Rants from the Crib

An Ob/Gyn gone mad

Explain Something You Know A Lot About To Someone Who Knows Nothing

I read a writing challenge today and it stopped me short.  “Take a complicated subject that you know a great deal about and explain it to a friend who knows nothing about it at all.”  Here’s the thing:  that’s my job.  That’s my job description, in a nutshell.  I am an Ob/Gyn and I deal with women’s reproductive health, which the average woman knows little about at all.  Women don’t know where their female parts are, what they do, what they look like, and how they can fail.  Most women aren’t even familiar with their external parts; they don’t know that the outside of their nether regions are called a vulva and not a vagina, which is internal.  The vagina is the canal inside.  The vulva are the parts outside, which are not called lips but labia.  Show me a woman who knows this and I’ll show you a biology major.  So I spend my days explaining everything.  I explain what the body parts are called.  I explain what they do.  I explain what they look like.  I explain compicated procedures, as I did in this blog post here.  I’ll admit, that’s not even too helpful without visual aids. 

Have you ever tried to explain how a baby passes through a dilated cervix, or how the cervix dilates?  I explain it like this:  you are putting on a turtleneck.  Your head is the baby’s head and the turtleneck is your cervix.  Imagine the hole in the turtleneck enlarging and the neck thinning to allow the head pass through.  And there you have it.  I have made up one of these little analogies for everything.  You can also describe a grapefruit passing through the opening in a tube sock, and this is useful explaining how the opening of the cervix can be behind or in front of the head. 

We can describe the pregnant uterus as a big light bulb with a blown up water balloon inside of it; the baby is in the balloon.  Again, this is my life.  It is my job description.  Describing the mechanics of a physical situation, or describing the reasons behind a physical reaction are challenges that I hope I meet every day.  I think I have come up with some good analogies over the years and hope to create many more.

How do you explain that cysts on ovaries are normal?  First of all, a cyst is defined as a single layer of cells filled with fluid.  A blister on your toe could be a cyst.  It’s just the word “cyst” that frightens people.  It’s not so frightening when you know what the definition is.  Ovaries create cysts every month; it’s their job.  An egg develops and it makes itself a nice little bubble filled with nutritive sugar water to support it.  Over the month the little bubble (gasp, CYST – now hopefully demystified) works its way up to the surface of the ovary and pops, releasing the egg.  So normal women of reproductive age make and release cysts every month.  So the next time the Emergency Room sends you out with the explanation “It’s a cyst,” they’re just trying to give you a reason for your pain and get rid of you.  That leaves your Ob/Gyn to deal with a panicky female:  “Oh nooooo, I have a cyst!!”  You have to talk them down out of their tree and explain that right now, I probably have a cyst too.  That’s just how things work.  Now this is not to say that a cyst can’t be abnormal; sometimes they are oversized, occupy space, and can cause pain.  Sometimes they even twist on their skinny little stem of blood vessels, cutting off the blood supply and causing a torsion, which just means that the blood flow to the ovary or cyst is gone, which causes incredible pain and is a surgical emergency.  So there can be bad cysts.  You just need to understand the difference between the two.  Cysts can also be abnormal if they have a solid component, which is not included in the definition of a cyst (remember, single layer of cells on the outside, fluid in the inside).  Solid component means a cyst may be more likely to be precancerous or cancerous.  That’s something that makes a difference.  But come to me and tell me that you have a simple fluid cyst under six centimeters on your ovary, I will probably say, “Meh.” 

I once had a patient ask me, “Do hysterectomies run in families?”  I found this to be a very interesting question.  After all, a hystorectomy is not a DNA linked trait.  It is a procedure.  The question kind of made me giggle.  I had to explain that things that cause a need for hysterectomies, such as fibroids, can run in families, but the procedure itself?  No.

A lot of things I can’t even answer, because nobody knows.  Why do women get recurrent vaginal discharge?  Rule out infection and I don’t know.  If I knew, I could retire and buy an island.  And I tell my patients just that.  Why do women lose their sex drive?  This is a huge problem, and there are so many potential answers that it is almost impossible to narrow down.  And for women, there is no treatment.  Viagra works in less than ten percent.  We are just out of luck there.  Occasionally medical problems such as diabetes or high blood pressure (or medications) can be a cause, but you can’t count on that.

So I explain what I can, and I fess up when I can’t, and between the two I think I’m giving patients a pretty fair shake.  But the little analogies I’ve developed over time have come in handy over the years, time and time again.  Like I said, it’s my job.


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