It's Not Hysteria: Everything You Need to Know About Your Reproductive Health (But Were Never Told)

by Karen Tang

My fellow OB-GYN and gynecologic specialists: You all know the beauty and shortcomings of our field. We chose a field of medicine with some of the highest malpractice rates and the hardest hours, one where even standard medical treatments are subject to raging political battles. We stay in this field because we love our patients and believe in the importance of the work.

A surprising number of professional gynecologic recommendations over the years have been based on the opinions of leaders in the field rather than on objective facts or scientific studies. For this reason, the most cutting-edge medical theories and treatments of their time have later been deemed incorrect—in some cases, after causing suffering that exceeded the original problem being treated.

Given that many women with medical conditions such as endometriosis and autoimmune diseases are initially told that their symptoms are all in their heads, it’s likely that many people diagnosed with somatic symptom disorders actually suffer from an undiagnosed physical malady. Since gynecologic conditions such as endometriosis, pelvic floor dysfunction, and premenstrual dysphoric disorder can cause a wide range of symptoms but don’t show up on imaging studies or lab tests, patients will often be told by doctor after doctor that there is nothing wrong with them and that the problem must be emotional or mental. Sadly, this is our twenty-first-century version of hysteria.

And despite the widespread use of hormonal birth control, there are very few studies comparing different brands and formulations in terms of side effects, tolerability, and effectiveness. The choice of which birth control to use is usually determined by patient preference and trial and error, whereas the type of medications used to treat non-gynecologic conditions such as hypertension and diabetes is based on studies and research.

Gynecologic procedures are reimbursed at significantly lower rates than procedures in any other surgical field, including urology, which treats the male reproductive organs. Compensation for biopsies of the uterus or vulva is much lower than compensation for biopsies of the prostate or scrotum.

Poor insurance payments combined with high malpractice costs, the stress of dealing with life-and-death scenarios, and legislative attacks on reproductive rights have led to an epidemic of physician burnout. In the United States, 40 to 75 percent of OB-GYN physicians report feeling burned out, and many are leaving the practice of medicine altogether.

When I see surgical patients in the office, I always draw the pelvic anatomy for them. Always. I don’t care if I’m talking to another doctor, a nurse, an astrophysicist, or a high-school student. I start from scratch because everyone deserves the same foundation of knowledge.