Dr Anita Mitra - The Gynae Geek

Copyright

Thorsons

An imprint of HarperCollins Publishers

1 London Bridge Street

London SE1 9GF

www.harpercollins.co.uk

First published by Thorsons 2019

FIRST EDITION

© Dr Anita Mitra 2019

Illustrations © Nicolette Caven 2019

Cover layout design © Ellie Game 2019

A catalogue record of this book is available from the British Library

Dr Anita Mitra asserts the moral right to be identified as the author of this work

All rights reserved under International and Pan-American Copyright Conventions. By payment of the required fees, you have been granted the nonexclusive, non-transferable right to access and read the text of this e-book on screen. No part of this text may be reproduced, transmitted, downloaded, decompiled, reverse engineered, or stored in or introduced into any information storage retrieval system, in any form or by any means, whether electronic or mechanical, now known or hereinafter invented, without the express written permission of HarperCollins e-books.

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Source ISBN: 978-0-00-830517-8

Ebook Edition © March 2019 ISBN: 978-0-00-830518-5

Version 2019-02-21

Dedication

For Menelaos, Achini and my mum

Contents

Cover

Title Page

Copyright

Dedication

Acknowledgements

Introduction: Down-there healthcare by the Gynae Geek

PART ONE: Anatomy

Chapter 1:External female genital anatomy

Chapter 2:Internal female genital anatomy

PART TWO: Periods

Chapter 3:Periods – the basics

Chapter 4:Irregular and absent periods

Chapter 5:Heavy periods and other period-related frustrations

PART THREE: Sexual Health and Screening

Chapter 6:Vaginal discharge

Chapter 7:Contraception

Chapter 8:Emergency contraception and termination of pregnancy

Chapter 9:Sexually transmitted infections

Chapter 10:Cervical screening and HPV vaccination

PART FOUR: Fertility and Getting Pregnant

Chapter 11:When you are thinking about trying to conceive

Chapter 12:Fertility and egg freezing

PART FIVE: Lifestyle and Women’s Health

Chapter 13:Stress

Chapter 14:Food

Chapter 15:Exercise

Chapter 16:Sleep

Final thoughts

Resources

Notes

Index of Searchable Terms

About the Publisher

Acknowledgements

It is such an honour to write something for the whole world to see. But I couldn’t have done it without the support of some incredible human beings who deserve huge thanks.

To Dr Rupy Aujla, my brother from another mother, for being the one who forced me to put myself out there to talk about something I believe the world needs to know.

To Dr Laura Thomas, for taking a chance on The Gynae Geek and inviting me on her podcast to discuss vaginas before that was a ‘cool’ thing to do.

To Dr Hazel Wallace and Alice Liveing, who both gave me a massive leg-up by collaborating with me on their social-media channels and giving me valuable advice about how to survive in the online world.

To Carly Cook, for her sass and support throughout the book-writing process and for hydrating me with many a mint tea. To the wonderful HarperCollins team – Carolyn Thorne, who saw the potential in my idea, George Atsiaris, Josie Turner and Julie McBrayne, who brought the campaign to life – thank you all!

To Adam Willis, my strength coach, but most of all my friend, for always being a voice of reason.

To my best friend, Achini Wanasinghe, and my mum, who listen to my moaning on a daily basis and support me no matter what. And all my other friends who have put up with being ignored for the time that I’ve spent writing the book.

To both of my parents for giving me the education that enabled me to be in the position to write this book.

To all the patients and my social-media followers who shared their stories and asked the questions that inspired it.

And finally, to Menelaos Tzafetas, aka ‘Mr Gynae Geek’, for being the one, in so many ways.

Introduction: Down-there healthcare by the Gynae Geek

It’s three o’clock on a Wednesday afternoon and I’ve just performed a surgical evacuation on a woman who was nine weeks pregnant before she miscarried. I’m in theatre, writing an operation note, when my bleep goes off. It’s A&E. I speak to a worried-sounding nurse who asks me to come urgently and see a patient: ‘Forty-one years old … bleeding very heavily … not pregnant … haemoglobin is four and—’

‘What did you say? FOUR?’ I jump in.

‘Yes, Doctor, four—’

‘OK, I’m coming. Put her in resus. And put in a large cannula if you don’t already have good IV access. Oh, and what is her pulse?’

‘One hundred and seven.’

‘OK, I’m coming, I’m coming.’

I’m worried. Why is this patient’s haemoglobin level almost one third of what is normal for a healthy female? I scrawl the rest of my notes in my best ‘I’m-in-a-rush-but-I’m-trying-to-make-this-as-legible-as-possible’ handwriting, a skill that’s almost second nature now. I grab a disposable green paper gown to cover my theatre scrubs and run down the corridor to A&E. I enter the resus department, my gown fanning out rather dramatically behind me, and rush into the patient’s cubicle.

She is hooked up to a machine that is beeping wildly because of her racing pulse, and there is a lot of blood on the bed. The nurse I spoke to on the phone looks concerned, standing over the patient who seems surprisingly calm, albeit slightly clammy. I ask her if she’s sure she isn’t pregnant; she laughs and tells me it’s impossible, and the nurse confirms the pregnancy test is negative. She tells me she’s having her period, but it’s much heavier than normal. I ask her how many pads she’s been using.

‘Pads?’ she asks. ‘Oh, I don’t use those until Day 2 or 3 when things have settled down. I normally take the first day or two off work and sit on folded-up bath towels because there’s so much bleeding. Today it was so heavy though that I was just sat in the shower for a few hours, washing away the blood as it came out. But I didn’t feel well, and I think I might have passed out, so I called an ambulance.’

I look at the patient, who is slightly obese and of South Asian descent, which, along with her symptoms, makes me begin to suspect she has a cancer. I ask her how long she’s had this bleeding.

‘Probably about twenty years.’

Twenty. Years. No wonder her haemoglobin is four. In fact, I’m surprised she made it this far without ever having had to come to hospital, especially as she has been losing iron at the speed of sound for two decades.

I perform an internal examination and blood clots the size of my palm begin to fall out of her vagina. Then, miraculously, the bleeding seems to stop. I wait for a few seconds to see if more blood will come out. Nothing. I wait some more … and some more … and then there’s another steady trickle. I instruct the nurse to get me some IV tranexamic acid (a drug to stop bleeding) urgently, which she does, and I administer it myself. I prescribe a blood transfusion and tell the nurse to give some IV fluids to stabilise the patient, while we wait for the blood to be cross-matched in the lab. I also prescribe tablets to slow down the bleeding.