rose-colored chunk of bloodied tissue and said, “The uterus.”
I held it in my gloved hands, with a mixed feeling of repulsion and pride, and when we did rounds on the patient later that night I blurted out, “I held your uterus!” She looked at me like I was the fungus on a moldy piece of pizza, but I bragged about it for weeks at school, as if it was something I did every day.
“Oh yeah. I had to do surgery on Friday. Just a uterus. Not heart surgery or anything.” So I guess gynecology coursed through my veins early on.
By the time I was a twenty- two-year-old medical student, I decided I would be an ophthalmologist, mostly because every doctor I met tried to talk me out of becoming an OB/GYN. “Terrible hours. No life. Crazy malpractice.” The rant rang in my ears. But once I jumped in during my first clinical rotation in labor and delivery, there was no turning back. I became a junkie, and labor and delivery was my drug.
While I loved the adrenaline-pumped hustle of labor and delivery, what attracted me most was that I cared deeply about women and the issues we face. My chosen field is not about vaginas. It's about people. Even after all these years, I sit in awe of the beauty within each woman. Am I vagina obsessed? Well, I'm writing this book right now, so maybe. But really, being a gynecologist is about loving, empowering, and embracing women. Vaginas are secondary. They just happen to need a little TLC from time to time.
Doesn't it gross you out to look at skanky snatches all day long?
No. It's really not like that. When you're a doctor, you get used to dealing with things others consider gross. When I was a medical student, I had a patient with severe abdominal pain who hadn't pooped in ten days. When we did an X-ray, the radiologist unofficially wrote on the wet reading: “Diagnosis: FOS” (doctor speak for “Full Of Shit”). We tried laxatives, enemas— you name it. Nothing worked. So it was my job, as the medical student with the smallest hands, to glove up, slather on the lube, and go poop hunting. There I was, up to my elbow in someone's bum, pulling out one hardened, putrified poop ball after the next. It took hours. Once you've done that, vaginas are a piece of cake.
Truth is, most women primp for the gynecologist. They respect the fact that someone's gonna go face- to-coochie. They shower, trim their pubes, and sometimes even spritz on a little Chanel No 5. For the most part, I've found that women practice good hygiene, even when I worked in public health clinics with women who were lucky to find fresh water to bathe.
Sure, there are exceptions. My paranoid schizophrenic pa tient Dalia never showered. Every time she came to see me, I had to plug my nose before I could get near her. But skanky snatches are no grosser than the vomit my patients hurl on me when they're in the throes of pain, the loogie a smoker hacks up, or the poop excreted by a woman during childbirth.
If you're a mother, you deal with this stuff all the time. Look at what our kids put us through. But just as you snuggle your little one when she pukes in your hair, we gynecologists do what we must to care for our patients. Sure, sometimes, what we must do is a wee bit distasteful. But just like motherhood, the joys and rewards of helping women outweigh any of the downsides.
What's the kookiest gynecology story you've ever heard?
One of my patients sued me for stealing her labia. Swear to God.I had only been in practice for a few months when Mabel came in complaining of abnormal vaginal bleeding. I needed to examine her, but this was no easy exam. Mabel was about five feet tall and about three hundred pounds, so finding her cervix required advanced gynecology skills. When I examined her, I inserted a small speculum we call “Skinny Minny,” then the typical larger speculum, followed by a giant speculum and, finally, the Great Mama of all speculums, “Big Bertha.”
Now, mind you, Big Bertha only fits a very small percentage of women. About the length and width of my forearm, this is one hell of a speculum, but the rare woman who needs it has such a long, gaping vagina that you can't even come close to seeing the cervix without it. Mabel was one of those rare women. I counted on Big Bertha to help me see Mabel's cervix so I could biopsy her uterine lining and get to the bottom of why she was bleeding.
I warned Mabel, as I always do, that endometrial biopsies are a bitch. While the cervix isn't particularly sensitive, the uterus protests when you poke something inside, causing a severe cramp, like a labor pain. When I warned Mabel, she looked at me blankly.
I once heard someone talk about gynecology procedures as fixing your car's engine through the tailpipe, and that's how I felt that day. I put Big Bertha inside Mabel's vagina and reached for the tenaculum, a scary-looking two-pronged device used to hold the cervix steady while you do the biopsy. With Big Bertha's help, I managed to identify the cervix and grab it with the tenaculum. This is where we hit a snag.
Just as I clamped the tenaculum onto the cervix, Mabel bellowed, “Whoaaaaa, Daddy- o, get that fucking thing outta me!” at the top of her lungs. She pushed against the stirrups like a cowboy on a bucking bronco, standing straight up and knocking out Big Bertha, the tenaculum still clinging to her cervix like a king crab. The tenaculum has a handle like a pair of scissors, and Big Bertha clung to the handle, swinging around between Mabel's legs as she leapt around like a bear with a bullet in its belly. Letting out a bloodcurdling scream, she grabbed me by my hair, kicking at my face, screaming, “Get it out! Get it out!” I tried in vain to release the tenaculum as I dodged her bucking bare feet.
I tried to reason with Mabel, but to no avail. I screamed for help, and my nurse ran in just in time to witness Mabel standing on the table, kicking her chubby legs in a flailing gynecologic cancan dance, with instruments hanging from her vagina. My nurse took her hand and, speaking like she was talking to a rabid dog, soothed Mabel back to the table, where I was able to remove the instruments.
Not surprisingly, Mabel never returned to have her biopsy completed, even when I threw out the word cancer. Had she ever come back, I would have taken her straight to the operating room and asked the anesthesiologist to knock her out. However, she never returned my calls or answered the registered letters I mailed.
A few days after our gynecologic fiasco, another doctor called my office about Mabel Nile. He said, “I've got this woman here, Mabel Nile. She says you removed her uterus and her bladder and cut off her labia, with no anesthesia, right there in your office. But I took a look at her, and all her parts appear to be where they're supposed to be. What did you do to her, anyway?”
A few days later, I got a letter from Mabel, addressed to “Dr. Rankinstein.” On the outside of the envelope was a child-like drawing of a spiky instrument next to two little rectangular boxes. Written on the envelope in red pen was: “You have something of mine, and I want it back.” Inside, I found a note, handwritten on lined notebook paper with scratchy, halting letters: “You stole my labia. Where did you put them? In the lab?”
A few weeks later, I received a notice that Mabel was suing me for stealing her labia. Shortly afterward, the director of security at another hospital called to tell me that Mabel had assaulted one of their doctors and was threatening to hunt me down. Fortunately, she never appeared, and after nearly a year of ridiculous legal hoops my lawyer was able to get the claim dropped. Then, almost three years after I first met Mabel, I received a summons to small claims court. Mabel was suing me again. I had to go to court, sit across from Mabel, and defend myself to the judge.
When I showed up in court, Mabel was already sitting on the other side at the plaintiff's table. I tried to muster every bit of human compassion I could find in my soul. I wanted to open my heart and forgive her for the three years of anxiety and incon venience she'd inflicted on me. I wanted to forget the letters I had to write to explain the situation to every single insurance company that didn't want me to be a provider because I was being sued. I wanted to let go of the humiliation of the investigation by the California medical board. I wished I could let my heart understand how hard her life must be, living in a paranoid schizophrenic world. I'm ashamed to say I wasn't that big a person. I was pissed, and every cell in my body just wanted to kick her.
The judge said, “Ms. Nile. Please state your case.”
“That doctor …” She turned and pointed a sausage finger at me. “She stole my labia!” she yelled, slamming her fists on the podium. “She's got 'em in a jar somewhere. In the lab. They're gone. Wanna see?” She started to pull down her plaid pants.
The judge stood up and brought down the gavel. “That's enough, Ms. Nile,” she said. Mabel pulled her pants back up.
“She's holding them hostage! They're in a jar, somewhere in her lab. I just want my labia! Tell her to give me back my labia!” she bellowed. The bailiff stood up beside her, but the judge shook her head. Mabel stared into space, and the judge asked her to take her seat.
It was my turn. “The Superior Court judge has already dismissed the case, your honor. This case has been adjudicated.” I then presented my request to countersue for malicious prosecution.
I could see Mabel turning red, like a cartoon character, with steam coming out of her ears.
The judge asked everyone to be seated, and the court was silent for a minute. Then she turned to Mabel and said, “What can we do to make you stop torturing this doctor?”
“Just make her give me back my labia!” she cried, throwing a
Excerpted from What's up down there? by Lissa Rankin
Copyright © 2010 by Lissa Rankin
Published in 2010 by St. Martin's Press
All rights reserved. This work is protected under copyright laws and reproduction is strictly prohibited. Permission to reproduce the material in any manner or medium must be secured from the Publisher.