Tips on how to get the most out of a telemedicine appointment with a gynecologist.
The pandemic has ushered in a new normal, and part of that involves managing almost every aspect of life without leaving home, adding an extra layer (or two) of complication and stress to our routines. It’s more important than ever to make sure you’re taking time to care for yourself by eating healthfully, finding ways to be active, and getting plenty of sleep. Staying up-to-date with well-woman visits and screenings is a critical part of staying on top of your health, too.
If you’ve been considering deleting your annual ob-gyn visit from your calendar because of COVID-19, you may want to think again, especially if you have any issues you need to discuss with your doctor. Most ob-gyn practices and Planned Parenthood are offering virtual wellness visits and help with issues like UTIs, birth control, and STD treatment by video chat or telephone.If you’ve been considering deleting your annual ob-gyn visit from your calendar because of COVID-19, you may want to think again, especially if you have any issues you need to discuss with your doctor. Most ob-gyn practices and Planned Parenthood are offering virtual wellness visits and help with issues like UTIs, birth control, and STD treatment by video chat or telephone.
Similarities Between Telemedicine Appointments and In-Office Appointments
“The truth is that in many ways a telemedicine appointment is not that different from a regular appointment,” says Lauren Streicher, MD, a clinical professor of obstetrics and gynecology and the medical director of the Northwestern Center for Menopause and the Northwestern Center for Sexual Medicine in Chicago.
“There is value in doing a virtual visit if your doctor is offering it,” she says. “It’s a good way to touch base if you have concerns or if you’re worried that you may potentially have something serious going on,” says Dr. Streicher.
Has Your Ob-Gyn Offered You a Virtual Appointment?
Streicher’s practice sent a letter out to each patient to give them the option to do their annual visit virtually. “We don’t know how long this is going to go on, and many people may not want to wait another full year to have their issues addressed.” So far about 50 percent of Streicher’s patients are scheduling a virtual visit, she says.
“A telemedicine appointment is a way to talk through things. Even though there are some screenings and procedures that obviously need to be in person, much can be accomplished through these appointments,” says Streicher.
Which Reproductive Health Issues Can Be Treated Virtually?
- Birth control You don’t need an in-person visit to be prescribed birth control pills, especially if you’re an established patient, says Streicher. Planned Parenthood offers help with managing your birth control, including emergency contraception, through telehealth as well.
- Urinary tract infections “In a perfect world you’d have a culture to test for a UTI, but this isn’t a perfect world right now,” says Streicher. This diagnosis can often be made via telehealth without an office visit, she says.
In most cases, Streicher suggests talking to your doctor before spending money on a UTI test from a pharmacy. “If a patient tells me that she has to pee every two seconds, there’s blood in her urine, and it hurts like hell, I don’t really need her to go out and buy a kit to tell her she has a bladder infection,” she says.
- Sexually transmitted diseases (STDs) If someone needs a sexually transmitted disease (STD) screen, that’s not going to happen in a telehealth visit, says Streicher. “You can talk about symptoms and concerns, and keep in mind that some doctors’ offices are open for testing. There’s also a lot of outpatient walk-in clinics if you’re concerned about a sexually transmitted infection. You don’t need a gynecology exam to determine if you have gonorrhea or chlamydia, you just need a urine test, she says.
- Abnormal cervical mucus The most common causes of excess cervical mucus and irritating vaginal symptoms are either a yeast infection or bacterial vaginosis, says Streicher. “A lot of women think they’re pretty good at figuring out whether it’s a yeast infection or bacterial vaginosis, but the studies show that’s not true; in one study, only 11 percent of women accurately diagnosed their infection,” she says.
Although a test in the office is the way to a definitive answer, often your provider can help by asking questions: What does the discharge look like, what color is it, is there an odor, etc. says Streicher. “You may be able to treat it with an over-the-counter medication, but if your symptoms don’t go away you may need an antibiotic or an office visit,” she adds.
- Rashes, bumps, and other uncomfortable issues At the vulvar clinic, women often present with painful rashes, burning, or bumps, says Streicher. “This can be miserable,” she says. “These conditions can be discussed in a telehealth appointment, and often patients are more than happy to use their camera to show the provider what the issue is,” says Streicher.
- Hormone therapyYou often don’t need an in-person visit to make adjustments to hormone therapy, according to Streicher. “I just discussed changes in hormone therapy with a patient yesterday. After hearing her symptoms and what was going on with her, I made some adjustments to her therapy, and we scheduled a follow-up appointment in two weeks to see how she’s doing on the new dosage,” says Streicher.
“My recommendation or the value in the visit wasn’t impacted by the virtual nature of the appointment, though that’s not always the case,” she says.
- Abnormal bleeding If you’re having problems with your period, whether it’s cramps or spotting or irregular bleeding, you don’t always need a test or an exam, says Streicher. “It’s helpful in many cases, but you don’t know that until you have the conversation. And, if your doctor determines you need a test, you’ll be able to get it,” she says.
What Types of Problems or Questions Require an In-Person Visit?
You may need to be seen right away for urgent issues such as a fever or vaginal infection that is unrelated to COVID-19, symptoms of an ectopic pregnancy, including pain in the pelvis, abdomen, or lower back, issues due to a recent surgery or procedure or severe vaginal bleeding, according to the American College of Obstetricians and Gynecologists (ACOG).
Non-urgent elective surgeries may also be delayed for weeks or months because of the pandemic. Your doctor will be the best source of information to determine the status of your procedure or surgery if you have one currently scheduled; there are also guidelines listed by the American College of Surgeons.
Answers to Common Questions About Telehealth and Gynecology
- Should I do a video or audio call? Most offices that are offering telehealth leave it up to the patient whether they want to do a video call or an audio call. Streicher’s clinic gives patients the option of a video chat or a regular phone call when they make the appointment.
“What I’m finding overall is that people who are using Zoom routinely for their own work actually prefer it; they feel like it’s a more ‘in-person’ encounter, whereas someone who is not familiar with it usually opts for the phone call,” she says.
If you’re new to Zoom or whatever platform you are using, try it out in advance, suggests Streicher. “Don’t wait until the time of your appointment to start experimenting with it. There might only be 15 minutes allotted for that appointment, and if you spend 10 of those trying to figure out how to use the technology, your time is gone,” she says.
- Is a virtual doctor visit like a regular appointment? Even though the appointment is virtual, the commitment is real, and you should be at your computer ready to go at the time of your appointment, says Streicher. “I think some people might think, ‘Oh, I’m five minutes late, what difference does that make?’” she says. “If you’re not picking up at your appointment time, the provider is going to go on to the next appointment.”
You have an allotted amount of time just as you would in the office, and so it’s a good idea to figure out the major concerns you want to discuss and have any questions ready ahead of time, says Streicher.
- Can I do a telemedicine appointment if I’m a new patient? Although you can schedule a telehealth appointment at many clinics, including Planned Parenthood, keep in mind they may not have access to your medical history during your visit.
“When I have a telemedicine appointment with an established patient, it helps that I’ve physically examined her in the past, and I’m familiar with her health history and issues,” says Streicher. “During the appointment, I have access to her chart so that I can see what we’ve done up until now. That’s very different from seeing a new patient; we can do more with an established patient,” she says.
- Can I get a new prescription? You can get a prescription filled or refilled via a telemedicine visit, says Streicher. “If we’re not seeing a patient virtually, we’re extending,” she says. “Normally we would reevaluate things like hormone therapy or birth control in an annual visit, but now we’re extending for three months, so continuing their prescriptions, with the understanding that we’ll touch base with them in a few months to see how they’re doing.”
If you are sheltering in place somewhere other than your normal residence, keep that in mind if your doctor prescribes any medications. Unless you specify otherwise, the prescription will get called in to your usual preferred local pharmacy.
What to Do About Missed Screenings, Expiring IUDs?
People get nervous about something with a due date or expiration date like a mammogram, Pap test, or an IUD, says Streicher. If you’re concerned, check in with your provider, says Streicher.
In many cases, there’s a lot of wiggle room, such as with IUDs (intrauterine devices). “If you’re supposed to come in for an exchange because you’ve been told the five years is up, that’s clearly not something you can do over the phone,” says Streicher. The good news is, many studies show that you can leave it in for a year longer and sometimes even two years, she says. “Some of that depends on your age, because a 25-year-old woman is more fertile than a 40-year-old, but we have really good studies that show it’s okay to let your IUD go another six months without replacing it,” says Streicher.
In cases where you need a follow-up or a scheduled screening, the level of urgency can depend on many factors, such as your age and health history. “There are situations where waiting a few months is perfectly fine,” she says. If you’re concerned or even just questioning if something is serious, it’s good to call your doctor and see if it can wait, and if so, for how long, says Streicher.
“We’re not sure how long these precautions with COVID-19 are going to be going on. Sometimes putting something off for a month is no big deal, but putting it off for six months, that could be a bit of a problem,” she says.
Don’t Assume Your Doctor Cannot See You
Keep in mind that most offices are still seeing patients, but often with a reduced schedule. Streicher’s clinic at Northwestern Medicine is scheduling in-person tests and appointments a few days a week for patients who need to be seen right way, she says. “They get screened at the door, they get their temperature taken, and everyone is wearing masks, everyone is being very careful with personal protective equipment,” says Streicher.