Getting the Most From Your GP Appointment, With Dr Aziza Sesay - Episode Transcript

Helen

Hi, I'm Helen and this is Why Mums Don't Jump. Busting taboos about leaks and lumps after childbirth. All the stuff that happens to your pelvic floor that no one ever talks about. Incontinence, prolapse, pelvic pain - problems that affect millions of women; one in three. I'm one of them.

I have a prolapse. My pelvic organs fell out of place after the birth of my second child and if you had told me back then my that I would be speaking about this stuff out loud, I would have told you to give your head a wobble.

Hello, welcome back and thank you for all your lovely comments and messages about last week's episode with Holly. If you ever needed some inspiration about how to tackle your prolapse symptoms, then she is it. And just to add that if we piqued your interest in vaginal pessaries - I've had quite a lot of questions this week -there are a couple of really great episodes you can listen back to. Also resources on my website and on my instagram. So please have a nosy around if that is something you're interested in.

Why Mums Don't Jump is sponsored by iMEDicare - Pelvic Health Naturally. iMEDicare provides devices or products for pelvic health that are safe and easy to use, helping you to manage your symptoms while you're on your way to recovery - products like Lumana activewear - fitness leggings and running shorts that have absorbent underwear built in for protection from leaks, whether that's wee or sweat or period blood or discharge. And the leggings have a phone pocket, which is music to my ears. You can find Lumana via the affiliate shop on the Why Mums Don't Jump website, where you'll also find a discount code. Thanks to the team at iMEDicare.

Today's episode then. I've been wanting to do this for ages. It's a bit of a starter guide for how to get the most from a GP appointment. And this is relevant to anyone with pelvic floor problems, whether it's incontinence or prolapse or pelvic pain or sexual dysfunction, whether you've recently had a baby or whether you're many years down the line. And what better person to do it than Dr. Aziza Sesay, GP women's health specialist, educator. She runs a health platform called Talks with Dr. Sesay, sharing evidence based health information, and she's a bit of a superstar in my world. She tells it how it is. As you will find out, she's great. And we sat down to record earlier this week and I started by asking her, how bad do your symptoms need to be before you seek help?

Aziza

So it doesn't matter how small it is, as long as it's impacting your life, go and seek help, is what I would say. I think the other issue is how we normalise some of these symptoms. And another thing that I often say, you'll hear me say this a lot, is it's so important that we normalise these discussions, because the truth is, it is so common. It is extremely common. And depending on where you look at your stats, they say one in two adult women will suffer with urinary incontinence. Others would say it's actually higher, others will say lower. And actually, we don't know the definitive figure because there are so many of us who are suffering in silence or don't realise, actually, what we have is not normal. So it's absolutely important that we normalise these conversations, but do not, please do not normalise the conditions. They are extremely common, but they are not normal.

So when we talk about symptoms, these are things like having forms of urinary incontinence. So this could be that you just leak urine whether or not you do anything, or maybe you have the urge to go for a wee and then you start leaking urine. The same with if you sneeze. So anything that puts pressure on your abdomen, if you sneeze, if you cough, if you laugh, if you run, anything like that, if you notice that you could feel like a bulge coming down from there or you feel like a dragging sensation. Also, it's not just urine specifically. It could be faeces, it could be your poo, are you leaking poo? Any of those sort of symptoms. And as I say, if it is disrupting your life, it's affecting your ability to, for instance, socialise or do things that you love. If you're someone who loves to go to the gym, now, all of a sudden you can't do that because you're worried about leakage. Those are the symptoms that we look out for. Okay, I'll stop talking.

Helen

No, I think that's perfect! And that's exactly what we need to hear. No amount of it is okay if it's affecting your life. And then where should we go? Because I know you can get treatment or you can get support and information from different places, but if you're under the midwife still, if you have someone who's recently had a baby, can you go to a midwife? Can you go to a health visitor, or should you always go to the GP? Is that always your first port of call?

Aziza

So I would say it's who you feel most comfortable going to, but knowing that your GP is definitely there. What we do know in this country, and I was looking at some stats earlier, and they said that research in 2022 by the Royal College of Obs and Gynae (Obstetrics and Gynaecologists), they said that they remained a significant barrier to women and people seeking help, including a lack of knowledge about pelvic floor health, embarrassment in discussing the symptoms of pelvic floor dysfunction, pelvic floor problems. So there are loads of barriers that exist, and as we say, it has to do with education. And this is why I'm really supportive of your podcast. But also due to embarrassment.

When we talk about the facilities that exist, if we start off, for instance, in women who are pregnant - they are trying to improve these barriers and putting things in place. So there is the Perinatal Pelvic Health Service that has been piloted in several places, and they're trying to make sure that it's all implemented nationally or nationwide by this year. We're hoping that that will be the case. And these services are supposed to be available up to a year following birth, so it's just being aware that they do exist. Unfortunately, there is a bit of a postcode lottery, so see what exists in your area.

The other thing I would say is, I've said about going to your GP to talk about the problem, and know that if you see your GP and you feel as though you're not being heard, or it's like you're being dismissed, please don't give up. See another GP. If that's the case, you shouldn't be suffering with this. And it's something that needs to be looked into. And I'm saying this out of personal experience because unfortunately, I've seen - these are extreme cases, obviously - but I've seen cases where, for instance, I had a patient who came in who had been struggling for 17 years, and they had seen AGP early on and was told, oh, it's fine, don't worry about it. So by the time she came to see me, she had a massive prolapse that was literally coming out of the vaginal entrance, and she thought that it was okay. So again, it's also understanding that, unfortunately, the reality is that not all of us got mandatory pelvic floor training. Not all of us got mandatory women's health training as well. And some of us, it would have been maybe a lecture. And if you missed that lecture, you missed it, do you know what I mean? It's only now they've made it mandatory for women's health training to be implemented in medical school from here on out. So it's just being aware that not everyone is specialised in the area. So if you may come across someone who may not know and you feel dismissed, know that there are others who perhaps have the training and the expertise to support you.

Helen

Yeah.

Aziza

Usually when you go to the GP and you've gone through your symptoms and so on and so forth, which we can discuss at length in a bit, we would refer you to specialist. So that could either be a urologist or urogynaecologist, a gynaecologist and also pelvic floor physiotherapist, which, again, personally, for me, we didn't get much training about the existence of pelvic floor physiotherapists. So it's only, I would say in the last few years for me, and this is me being 100% transparent, that I realised the importance and value of pelvic floor physios. And that's because I had children.

Helen

Yeah, right

Aziza

Right. I only heard about them and understood the importance and what they do after I gave birth to my daughter, who's now six years old.

Helen

I've had similar messages from other GPs saying, you know, I thought I knew about pelvic floor issues, but then I went on mat leave, had a baby, and now I understand it further...so it's just. I mean, I'm almost feeling that sometimes maybe we need to have a little bit of. Well, actually, I was going to say compassion, but that's not the right word, just an understanding when you go to the GP that, yeah, they may not...they can't know everything. They're not the oracle of all health issues, they're a general practitioner. The clue's in the name. So, actually, to go in there with a little bit of...having done a little bit of research yourself and have a little bit of sense of what might be around in your area, presumably that is going to be a useful thing, right?

Aziza

100%. So, first of all, I would also say, like, if you are going to see any healthcare professional about this issue...first of all, well done. I'm proud of you. Thank you for putting yourself first, because that's one thing that we just don't do and we kind of live with things for a long time, so that's a big first step. But I would also encourage you to be prepared, because unfortunately, especially if you're going to go see a GP, it is a ten minute appointment. Some places you may be lucky, it can be 15, but that's still not enough time. So it's always helpful to be prepared to know what you're going to talk about, know of these things, because there's something called the golden minute. So when we're taught communication skills from medical school through to GP, we're taught about this golden minute where we ask an open question, and we always start off with open questions like, how can I help today? Or what brings you here today? And so on and so forth. And we allow about a minute for the patient to open up and tell us about whatever it is, what their issues are and so on. Right? And if you're quiet, you know, we give you a little, we won't give you a whole minute of you being quiet, but if we do try not to, we should try not to interrupt you, at least for the first minute.

And in that time, that's where you can, with all the information that you have - what are your symptoms? When did they start? How have they progressed? Have you tried anything so far? Has anything improved it? Is there anything that makes it worse? Can you pinpoint when you think it may have started or what would have triggered it, so on and so forth? And then you also want to be prepared with what you think may be going on. And I'm not saying that you have to be a doctor and you should diagnose yourself or a specialist or anything like that, but as you say, often as GPS, and I usually say this, like, I see patients from conception, from when they're in their mommy's belly, to elderly patients, end of life, right? And anyone can walk through my door, it's not, I don't have a women's health or gynaecological health hat on immediately, because I could have just seen a baby with a viral infection. And sometimes all these tabs are open in my head. And often it's really helpful if you say, I'm actually concerned that it could be this, and say, oh, yeah, of course, course. That triggers that memory, you know, and then you said that we are generalists, but yes, some of us have expertise in certain areas. So I have an expertise in women's and gynaecological health. That's my interest, my specialist interest area. But I have colleagues who have expertise in, for instance, cardiology or diabetes. So if you come to me about certain things that I don't have expertise and you probably think she doesn't know what she's talking about, but actually it's just because in that area, I don't have all of the information, so it's also remembering that fact.

So anyways, again, I digress, sorry, but with regards to the things to be prepared for, I would say come with all of those things. And again, an ideal consultation. Often we are taught as gps to ask the questions, what are your ideas? What do you think is going on? What are your concerns? What is it that you're most concerned could be, and what are your expectations? So have ready what you want. If you know that you want to be referred to as specialist and you want to explain why that's the case, let us know. And obviously, if it's something we can do, we'll do (it). If there are things that we can try before you get referred, because in some instances there are situations where we can try things, so that when you do get to the specialist, and often the wait times is long, you've already tried it, you know what I mean? And they can then move on to whatever the next step is at that point.

Helen

Okay, so you've been in. Oh, the other question I was going to ask about the GP appointment is, will there be a vaginal exam?

Aziza

Yes. So that's a really great question. And that was the other thing that I was going to say. Prepare your mind for that, because it's very likely to be the case. Like the majority of the times it will be the case, unless you see a GP who perhaps doesn't have the specialist interest in the area or doesn't have the expertise. And often they'll be honest about it and they'll say, actually, I'm going to refer you to a colleague, which can happen, so be prepared that usually you'll have to be naked from bottom down. We'll usually put a sheet to maintain your dignity. We'll have a look at the area to see is there any visible prolapse, are there any visible scars or so on? And then we may have you cough again to see whether or not that triggers the leakage or incontinence. And then we may do a bimanual, which is where we put two fingers into the vagina. We may ask you to try to squeeze against it so we can try and assess your pelvic floor muscle strength. And then we may insert a speculum again if we want to see whether or not there's a prolapse and whether or not it's visible. I mean, sometimes, if it's quite a severe grade, you can see it coming out of what we call the introitus, the opening of the vagina. But other times, you may need to put speculum just to confirm that that's what you can see. So, yes, the answer is often you should do before you get referred.

Helen

It's hard, isn't it? No one likes those exams. But, you know, I think especially, like... I don't know...what I find if I go for a smear test. I find, like, I have to apologise for my prolapse. I'm like, I'm really sorry, I know I've got a prolapse. I don't know why I find myself doing that. You know, it's a challenge, isn't it? Deep breaths. Get in there, get it done.

Aziza

I guess what I would say is, I promise you, you're not the first.

Helen

Nobody cares. Helen. Just get on with it! Haha

Aziza

I don't know. I mean, it's understandable why you feel that way. I feel like it's ingrained in us and it's society and there's so much shame and stigma and it's perpetuated by the censorship we faced on social media and just all advertising outlets out there. But things are getting better and I think once we continue to normalise the conversations and the discussions, hopefully there will come a time where we just lay on the bed and, like, 'Do what you need to do and sort me out'.

Helen

Please don't have a big panic about where to fold your knickers and whether to hide them under your trousers and all that.

Aziza

We're not looking for them and we won't judge you.

Helen

Look at that thong!

Aziza

You don't need to groom yourself. It doesn't matter if you have hair. Like, ultimately, what we want to do is the assessment that we need, and, in fact, what we're most focused on is what the issue is. And again, confidentiality. We're not allowed to go and talk about that would be so wrong. Ultimately, we are there to do our jobs and I promise you, we see thousands over the course of our career. Please, please, please don't worry and never apologise. And something that is always the case is that we never hear men apologising, ever, about these issues. There's no, sorry. It's just like, get on. We, as women, we're always apologising and we don't have to. This is. You've come for a health assessment, just like me looking into your mouth to look at your tonsils is the same sort of thought process I have when I'm looking in that area as well.

Helen

Yeah, sorry, I got a bit....I got a bit hung up on the old vaginal examination there! Right. Moving on, then. Can we talk about...can we talk about the six week check? What should you expect if you're a new mum? And is that a good time to say if you're worried about pelvic floor symptoms or is that too soon after having a baby?

Aziza

Yeah. What happens is we go through what happened during your delivery, what type of delivery it was. Were there any complications? Did you have any complications within yourself? What? Were there any plans put in place? Are you having any symptoms now? Are you breastfeeding or bottle feeding? Again, that question is a standardised question. There's no judgement to the mom. It doesn't mean that you have to be bottle feeding or you have to be breastfeeding. We just need to know where you're at, if you've had a c-section, how's the wound? Is it healing well? Are you having any pain? It's basically a well rounded checkup on mom, make sure that everything is okay. And it's also the opportunity to talk about contraception, which often is the last thing on a lot of the mom's life. Like, I'm not even thinking about sex, forget that. But often that's what happens in that area and what I do find. And this, for me, this is a personal request that I'm hoping that in the future it's something that we can put in place, like maybe a couple other checkpoints, because six weeks is a great time. But I have not had any experience, if I can remember, of any mom telling me about their incontinence problems at that point.

What's really interesting for me personally is that, and there's one story in particular of a patient who I saw at the six week check. I did ask and there was nothing said. And I saw her a few times after with her baby because the babies was having issues and I guess we built a relationship and there was banter and everything was great. She was nine months postpartum when she told me that whenever she had sex with her husband, she would leak a lot of urine. And I just thought to myself, my God, should I have asked her at those stock points anytime I saw her? Would that have helped? Because I never then voluntarily asked after the six week check, you know what I mean? Because it was fine. So I guess, yeah, I guess anyone who's listening to this podcast. If you are six weeks postpartum and you're going, or you're postpartum and you're about to have your check, please remember that you can mention it at that point. And just because you're having it then and there doesn't mean that it's going to be something that you'll have to live with for the rest of your life. Sometimes it could just be a short term complication. And pelvic floor exercises again, we can refer you to pelvic floor physio if necessary. You can self refer, as I say, to the Perinatal Pelvic Health Services, because it's up until one year postpartum. And then there's some apps as well. They're available. The Squeezy App is quite good. So there's that. But it's also remembering that at any point at all, please mention it. If you're struggling, please, please, please do not suffer in silence. Please don't get to that. Because when I asked the mom at that point, she was like, I was so embarrassed, I didn't know how to tell you. And we had a frank discussion. I was like, I'm here, you can open up to me. You could say, but it's fine, I'll refer you. And I did, and she's having the treatment now, you know what I mean? But it took courage for her to say it, even though we had a great relationship. So normalise the conversation.

Helen

Still a long way to go around all of that, isn't it? Because it's just like, if you don't even know that, that's a thing that can happen before you go and have children and afterwards that you think like, you're the only one. And then it's that part of our body which we're really embarrassed about anyway. And your brain's exploding from all the new baby stuff and you probably think...

Aziza

And your focus is baby, right? And you also feel guilty, almost like, I have a healthy baby, you know, fertility problems is becoming much more common. Is it one in six at the moment of couples who are struggling with fertility? So it's kind of like, I shouldn't complain, it's fine. It's just wee, or a little bit of poo sometimes here and there, you know what I mean? So I think, as you say, as long as we have these conversations, and again, it's so important that we have the education, I think, early on, but spiral learning. So you teach young individuals about potential complications that can happen. And I think it's just getting the balance right, because I know why nobody really spoke about this, because it's also the whole, I don't want to scare people into not having children, you know, but if prevention is better than cure, and again, someone said something I really liked before, they're like, we often take a reactive approach rather than a proactive approach. And in this regard, if we start early with the pelvic health information, pelvic floor exercises from young and preventative measures to stop the dysfunction from happening, or if you already have it, having the knowledge early on to prevent it from progressing at a point where you need the surgery, you know, it can make such a difference. And again, this is why I really applaud you, Helen. Thank you for everything you're doing.

Helen

I really like that spiral analogy. Actually, I haven't thought about that before because that's what I...you know, a little bit of information from a very young age, and then a bit more and a bit more and a bit more, and then it's not all this, like, 'This could happen if you're pregnant at childbirth' and all that. Yeah, I like that analogy a lot.

So, yes, we were talking about feeling that you might be dismissed, and obviously you touched on it earlier. That unfortunately does happen sometimes you might be told it's normal, at least the baby's fine, or you've had a baby, what to expect. Or I've heard it's good training for menopause, that sort of, like all kinds of things.

Aziza

Wow.

Helen

But if you didn't have a good experience when you did go to seek help, let's say. Let's say with the GP, and you mentioned you can change your GP or ask to see someone else. How would we do that without it being really awful and embarrassing? Do you have to change the whole practise? Can you just have a quiet word with the receptionist? Or how does that work?

Aziza

First of all, I'll say it's really nice that you care about the feelings of your GP, but what's most important is you and your care, so don't feel bad. Depending on the GP surgery...so if there's a bigger surgery, it doesn't matter if you saw one doctor and you weren't happy, you can see another doctor, that's fine. You are entitled to that. That is 100%. You're right. Sometimes you can chek out the websites of the surgeries and you can see which doctors may have specialist training or an additional diploma in for instance, women's health in this regard. So often it's either they have something called the DRCOG which is the diploma for the Royal College of Obstetrics and Gynaecology, or they may have the DFSRH, which is the diploma with the faculty of Sexual and Reproductive Health. So often, if you see those letters after their names, you'll know that, okay, this one has some idea of what might be going on, so perhaps I'll see that doctor. So that's something you can do beforehand. I'm not asking you to do - I feel like I'm getting you to, like, do so much research and notes before you see a doctor - But I just want to...

Helen

That's a thing that you can do.

Aziza

Yes. These are things that you can do. You don't have to do it. If you are in a single man practise...not being a man. I'm not saying there's anything wrong with male GP's, some male GPs really get it as well. But if it's a single run practise and you really, really struggling and you feel like you're hitting your head against the wall, you can register to any other practise close to your area and you can do the research. I think if you go to NHS choices. Sorry, that's my chair. My chair keeps farting, not me! Sorry.

Helen

Yeah, we believe you. Haha

Aziza

Okay. I love you, Helen. Haha

Okay, so, yeah, you can. You can look up the GP surgeries in your catchment area, right? And then again, if you want to, you can go and have a look. Do they have a GP that has the letters next to their names? And then you can register if they're accepting patients and know that if you. If you do see a GP and like the first time you saw them, you didn't have a great experience. If you can go again, perhaps with moral support, and explain at that point what it is that you were hoping for and if they refuse, you can ask them why. That's another big thing. Know that you can ask questions when you're at this GP surgery, if they think that you have something and you don't quite understand how they got to that conclusion, you can ask, oh, why do you think that? Or why are you referring me to that person? Or why are you deciding to do this instead of that? And they shouldn't be...be defensive. It's your, again, it's your right. And again, if you're struggling and you feel like you're hitting a brick wall, then by all means go to someone else, but just know that you have options and ultimately you are in control.

Helen

That's super useful and I think empowering for people to know that when they go in. I'm going to let you go in a minute, but one last big, really big question that you need to answer in just a short amount of time, but wave your magic GP wand. What needs to change to give women a better experience? Because we know there are a lot of women who don't have a great experience. What needs to change?

Aziza

I just think that we need to believe women. That's my biggest gripe, because whenever...and even when the Department of Health released the survey in which they got 100,000 respondents, it was 80% who said they didn't feel listened to. I think once we sort that out - and I feel like 80% isn't even high enough, you know what I mean? Of all the DM's I get through this platform and all, and I get it from my own patients who come to see me, I didn't feel like I was listening to. And it's just taking that little bit of extra time for someone to leave their home to wait for an appointment to come and see you about something that often is quite embarrassing. That is something. So I just wish that we perhaps maybe had more training as doctors in general and also not losing that compassion. It's hard because, and this is me, I guess I'm being a little bit political. If they put more money in for the training, for the support, it would be better. Ten minutes is such a short...how are we going to have a consultation in ten minutes? I sometimes tell people, try and book a double appointment. Those can be gold dust. They're few and far between and not many surgeries will have that. And sometimes, okay, I see a patient. We don't have enough time to discuss all of this the way I would like to. Let's book another appointment to have a chat about it and then put that in place. So there's just...I just wish that we believed women, we made women a priority because we haven't been for so long. It's almost like we were an afterthought. Even though we make up 51% of the population in the UK, if we get that right, and with more and more of us advocates together, I mean, we recently had the EveryWoman Festival, which is amazing, right? There's so many of us who are speaking from the same voice, but if we can change that, there would be so many happier, thriving women. But through that, the whole population. And I'll leave you with my favourite quote by António Guterres which is 'When we exclude women, everybody loses. But when we include women, the whole world wins.' We are the matriarchs. We make the world work. I just wish we could get that right.

Helen

Doctor Aziza Sesay what a brilliant quote to end with. I told you she was good ! As ever, please don't take any of this as medical advice, but do seek out your own professional help. I hope it was helpful, though. I really I certainly feel more tooled up because of it. And you can follow Aziza on Instagram. She is @talkswithdrsesay, all one word. And if you're enjoying the podcast, please spread the word, leave a review, tell a friend, or share it on a WhatsApp group. Put an advert on the side of a bus if that is how you roll. It's really the only reason this podcast has reached as many people as it has, and I'm so grateful for that.

I'll be back next week, but in the meantime you can find me on socials @whymumdontjump or via my website, which is whymumsdontjump.com and don't forget to sign up for emails so you don't miss a thing.

Season five of Why Mums Don't Jump is brought to you by iMEDicare - Pelvic Health Naturally. The team at iMEDicare are passionate about improving quality of life for patients with pelvic health problems, and they supply products that are safe and easy to use as part of your rehab journey. Products like the Efemia bladder support - a reusable vaginal pessary for stress incontinence, helping you to stay active without worrying about leaks. Made from a soft and flexible silicone, Efemia is widely available on NHS prescription as well as through the affiliate shop on the Why Mums Don't Jump website, where you'll also find a discount code. Check it out.