Our marketing team has a tool that shows what phrases people plug into Google. Here's a short sampling:

• Do urinary tract infections go away on their own (70 searches per month)
• Why do I pee when I jump (140 searches per month)
• Why is my vagina dry during sex (170 searches per month)
  
  

Many people turn to "Dr. Google" for instant answers or reassurance when experiencing troubling symptoms. This is especially common during off-hours, like at 3:00 a.m. when a person can't sleep.

The problem arises when these same people don't consult their healthcare providers—or if they do, they have difficulty asking their doctors about such sensitive topics.

Stephanie Larrick, a women's health nurse practitioner who works out of our Women's Health Center in Dedham, believes strongly in educating patients, especially women, about normalizing open communication regarding their bodies and concerns. Below, she provides tips for helping people do exactly that.

As with all content on our blog, the following is educational, not medical advice. Always consult your physician regarding your unique healthcare needs.

First, tell us about yourself, including why you became a women's health nurse practitioner (WHNP).

STEPHANIE LARRICK: I started as a nurse in the maternal newborn area. I rotated briefly through postpartum labor and delivery and then spent most of my career as a nurse in the NICU. I worked with a lot of postpartum moms, and it just became very apparent that a lot of women didn't know how their bodies function and what's normal and what isn't. One of my favorite parts of my job was providing education and teaching. My patient might've been the newborn, but their mom was also my patient.

I thought that specializing in women's health would be a great way to reach more women and educate them on their bodies, including how their bodies work and basic anatomy. So, that's how I ended up as a women's health NP.

What's the best way for women to learn about their bodies on their own? Do you have any go-to resources that you tell patients about?

STEPHANIE LARRICK: Avoid websites that are trying to sell you anything. That's the number one red flag. An excellent resource for the female reproductive system is womenshealth.gov. There's information on many things like the menstrual cycle, menopause, and yeast infections. It's just a good source of information.

And then, more specifically for urogynecology, check out Voices for PFD (pelvic floor disorders), which is affiliated with the American Urogynecologic Society, or AUGS. They've got some great handouts that we often give to patients. Also, check out yourpelvicfloor.org, which the International Urogynecological Association(IUGA) runs. That’s another resource we share with patients.

But in general, if you're trying to google reputable sites, look for ones run by the federal government—those websites will have a dot gov at the end. Medical schools, like the Cleveland Clinic or Harvard, are also great sources.

What changes need to happen collectively (as a nation, as a society) to normalize open communication about our bodies?

STEPHANIE LARRICK: I think the first step is teaching children their anatomy, including correct names. We also need more access to sexual and reproductive health in schools where children can learn about proper terms and normal functions of their bodies without being made to feel embarrassed.

Healthcare providers in general can also work to be more open and comfortable starting the conversation on pelvic health. Some women only see their primary care providers for annual exams, and if pelvic health isn’t being discussed, concerns can go unaddressed for a long time. For example, so many patients think that after menopause or after a hysterectomy, they never need a pelvic exam again, which isn't true—you DO still need yearly pelvic exams.

Bottom line: Doctors, in general, must become more comfortable with doing a pelvic exam or recommending and referring out if uncomfortable. Just asking a basic question like "Are you having any vaginal concerns?" can start the conversation.

How do you broach sensitive topics with your patients?

STEPHANIE LARRICK: I have the added benefit of working in a urogyn specialty. So we know there's something concerning about the pelvic area the moment a patient walks through the door.

For me, I begin by building some rapport with the patient. We'll review easier topics like other health conditions, medications, and anything that gets them comfortable talking.

Something I like to do is bring attention to a specific topic. For example, if they checked a box about vaginal dryness on their intake form, I can simply bring attention to it by stating that vaginal dryness is common, especially after menopause. And then I can ask if they're experiencing any vaginal dryness. Do they have any symptoms?

I find that's a better approach than asking too broad of an open-ended question like "Are you having any problems today?" Because patients are more likely to acknowledge an issue if I specifically bring it up, rather than having to rely on them to say, "Hey, I'm having a problem with vaginal dryness."

And then making them aware that they're not alone—that many of these conditions are quite common and treatments exist—is important and helps the patients feel more comfortable.

Is there anything that you're consistently seeing that surprises you? Maybe a misconception that you want to clear up?

STEPHANIE LARRICK: The one thing that I hear a lot goes something like this: "Oh yeah, I've been leaking urine since giving birth 40 years ago." I mentioned before that many of these conditions are common. But just because something is common doesn't mean it's normal—and it doesn't mean you have to just live with it.

So, leaking after childbirth is a big one that I hear all the time, and I don't think people realize that's not supposed to happen. Is it common? Yes. But common doesn't mean normal. And the good news is we have ways to treat bladder leakage.

Another thing that surprises me is how many women are uncomfortable with the vocabulary describing their bodies. I'll ask questions like, “Are you having pain in this area on the labia?” And they might respond, “What's that?'”

Or if I use terms like labia, vulva, and vagina, some patients can't even tolerate hearing the words, let alone discuss what their problems are. So, the number of patients uncomfortable with their anatomy has surprised me. But it's also one of the reasons that I got into this area of medicine.

As for a misconception, I want to again stress the importance of yearly pelvic exams. You don't age out of those.

Also, if something is bothering you, don't wait five years to address it. So many women will say to me, "I wish I would've come in sooner. I wish I would've gotten treatment as soon as this became a problem." Because everything I treat as a women's health nurse practitioner concerns the quality of life. If we can help you, there's no point in suffering.

What tips do you have for patients feeling nervous, hesitant, or vulnerable when discussing tough topics with their healthcare providers?

STEPHANIE LARRICK: So first of all, this is our job, this is our area of expertise. You won't shock us. We've seen it all. So try not to feel embarrassed. I know that's easier said than done, but we're used to talking about things like urine leakage, fecal incontinence, and pelvic organ prolapse. We deal with these issues all the time.

I recommend that patients write down their questions or concerns ahead of time when they're at home and feeling comfortable. They're sometimes nervous or forget what they want to ask when they enter the exam room. But if they have a little written reminder of what's going on and what brings them in, that can be helpful.

And that's what it's all about. We're here to help them. We're not here to judge. We want to help provide education, answer questions, and make them feel better. It's a judgment-free zone. It's a safe space to discuss any concerns that they have.

At GBU, we strive to make patients comfortable so they can talk openly to their doctors about sensitive issues.

Our urologists, urogynecologists, nurse practitioners, and physician assistants strive to make all patients feel comfortable when discussing sensitive topics. Your quality of life matters. Let us help. Request an appointment.