Dr. Annelise Swigert was asked by Three Women and A Bottle of Wine‘s Kim Insley, Lynn Melling and Julie Bartkey to give them some insight for women on what’s going on down there. Here’s the fun night they all had discussing women’s health for teens, prenatal care and gynecology.
Julie Bartkey: Yeah, they’re of the, I don’t care if you’re going through menopause
Lynn Melling: Right? They’ve got Viagra, and we got nothing.
Kim Insley: This is Three Women and a Bottle of Wine.
Julie Bartkey: Three friends.
Lynn Melling: Three former TV reporters.
Kim Insley: And one bottle of wine.
Julie Bartkey: Delving into whatever interests us.
Lynn Melling: News, not news. What affects our lives, because it’s probably affecting yours too.
Kim Insley: I’m Kim Insley.
Lynn Melling: I’m Lynn Melling.
Julie Bartkey: And I’m Julie Bartkey, and now on with the pod.
Kim Insley: Welcome to Three Women and a Bottle of Wine. I’m Kim.
Julie Bartkey: And I’m Julie.
Lynn Melling: And I’m Lynn, and with us for this segment is Dr. Annelise Swigert from Southdale ObGyn.
Julie Bartkey: And why is she here? Because whether you are 18 or 80, there’s still a whole lot going on down there.
Lynn Melling: There’s a lot going on down there, yes.
Julie Bartkey: We’re about to get really real.
Kim Insley: So, welcome. Dr. Swigert. First up, you’re not just a Minneapolis-Saint Paul Magazine Top Doctor, which is pretty awesome in itself, you’ve embarked upon another journey even more impressive: you are a mom of a teenage daughter, a teenage son. So all of this is kind of right in your wheelhouse, isn’t it?
Annelise S.: That’s right, and in fact, I had the wonderful opportunity to have a patient come see me who I had actually delivered.
Hosts: Oh wow. No way! [crosstalk 00:01:16]
Annelise S.: So now I’m starting to take care of my patients’ daughters, which is just fantastic.
Kim Insley: Well isn’t it great to graduate from medical school when you’re 10? I mean… [crosstalk 00:01:23]
Julie Bartkey: I was just going to say you can’t see her, but trust us when we say that, it’s hard to believe. You look amazing!
Lynn Melling: You preserve quite well.
Kim Insley: So let’s start with teenagers then. Okay. A question that I’ve often wondered: when should a young woman’s start seeing an OB-GYN?
Annelise S.: Well, I think that’s a great question, and we’ve been doing a lot of work in our clinic talking to families and teenage girls about kind of doing that first teenage visit. I think a lot of girls and young women are so anxious about seeing an OB-GYN because of the pelvic exam, and it’s kind of scary, and to get undressed and feel vulnerable in front of someone that you don’t know. But we usually start our teenage visits without an exam. It’s a way to kind of get to know your doctor and to create a trusting relationship. And I talk to teens about coming in somewhere between 16 and 18 if everything’s going well to start a conversation, to better understand what’s normal, what’s not normal with things like your period. What are your contraceptive options? What are things like Plan B? How do you give safe consent and understanding? There’s a trusted person to help you through that. So we will often start that relationship at that age.
Annelise S.: Obviously, we often see younger patients if there are issues, if young girls are having issues with their period or other, things down there. As you said, we certainly see patients down to age 12 actually and even younger.
Julie Bartkey: So Dr Swigert, as you know, teens do get so much information from the friends and from social media. Clearly not all of it is accurate. For example, you can’t get pregnant when you kiss somebody. I had no idea. [crosstalk 00:03:01]
Lynn Melling: Or from a toilet seat[crosstalk 00:03:03].
Julie Bartkey: although sometimes I feel like I do. But anyway, what are some of the myths that we can debunk right here?
Annelise S.: Well, we try to make sure that in debunking myths we don’t help teenagers be too safe with sort of the choices that they make. So, one question is what does? We get a lot of questions about what does it mean or I know that teens talk about what does it mean to be a virgin and do you have to have a certain kind of sex to still be a virgin and what does it mean to get, in terms of like you said, getting pregnant and you do hear it just takes one, it just takes one sperm. That’s actually a true fact, right. So that you can have intercourse or have close relations and put yourself at risk for that. You can put yourself at risk for all STDs without actually having intercourse or for most STDs. So I think I talk a lot to actually women of all ages, that even close physical contact, you just need to make good choices and be, be cautious and understanding.
Julie Bartkey: Is there one though? Did you hear something that just kind of blew your mind? Like how did this get out there?
Annelise S.: The one thing that always sticks in my mind, this actually is related to pregnancy because there’s just like, there is about the woman’s by, there’s quite a bit out there about pregnancy and this about pregnancy. But we did have a patient call once extremely anxious and upset because she had swallowed her a piece of gum and she was concerned that the gun was going to somehow strangle or get into the baby’s hair.
Lynn Melling: Into the hair? She was worried about the hair?
Annelise S.: Which just goes to show you that…
Julie Bartkey: Aw, bless her heart.
Annelise S.: Right? I mean, and I mean just the understanding of the anatomy of where their pregnancy is growing into. And you’d think that by the time someone is halfway through a pregnancy and in the clinic that they would have a basic understanding. But, it starts honestly sometimes with basic anatomy.
Lynn Melling: Well you’re so, your daughter is 15 years old, so well ahead of her time. So she’s on the national teen council for planned Parenthood. She serves as an educator for teens here in the Metro, which I think it’s so empowering to see a young woman being ready to and willing to, to have these conversations. Do you think it’s easier for teens to have these conversations and get this information if it’s coming from another knowledgeable teenager?
Annelise S.: I definitely think it is and I think that they can speak a language and answer questions and look at things in a way that we can’t understand and I think that they know the things that are scary and on teen’s minds that we don’t understand, even as parents or as physicians or healthcare providers.
Kim Insley: You asked your daughter also earlier today actually Dr. Swigert to tell you what she thought the issues were or the most important things for kids and she gave you this beautiful quote and I just would love for you to read it.
Annelise S.: Yes, I will. I did ask her, I said, what do you think is the biggest issue in reproductive health facing teens today? I asked her and this is what she responded. “What we discuss at teen council ranges from acceptance and care for everybody, including in the LGBTQ plus community to basic things like anatomy. I would say right now the most important issue is that so many teens don’t have access to necessary information that they need to understand their body and themselves regardless of a person’s race, ethnicity, economic state, gender identity, religious affiliation. Everyone deserves non-biased education about their body and their choices.
Annelise S.: That’s why teen council is so important. We are allowing teens to access this education through an organization that they can learn to trust and go to it necessary. Education, shouldn’t discriminate and teen council makes that goal a reality”.
Julie Bartkey: Wow, that’s beautiful.
Annelise S.: I know.
Lynn Melling: So for teens, because not all teenagers have access to that kind of information, whether it’s because of their families or where they live, it’s in a rural area. So are there ways, are there places that you would recommend, so if a teenager or a parent or someone who’s listening to this knows of a kid who needs access to information, are there any easy places that they can go to?
Annelise S.: Well, let’s say you know obviously aside from, you know, health informed websites such as like Mayo.org, Planned Parenthood [inaudible 00:07:17] actually has a fantastic Instagram feed and the teen council has an Instagram feed and they post daily information about these exact ideas and concepts. So, so much about Planned Parenthood is really about women’s health, but beyond that, everything that my daughter talked about, which is safe choices, understanding your body, self-respect, respecting yourself, having others respect you.
Lynn Melling: That is girl power.
Kim Insley: Absolutely.
Julie Bartkey: Dr. Swigert, can we jump up to my age group a little bit here? [crosstalk 00:07:46]
Annelise S.: Of course!
Julie Bartkey: You had just these women in their late forties fifties late fifties early sixties even as we’re hitting that menopausal premenopausal timeframe, what are some of the changes we can expect? Things that we can’t just necessarily read on Web MD?
Annelise S.: Well, I’m going to say I’ve started to tell my patients that being 47 is sort of like being 17 again, that all of a sudden everything you had right before your period acne, breast tenderness, bloating, five pound weight gain, cranky, mad, angry, crying. Right? [crosstalk 00:08:18]
Lynn Melling: We have to go through that again. [crosstalk 00:08:20] Are you kidding me?
Annelise S.: I mean, it’s these, these, these really sort of drastic hormone fluctuations and the physical symptoms, they cause a real.
Julie Bartkey: Oh, my son just had a little levity. At one point. I was so mad at him over something so stupid. He looked at me, he’s like, I don’t even know who you are anymore. It’s like, Oh, there’s a moment. Yeah. And you can’t talk to a 17 year old boy about menopause.
Kim Insley: So quick questions.
Annelise S.: Unless you’re an OB GYN.
Julie Bartkey: Right?
Annelise S.: My poor son has to hear about everything.
Kim Insley: So my question back to acne, but I have noticed that I’m starting to get acne around my face. Like where a man would have a beard. I’m now getting breakouts.
Julie Bartkey: Are you pregnant?
Kim Insley: Absolutely not. No, no chance. But is that, I mean, hormones, it’s, you just don’t even expect these things. This has never been a problem before.
Annelise S.: You have, so what’s happening is instead of, in our, in our late twenties and thirties our homelands are going on in this nice sort of level, even keel, right? And we’ve got two hormones. You’ve got estrogen and progesterone. Those are the two female hormones and as we get into our mid to late forties we start to have these more drastic fluctuations. So we’ll have like a surge of progesterone which can cause the acne that you’re talking about or the bloating that women feel and then you sort of have a drop in estrogen levels and you start getting the hot flashes. So it really is about the level of hormones and progesterone. That particular hormone is a cousin to androgen, which is a cousin to testosterone and so that’s where you get that androgenic effect of the progesterone.
Kim Insley: Super!
Julie Bartkey: I’m quite a fan of the little stray hair that I’ll pop out that’s never been there before.
Kim Insley: The one thing that [crosstalk 00:09:57]
Julie Bartkey: we’re getting real right?
Lynn Melling: Surprised me, is just how like, I had never heard of perimenopause and then this whole process takes forever and as you and I were talking earlier, it also happens at the same time when Holy hell is breaking out with your kids. You have aging parents perhaps maybe a job change or you’re getting back into the job market. It’s just really hard. And this, we’re talking more than a 10 year stretch in some cases. Aren’t we?
Annelise S.: You know, it can be, I think it’s most pronounced probably 45 to 50 but I certainly have women at 40 coming in saying I’m feeling these hormone changes. All of a sudden I’m having headaches. I didn’t have that before. I am having the five pound weight gain right here and I didn’t have that before. So you’re right. For some women, those hormone fluctuations last up to 10 years. For some women they’re a month. It’s really variable.
Lynn Melling: [crosstalk 00:10:47] And women are choosing to have babies later. I know I have a surprise package who came at 42 so I had those post-baby hormones mixed with premenopausal hormones. It was the recipe for a perfect storm. And I’m not the only one. There are a lot of women out there having their children in their late thirties early forties now. So how do they reconcile any suggestions on how we can kind of navigate through this without drinking a lot of wine?
Kim Insley: More than one bottle?
Annelise S.: Well, I mean I think you’re right. I, the women, lots of women having babies when their 35 to 40 but also a lot more women 40 and older than we ever have seen before. And you’re right, they’re facing different health challenges. Certainly very important to get exceptional prenatal care I would say because there are other risks to mom when you’re pregnant at that age. And you’re right, I think women face other issues postpartum, we know that all women are at risk of postpartum depression and anxiety, but I think at that age the adjustments are more pronounced. I think to your own peer group isn’t necessarily going through what you are. So I’ve heard from a lot of my patients having babies in their forties where do they find that peer group of moms that are actually understanding what they’re understanding? Many of those Moms, they have much older children, maybe it’s a second marriage or maybe it’s actually their first baby and they want their peer group to talk to about breastfeeding and what kind of car seat do I buy and you know, which preschool do I go to?
Lynn Melling: And on the opposite side of that, then there’re women who are struggling with infertility, who have been trying to conceive. What are you noticing in terms of trends? There’s so many more options out there for treatment of this, but I’d love to know your thoughts on for listeners who might be struggling with infertility, any words of wisdom for them?
Annelise S.: Well, I think that a lot of women out there hear this number 35 and that sort of become this sort of weird number where, oh my God, I’m 35 I haven’t had a baby yet. And that is a number that came out of genetic tests and insurance coverage back in the eighties so sort of that that is not really like a hard and fast age, so I think a lot of women focus so much on that age, but what I do tell women is it is true that from 20 to 40 every single year your fertility declines a little bit and the miscarriage rate goes up a little bit. It doesn’t drastically change at 35 but it continues to change. I think the most important thing, no matter what your age is, have a conversation sooner than later with your doctor.
Annelise S.: Sometimes women think they’re having issues with fertility they’re not, but having a good solid checkup, getting all your questions answered, understanding what you can and can’t get from say fertility app, I have lots of patients using fertility apps. I think the science for helping women get pregnant is phenomenal right now and it’s changed a lot. Even since I entered medicine and even in our own community.
Annelise S.: We have lots of options for women and so getting in to see your primary care provider who can help get you to the right place. Egg freezing is sort of the new thing on the horizon that we’re all hearing a lot about. I think, we don’t know yet, what is the data going to tell us if you freeze your eggs in 15 years later, try to use one. We don’t really know that yet, but that technology is there, so it’s really, it’s always about as much knowledge as you can have. What are all of my options, what do I need to do so I can make the best informed decision for myself?
Kim Insley: Another thing that you’ve noticed over the years is that our definition of families are changing a lot. You talked earlier, your doctor was talking, or your daughter was talking about LBGTQ people. You have couples who are same sex couples who are trying to get pregnant or they have a surrogate. Speak to that a little bit about how we include everybody in this health issue and having a family in and being good parents and being healthy if you’re trying to be a parent.
Annelise S.: That’s a great question. I think I really pride myself on our clinic and all of our healthcare providers because what we tell our patients is there are many definitions of family and everyone defines family in their own way, and that could be a male and a female, married or not married, two women, two men, or even as a single woman or even a single man who in all of these iterations of family wants to have a healthy baby. And so my job, again almost going back to the same fertility question, how can we help get you all the resources, information that you need so that you can have a healthy family. And we’re helping couples with finding donor sperm, with insemination, with helping support same sex couples as they navigate the legal system, navigate things such as who’s going to give the baby the first bottle over at the hospital. We provide compassionate and safe care and we don’t judge. I mean I really go back to there are so many definitions of family and I’m always telling my kids that too.
Julie Bartkey: I love it. So can I loop it back to my age group again? I want to talk about sex. [crosstalk 00:15:38] Lets talk about sex, especially as women are entering this menopausal stage, some women lose their sex drive. How do you counsel them and what can people do to, to try and make sure their sex drive is intact if they so want it to be?
Annelise S.: That’s a great question. I get asked that all of the time from women that are 42 women that are 70 and you know, again, when we get into this peri-menopause discussion and our hormones changing and life stressors, I mean studies have shown libido in women is very complex. You know, it’s not like men where you can give them a Viagra and then all of a sudden we’re good to go. Right? So studies that have looked at pharmaceuticals for libido for women have not been very successful because it’s very complicated. So it’s about women feeling focused and safe and relaxed, being healthy, healthy eating, exercise along with libido though, there’re other changes that happen in menopause and some of those changes that are due to our lack of estrogen can actually make sex painful. So women who had a great sex life and maybe even still have a great libido are now dealing with issues of painful intercourse.
Annelise S.: So that’s something that we a have a lot of treatment options for in our clinic. Everything from lubricants, to estrogen, to a laser to help improve the tissue functioning in the vagina. It’s called the Mona Lisa laser.
Kim Insley: Really?
Julie Bartkey: Really, that is fascinating.
Annelise S.: Candace Bushnell wrote about it in her new book. She’s author of Sex in the City, she has a new book out. It’s like is there still sex in the city? It’s a fantastic book if you guys haven’t read it and there is an entire chapter about women dealing with painful intercourse because of low estrogen levels.
Julie Bartkey: I would argue that maybe the equivalent to Viagra for many of us women is just seeing your partner at the kitchen sink with a dish towel.
Lynn Melling: Men if you are listening. Take notes. [crosstalk 00:17:28]
Julie Bartkey: That is foreplay. 100%.
Kim Insley: That leads to another topic though and that is couples aren’t always on the same page when it comes to their libido.
Julie Bartkey: What are you talking about Kim?
Kim Insley: If you’re going through menopause or you know, it’s just not always the same. And so there has to be a lot of communication I would assume.
Annelise S.: You need a lot of communication and it kind of, it’s sort of the same thing you face when you have a new baby too and you’re the mom and you’re exhausted and you’re breastfeeding. You just don’t want to have sex. And actually your estrogen levels are low then too. And it’s about making time, communicating, feeling respected. And you know what I tell women, there’s nothing wrong with you. I mean, a lot of women, no matter what age they are, they fear something’s wrong with them if their libido’s not where they think it should be. And sometimes it’s just really talking through what’s going on in your life right now, how can you make changes to feel safe and respected and rested and happy and content and just giving women the support to realize there is nothing wrong.
Lynn Melling: Yeah. And there’s nothing wrong with reading 50 Shades of Grey if it helps boost your libido. [crosstalk 00:18:35]
Julie Bartkey: Watch the movie [crosstalk 00:18:37]
Annelise S.: It wasn’t as good as the book was.
Lynn Melling: There is other good movies too by the way.
Kim Insley: Aren’t there a lot of misconceptions about, let, let’s jump up another generation, seventies eighties beyond, I mean, seniors want to be healthy and active and I’ve heard that STDs can be a problem in amongst elders. Do you counsel a lot of people of that age group? What kind of questions do you get?
Annelise S.: You know, well I can go, we could be talking about, there’s like the 70 and 80 year olds and I think that are living in different kinds of like group communities maybe where they’re just kind of redefining, what they do with their time and who they spend time with, if their life partner is no longer with them and I think most STDs are not, I’m going to say a significant health risk in that particular population. I think then there is the population of women say in their late forties or early fifties who maybe their life is changing and they’re having new partners or new experiences and they are having to think back to their 20s and wondering am I at risk and to those women in that age group who are also still possibly facing the risk of an unplanned pregnancy.
Annelise S.: I do have to go back and have the discussions about, okay, here’s what you’re at risk for. Here’s what you can do to prevent it. You know? Yes, you should be using condoms. Yes, you should be using birth control. You know, here are the symptoms where you need to come and see us if something’s going on.
Kim Insley: Because it’s not just about, Oh, you can’t get pregnant anymore, so don’t worry about it.
Annelise S.: Right.
Lynn Melling: Exactly.
Kim Insley: There’s other stuff.
Julie Bartkey: So I want to ask you, your title is OB GYN, everybody seems to focus on those baby bearing years. Do you no longer need to see an OB once you’re a post-menopausal?
Annelise S.: No. I would argue women should see me for their entire life. I mean, again, a woman’s body just doesn’t…
Julie Bartkey: I think you’re cool.
Annelise S.: I mean, think about it like who do you, is your cardiologist’s going to do your pap smear.[crosstalk 00:20:40].
Kim Insley: I went to an internist and he was like, okay, breast cancer, you have your gynecologist handle that for you. He was like, you didn’t want to touch anything.
Julie Bartkey: That’s not, never even occurred to me that anybody else would do those, those particular exams.
Kim Insley: Yeah. I mean it was part of it, if you get a physical right.
Lynn Melling: Sure.
Kim Insley: He didn’t want to go there.
Annelise S.: Well and we, and we’re primary care for a lot of them and especially young women who frankly really their main health issues are going to be reproductive health their periods, breast cancer screening. So we do a lot of primary care for healthy women. But even for women in their sixties and beyond, it is so important to get a well woman exam. You know I have found numerous cancers in women in that age group, you know other health issues that may go unrecognized symptoms that they cannot even articulate or don’t feel safe articulate into another doctor. So you know, we certainly support having a woman seen OB GYN every year for a well woman exam.
Kim Insley: Wouldn’t you have a better option of finding an ovarian cancer maybe then.
Annelise S.: Ovarian cancer, Vaginal cancer, Valvar cancer, Bladder cancer, Breast cancer obviously. So it’s important.
Kim Insley: All right, well we are going to take a quick break when we come back the Final flight.
Kim Insley: Three women and a bottle of wine is supported by five one five productions, five one five productions in a video production business with base camps in Minneapolis and Demoine, Iowa, EN who’s so great and his crew understand the art of creative storytelling and they know how to make video look really, really good. Learn email@example.com our logo was created by Aaliyah to salts, a creativity guru, offering art workshops to everyone from business executives to book clubs because we all have untapped creative potential, just waiting to be young. You can find her contact information on our website.
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Julie Bartkey: Welcome back everybody for our final flight. This is the time we have when we take a little bit of time, have some fun with our guests. Three quick questions to help us learn a little bit more about you. So the first question, I understand that you love to travel. What’s your ideal vacation and why?
Annelise S.: I do love to travel. I just got back from the Riviera on Sunday and my ideal vacation is going somewhere and really experiencing life there, eating the food with the locals, talking to the locals, walking down the street, walking into little storefronts. I was in Haiti for a mission trip about a year and a half ago and one of my favorite things was just walking through the streets, talking to the people, tasting their food and so whether it’s Western Europe or whether it’s South America or Asia or even, you know, developing country, I’m just living that life, living the life of the other people another place.
Kim Insley: I love.
Lynn Melling: That sounds amazing.
Kim Insley: And she’s fluent in French, I must add. [crosstalk 00:23:53].
Lynn Melling: So what is one of the stranger misconceptions you’ve heard about women and the reproductive health?
Annelise S.: Well, I will save him practicing a long time. I’m not going to say how long because [crosstalk 00:24:06] I have gotten so many unusual questions, so many unusual stories. Many of them I will say came out of a residency when you know you are kind of in your training and you’re really in the trenches seeing patients 36 hours a week. But we did see a couple in our infertility clinic who were having trouble getting pregnant and they couldn’t get pregnant. And so it was my job is like the first year resident just sort of do that initial evaluation, sort of starting to ask kind of some basic questions, and what ended up coming out of that conversation was they were trying to get pregnant through the wrong hole. [crosstalk 00:24:41]
Kim Insley: I mean I feet like such a good doctor, I could fix their problem [crosstalk 00:24:52] anatomic diagrams. I was, I helped them get pregnant. [crosstalk 00:24:55]
Annelise S.: It was sort of like, like the, the, the meal and the couple was sort of camper. Nice. Like I sort of wondered if maybe he actually knew. Yeah.
Kim Insley: You know, I’m thinking she sent you flowers after [crosstalk 00:00:25:11].
Lynn Melling: Maybe named her firstborn. [crosstalk 00:25:15]
Kim Insley: Okay, well speaking of getting pregnant then we hear a lot of a lot of things. So lastly, are there any really tried and trued ways, true ways for women who are at their due date who want to get that baby moving out? Cause we hear a lot of things.
Annelise S.: well there are a lot of a wise tales and a lot on social media about all the different things you can do. Raspberry leaf tea and tonic water and garlic. But there is actually scientific evidence that supports having sex can definitely cause labor to start.
Julie Bartkey: Thank God you said that.
Kim Insley: [crosstalk 00:25:46] and a woman’s out to here. She’s all for it. It’s the dad that it is like, yeah. What did you mean? Aren’t I going to hit the baby’s head or something? [crosstalk 00:25:58].
Julie Bartkey: We are never dropping final flights for this podcast. Dr. Swigert, thank you so much for joining us today.
Lynn Melling: Dr. Ana Lisa Swigert and you’re with Southland OB GYN. Did I get the right?
Annelise S.: Yes. You did. Thank you.
Kim Insley: Thank you so much.
Lynn Melling: [crosstalk 00:26:21] This has been a blast.
Annelise S.: It’s so fun, I was telling him I want to do this every week.
Kim Insley: We got to have a part 2.[Crosstalk 00:00:26:30]