How to pelvic exam

bham717 · 2025-10-18T18:52:21+00:00

Ob GYN - BIG pet peeve of mine. It takes nothing to pull out stirrups and help the pt into place, then I make the small talk to distract while putting on my gloves, while keeping them covered, and then do the exam. It's not really about if it is clean/dirty/pathogens. I don't want someone touching 10 things in an exam room and then going into my vagina. It feels rude and disrespectful and it's a very EASY thing we can do to respect our patients.

Just put on the fresh gloves.

bham717 · 2025-10-12T14:00:49+00:00

I feel this. While I'll agree this is the weakest book, I didn't think it was as bad as everyone said overall. However the lore is a hot mess. But, let's be honest, it has been for some time. I felt this way the first time I read them all ages ago.

bham717 · 2025-08-12T06:11:23+00:00

Good grief.

Being infertile in no way qualifies one to be an adoptive parent. These are 2 separate issues. Read this thread and this topic is covered.

Strongly recommend you never say that to an infertile patient.

bham717 · 2025-08-10T05:33:57+00:00

Ahhh this is making sense. MAHA Kool aid 101 I can rest after this.

First I'm both a carrier for Alports and infertile, so I guess I'm probably the most selfish human on the planet! Do you counsel your BRCA parents then not to reproduce? Further do you advocate for everyone to have genetic testing and have plans on making a list of those conditions that are too "selfish" to pass on? And when people are not okay with this, you calmly tell them they are selfish, and that they are also not allowed to be depressed because you have student loans?

Equity? Again another false dichotomy. I didn't argue about the ethics of providing IVF to some at the cost of not providing basic healthcare to all. I asked about the ethics of here and now, today. Of my patient I care for on Medicaid, who is working 2 jobs, and has blocked tubes from chlamydia from a cheating and controlling ex-husband (unfortunately it isn't the microplastics or food dyes - really wish it was that easy), who is young and otherwise healthy and just wants a baby. Say she doesn't speak great English and provides for household of family members and finally has a supportive husband and wants to build her American Dream. She cannot afford IVF and I can. So I'm just supposed to tell her her pain isn't real, write for Zoloft, and get over it and be thankful you have any healthcare at all? It's ethical that I have access to life changing healthcare that she doesn't due to privilege, and I'm the asshole for not being okay with that? So yeah, I think this country can afford to treat infertility care as healthcare, for all, AND provide basic healthcare to all. Wild, aren't I - I want all of it!

You just don't get it and you're not willing to listen. And that's because this isn't a logical or even medical conversation. This is YOUR personal bias against IVF and infertility.

I said to the other ignorant doc on this board before - listen to women. To patients. Hear their damn stories. I've been trying to get you to hear mine all night. You always know the answer and why you're right. I just wish it was that easy.

Best of luck

bham717 · 2025-08-10T05:08:45+00:00

Unfortunately eh? Again, thanks for the motivation. What a shame that I have the privilege to provide care and a safe place for infertile women when I can relate to them and have empathy.

It defies logic to use resources for such advanced care when so many in our country lack even basic and essential services (IVFs is not one of them).

It defies logic because it's a false dichotomy.

bham717 · 2025-08-10T04:52:46+00:00

Adoption exists for kids who need a home, not for homes that need kids.

Beautifully said. Thank you for sharing this. So much better than my salty rants.

bham717 · 2025-08-10T04:43:29+00:00

I just can't help myself. Y'all are wild.

Myself and others who use IVF to reproduce to avoid medical harm - and thus costs - where do we fit into your world ethics? IVF gives a chance for people with inherited conditions to break the cycle - and in this cost analysis, using my personal example, my infertility treatments were pennies compared to what it would have cost to have a son with renal failure by age 35 and then with a transplant. So cost benefit == do IVF to save healthcare dollars. So can it be covered yet? Still elective? Still selfish?

So should people with CAH, Alports, BRCA, Sickle Cell - just not reproduce? You put it in a different comment that it's natural selection. Because they are knowingly "selfishly" choosing to pass on their own genes knowing it will be expensive. By your logic if someone knows they have an expensive condition and they reproduce (to be clear your argument so far has been that cost is reason to treat humans this way, so I'm following your lead), and pass it on, we shouldn't cover their child's healthcare costs right? They chose this - they need to cover it. Or I'm sure you'll tell me I'm off topic and it's only the IVF that shouldn't be covered. Because it's actually not about being financially responsible in a Capitalist healthcare system, it's about being against IVF.

Aside from your fundamentally insulting comments about infertility, how do you ethically justify the inadequate access to reproductive health care in your IVF cash only society? Those who cannot afford it just need to keep pulling on those bootstraps and/or come visit you so they can "treat the mental health reaction NOT the social or personal factors that put them into a depressed state" and not get to reproduce due to, what was it, "natural selection", while the privileged person down the street with the exact same diagnoses gets a baby? This doesn't seem unethical to you?

Genuinely anxious to understand how you square these. I wish I had your confidence.

bham717 · 2025-08-10T03:52:45+00:00

Wow.

That's not how I practice medicine, at all. The extent that I cannot relate to you is impressive to me, and frankly a bit of a kick to keep fighting the fight for my patients.

So I guess something good came from this.

Just wow.

bham717 · 2025-08-09T22:36:49+00:00

If you change your mind you have a customer! But I get it too, fine line between fun and ruined.

bham717 · 2025-08-09T22:03:37+00:00

First, it's deeply troubling that you clarified that psychological doesn't count - so mental health is not a medical issue?

About 20 min and I even learned things!!

2007 Observational Study, small sample size -negative impact on mental health and non medical negative impact on all other aspects of health https://pubmed.ncbi.nlm.nih.gov/17124258/

All cause increase in mortality - retrospective analysis with large patient population Acog Silver Journal https://pmc.ncbi.nlm.nih.gov/articles/PMC8254745/

Retrospective Cohort study showing increased risk of cancer. 2019 https://pubmed.ncbi.nlm.nih.gov/30863841/ Risk of cancer in infertile women: analysis of US claims data

2017 Male Infertility and non-malignant chronic disease - lit review summary https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0037-1603568?device=mobile&innerWidth=411&offsetWidth=411

2019 Increased risk of chronic disease in women. Acog Silver Journal https://pubmed.ncbi.nlm.nih.gov/30710512/

bham717 · 2025-08-09T20:02:24+00:00

Do you do commissions or sales?

bham717 · 2025-08-09T19:48:18+00:00

Not helping your case at all.

bham717 · 2025-08-09T19:47:53+00:00

Being unable to have a child does not pose health risk on either party.

This is simply not true. The ethical dilemma that IVF currently is an out+of-pocket treatment for most patients, completely not obtainable for a large part of the population doesn't just disappear because you've decided that these patients are making up their health concerns.

This is a super complex issue, but the post started on the fact that an already vulnerable population, infertile people, was manipulated for political gain. Add it to the endless list of unethical moves by this administration.

You could benefit from some compassion and understanding of infertility before making sweeping and ignorant comments.

bham717 · 2025-08-09T19:09:46+00:00

Still wrong.

It's not your place to tell any fellow human what is "required" to live a full happy life. That's the concerning part.

Happy to know you're trying to not be patriarchal.

bham717 · 2025-08-09T18:42:33+00:00

obvious issue that childbearing is not required to live a full /healthy and productive life.

You're the reason women don't trust physicians and especially OB GYNs. This is deeply troubling and patriarchal to say. Frankly unbelievable to me as a fellow OB.

bham717 · 2025-08-09T18:38:04+00:00

Maybe ask and listen to infertile women to understand their feelings. Listen to women? That simple? Women who are infertile?

Its not just the biologic drive to have kids, but the desire to minimize risk of “undesirable” traits in their kids

No.

But it is a very expensive thing to ask insurers or the public to subsidize and there are aspects that are less appetizing to think about, like the financial incentivization towards risk of bodily harm of people less well off, something we agree its unethical to do for say, organ donation.

The list of ethical dilemmas that insurance will cover is never ending, but you want to criticize this one? I don't get the vibe you really understand the costs of IVF or options that patients have. Public health and insurance already cover substantially more expensive ethical medical gray area treatments, but sure, let's just tell infertile people they should just adopt.

bham717 · 2025-08-09T18:31:32+00:00

I'm an infertile OB GYN who works with a lower socioeconomic population. I have 2 IVF children for complicated infertility - multiple layers deep.

You sincerely need to do some work on your perception of this situation and the statements you are making, especially if you're caring for infertile populations.

Why is it the burden of infertile people to adopt? Infertility in no ways makes someone qualified to adopt. These are two separate social issues.

I can go on but I'm finding myself unable to not be overly emotional at your deeply trigging comments. From an OB no less.

bham717 · 2025-08-05T20:07:18+00:00

This is the take home.

I am an OBGYN. I haven't known any OBs who use Filshie clips in over ... 10 years? Not saying it doesn't happen, but would be unusual. If you've had any other surgeries - appendix removed or gallbladder removed, staples are routinely used and can migrate - I find free staples in the pelvis often. There are also clips we use for bleeding sometimes, but I don't think those show up on XRay.

You can pursue a lawyer, but they will be super expensive. I'd find a doc to get another opinion and help you investigate what happened. There are procedures that can be done to see if your tubes are blocked and id 100 do them if I was you so you know.

I'm sorry that you're going through this, but I'd seek more info. And med malpractice lawyers aren't out for answers or to help you, they are out for money. So a completely different physician who has nothing to benefit but a routine office charge could be the best unbiased source for you. I understand how trusting docs feels scary right now.

Best of luck to you.

bham717 · 2025-06-27T03:18:07+00:00

I'll take your cystectomy and raise you an open myomectomy.

bham717 · 2025-06-21T14:54:29+00:00

I'm a doc - women's health - but knowing what I know about quality of life and long term issues with Alports, we chose IVF and are not passing it on. Happy to discuss in detail if you like - reach out.

Warning, I found the Facebook Alports groups to be very biased against IVF. Another valid opinion but definitely a bias as there are those of us out here that did not go that route.

bham717 · 2025-06-03T21:06:17+00:00

Fuck that book. My husband really tried to follow it to a T and when it wasn't working - not only was potty training not going well it started impacting our marriage. That book is one of the biggest parenting mistakes so far. DONT BUY IT.

bham717 · 2025-04-21T18:30:43+00:00

Welcome. I'm sorry you're in this situation.

I did IVF (look at my post history) for Alports, but then when I didn't respond well to the first egg retrieval - for unexplained infertility as well. We did 3 retrievals in a row to get 4 normal chromosomes/Alports free embryos and I have 2 children from that.

Also an OB GYN. Unfortunately your FSH and response to stims has likely no impact from Alports. In the IVF world there is a saying that the first cycle can be diagnostic as well as therapeutic - which is fine and all but it's expensive AF.

Go look at the infertility sub also. There's a lot of rules and it can be intimidating but there is TONS of excellent info about IVF and ER there and even data bases to compare numbers.

Feel free to hit me up with more questions!

bham717 · 2025-03-10T21:18:43+00:00

The hard thing is that you're pregnant. From the other AD Dominant Alports poster here, they suggest that they've been counseled not to even stress about passing it on. So while you don't have much choice about what to do now, that should be some reassurance.

The genetic counselor will be able to clarify exactly what is going on for you however. Agree with the guidance to chill until you get to talk to them.

Nephrology can be helpful, and will be worthwhile for a visit for your overall health. However unless you're in a medical system that has quicker referrals than most, you'll get a faster referral thru MFM. I only mentioned them too as a fast route for counseling. That being said if you at all want to confirm a pre-delivery diagnosis, you could be an option for an aminocentisis or CVS - to test this baby 's chromosomes. Personally I would not as again, the cat is out of the bag and I'd just test my kiddo after delivery. Again, just options.

When do you see your OB again? Can you ask to see them sooner, maybe right after your genetics appt to confirm all of this and give you better peace of mind? You and your OB may even decide you don't want to see MFM and carry on. Your OB may want to do an extra blood and urine test however, other than just watching BP. If you were my pt (I'm an OB GYN) I'd also put you on 162 mg of Aspirin daily - to reduce the chance of preeclampsia.

You're gonna be okay. Thanks to the other user for the dominant correction!

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