Excerpt: 'Ask Dr. Marie,' by Marie Savard

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ABC News medical contributor Dr. Marie Savard tackles the most intimate questions women have about the female reproductive system in her new book, "Ask Dr. Marie: Straight Talk and Reassuring Answers to Your Most Private Questions." In a tone a best friend or sister might take, Savard explains what's normal and what women should do when they believe they have problems.

Savard tackles issues according to life stages, moving from menstruation to menopause and beyond. She also describes how to get the health care you need and ways to make the most of the little time you have during a doctor's appointment.

Read an excerpt of the book below, and head to the "GMA" Library for more good reads.


The Doctor Will See You Now

Let's imagine for a moment that my office door is open. Come on in. We'll close the door so we can have some privacy. You're free to take all the time you need to educate me about yourself, share your concerns and questions, and learn from my knowledge and experience about women's health. Even more important, I want to give you information that will make you marvel at the miracle of your woman's body and inspire you to become your own primary caretaker for every aspect of your health, including prevention, medical records, lifestyle, and decisions about treatment options. After all, who cares more about your health than you do?

Before we begin our ideal office visit, I'm going to take off my white coat and come around from behind my desk to sit in the chair right next to you. I'm a doctor, but I'm also a woman. I want to connect with you as a person who has the same awe-inspiring but sometimes troublesome body parts that you do. I've been in the stirrups for gynecological exams, and I've given those same exams. I've lived the female life cycle of fertility from puberty through pregnancy, childbirth (a firstborn son, followed in short order by twin sons!), breastfeeding, menopause, and life after menopause. Not only that, but I've had my share of problems "down there" as well.

Yet in spite of the fact that I'm a doctor married to a doctor, at times I've been as guilty as the next woman of suffering in silence either because my complaints didn't seem important enough to mention—or because they seemed, well, unmentionable. I've gotten over that as you'll find out when I come forward with my problems in some of the chapters of this book. The point is, though, that even I kept these "female troubles" to myself for decades. I have long told each of my patients that whatever questions she has, she is not alone. Yet I had a blind spot when it came to myself. Believe me, opening up has been liberating. I'll also admit that when I was a young woman, I used to be influenced by the old patriarchal "yes, doctor" model of the physician as an all-knowing authority figure whose wisdom was not to be questioned. That era has long since passed and I've followed my own advice about taking charge of one's health and establishing a doctor-patient relationship based on mutual respect and clear communication. Yet I have become well aware that this is not always easy to put into practice, given the constraints of the health-care system in the United States today. For obvious reasons, office managers and group practice administrators are not pleased with physicians who spend as long with each patient as she truly deserves. (Nor are many physicians themselves, who worry they can't cover their expenses if they see too few patients.)

Consequently, the ideal picture I painted about our long and in-depth consultation in my office would be all but impossible to achieve in reality. That was my impetus for writing this book for you, as an alternative. The idea first came to me back when I was one of four physicians in a group practice with "panels" of thousands of patients. If you had been one of my patients, your visits with me in my office would have been limited to a mere fifteen minutes, which translates to about seven minutes of face time with the doctor, unless you had been scheduled for your annual full physical exam. Even then, we would have had a scant thirty minutes together to cover not only medical issues but everything else you might have liked to confide to me.

If you had been given enough time to relax and open up to me, you might have talked about your sex life, or lack thereof. Or perhaps you would have been honest about the moodiness you had been experiencing at the mercy of hormonal fluctuations, whether as a teenager, a new mother, or a woman entering menopause. If you hadn't felt so rushed, you might even have gotten up the courage to tell me about troubles with your "private parts" that you've been too embarrassed to talk about, such as wetting your pants when you sneeze or cough, straining to have your bowel movements, feeling fat and bloated, or leaking through pads and tampons so that you stain your clothes and sheets. Usually, however, the visit would have been over all too quickly and you would almost certainly have left my office feeling frustrated because only your most urgent or immediate concerns and conditions had been addressed whereas what impacts the day-to-day quality of your life was probably not even considered. I was frustrated, too, when I was forced to do the medical version of speed dating with my real-life patients. That's why I eventually limited my practice in order to devote most of my working hours to bringing my message of health empowerment to women everywhere.

During my years since then as an author, television and radio commentator, speaker, and consultant, this message has become my mission. At its core it remains the same as it was when I made the decision in medical school to train as an internist rather than as a gynecologist. The year was 1973. Back then there was no formally designated specialty in women's health in the holistic sense of treating the patient instead of just the parts. My first rotation that summer in obstetrics and gynecology made me aware of the gaping need for just such a specialty. I decided that by choosing to become an internist—a "family doctor" who could take care of both men and women—I would get a broad-based medical education that would arm me with the greatest range of knowledge and hands-on experience. Although I wanted to focus on women's health in the long run, I felt strongly that by including men in my practice, I would be better able to understand "all that ails us" as women and to help us help ourselves. That proved to be true as I learned in the trenches day by day during the many years that I had male as well as female patients.

Eventually though, I did begin to concentrate on women's health issues. By 1979, I was a fellow at the University of Colorado having completed an Internal Medicine residency at the University of Pennsylvania. I was looking for a research project. Coincidentally, I had just finished taking a seven-day regimen of antibiotics for a bladder infection called cystitis. I was annoyed at how much trouble it had been for me to find a doctor and get an appointment quickly, and I was also not pleased about the cost of the physical exam, the urinalysis, the urine culture, and week's worth of medications. On top of all that, I was worried that I would end up with a vaginal yeast infection since I knew that the drugs would upset the natural flora of the vagina. Sure enough, I did get yeast vaginitis and then I had to pay for medication to cure that!

Even more important, I had been hesitant about taking the antibiotics because a few years earlier my lab partner and girlfriend during my first year of medical school had died from complications of a severe allergic drug reaction to a sulfa antibiotic that she was taking for cystitis. The drug allergy symptom was a skin rash that was misdiagnosed as a viral infection called pityriasis rosea. She kept on taking the sulfa antibiotic and it eventually killed her. What was so eerie for me was that back then I too had symptoms of cystitis. I was having trouble getting in to see a doctor, so my friend actually gave me her follow-up appointment for the cystitis because she was preoccupied with her newly developed skin condition. No wonder I have spent much of my career teaching women how to manage their own health, how to collect, read, and save their own test results and how important a complete and accurate medical history is. I lost a dear friend years ago in part because she didn't know how important it was for her to be proactive about her health.

Not long after I took the medication for cystitis, I read a research study published in the prominent New England Journal of Medicine that reported on how women with symptoms of a urinary tract infection could be accurately diagnosed and successfully, safely, and efficiently treated just on the basis of their response to a three-day course of antibiotics. I learned about a simple method of culturing the urine called the dipslide method, which seemed like a terrific and inexpensive tool that women could use themselves to diagnose their own urinary tract infections (UTIs) at home. They could thus avoid the cost of a doctor's visit and pay only for a short course of antibiotics while minimizing the side effects of medication. Empowering women with information and control was part of my DNA from the beginning, so this study really got me excited! I knew I had found the research area I wanted to devote myself to during my time in Colorado. The results of my study were eventually published in the prestigious American Journal of Medicine. The study also launched my career in women's health, patient empowerment, and the use of evidenced-based medicine to inform patients and doctors alike about the best and most cost-effective treatments.

By the mid-1990s I was the director of the Center for Women's Health at the Medical College of Pennsylvania and a regular columnist for Woman's Day magazine as a women's health expert. As it happened, I was on the leading edge of this specialty precisely when the recognition in medical circles that women are not just "small men" came at last. I felt somewhat vindicated. I had long been a proponent of treating women with regard to the fact that we metabolize differently from men, that our livers work differently, and that our powerful hormones are sometimes protective and sometimes a challenge to our overall brain and body well-being. Soon I became an advisor to the spanking-new Subcommittee on Clinical Competency in Women's Health of the American Board of Internal Medicine.

Because I'm not a gynecologist but rather an internist with a specialty in women's health, my expertise about the strictly female concerns of the area "below the belt" is informed by my in-depth knowledge of the body as a whole and my awareness of the potent mind/body connection. As you may know, the phrase "below the belt" comes from a boxing rule that prohibits hitting a man's groin. What's interesting is that in the 1970s when women's boxing became a professional sport, the "below the belt rule" was applied to women as well, in order to protect the womb. Male and female boxers alike now wear external protectors so that there's less chance of damage to the organs we need in order to conceive. I like the idea that we should also learn to protect our precious area internally with good health knowledge and habits rather taking a chance on harming it with life choices that "hit below the belt."

There is also a general lack of understanding about what really goes on "down there" and a good measure of mortification about the often smelly, sticky, itchy, leaky symptoms of what we still refer to among ourselves as "female troubles." That's the reason I chose to make our internal female organs and our "plumbing" the main focus of this book. I do make some references to our breasts, but only when issues concerning them are intrinsically tied to the functions and problems of our mysterious inner gynecological landscape.

Having said all of that, I want to add that I started my career in medicine as a nurse. During my years on the wards and in an intensive care unit as a critical-care nurse, I had the opportunity to develop personal connections with patients. I cared about them and I wanted to be an advocate for them. That was the beginning of my lifelong passion for patient power.

A turning point in my life came in an ICU late one night when a sweet, frail woman in her eighties with a brain tumor began the violent, rhythmic convulsions typical of a grand mal seizure. I knew she needed intravenous Valium, and fast. However, as a nurse I was not legally allowed to administer the medication without a doctor's verbal order. I called for the intern on duty and then waited what seemed like an eternity while the woman continued to twitch and shake uncontrollably. Finally a very young doctor, groggy from the sleep deprivation typical of all residents, arrived and insisted on doing a brief examination rather than take my word for what was happening. I felt utterly powerless and demeaned. In that moment, I knew without a doubt that I was going to find a way to go back to school and become a full-fledged physician. Like the vast majority of women of my generation and my mother's generation before me, I had seen teaching and nursing as my only two career options. My mother herself was a nurse and I followed her example. Yet my epiphany that night in the ICU in 1970, bolstered by the rebirth of American feminism that was under way, spurred me to enter the almost-all-male preserve of M.D.s. Looking back, I see that I knew even then that my mission would be to empower women as the guardians and nurturers of their own health.

To that end, women must understand their bodies and be tuned in to their personal health. I urge you to honor your intuition and emotions, including not giving anyone else's opinion or needs higher billing than your own, be it a partner pressuring you for sex or a doctor disregarding your questions and concerns. The "Golden Rule" asks us to "Do unto others as you would do unto yourself." I would argue that for women, we need to flip that around so that it says, "Do unto yourself as you would do unto others." What I mean is that you need to take care of yourself with at least as much devotion as you take care of everybody else. We tend to put ourselves last on our list of priorities but that's not good for those we love any more than it's good for us.

My "Golden Rule of Women's Health" applies to all of us at all ages and stages of our lives. Are you a teen who's only recently started getting your period? Are you a woman in your childbearing years? Are you a woman approaching or going through menopause? Are you a woman enjoying the decades of life after menopause that were denied to so many of our grandmothers and even our mothers before medical advances dramatically upped our life expectancy? Whatever the case, the following pages offer clear, comprehensive, and compassionate answers to your questions about sex, libido, hormones, and everything else that goes on "down there." You'll hear the voices of real women dishing about the intimate and sometimes funny details of everything from birth control to bladder problems to menopause. I'll give you lists of symptoms so you'll know whether to get help for those aches and itches and discharges and bumps.

You'll also find:

straight talk about what I call Smart Sex
lists of diagnostic tests including those you can do yourself
solid medical advice about treatment options ranging from over the- counter and home remedies to surgery
translations of medical jargon into language you can understand
examples of actual medical test results
sketches to help you understand once and for all what's going on "down there"
advice about how to get the most out of the doctor/patient relationship
plenty of encouragement to help you find a fresh and positive
perspective about the inevitable transformations you'll encounter as you enter each new chapter of your life

In many ways, this book is even better than that hypothetical office visit I asked you to imagine. You can come back to these pages again and again whenever a symptom or a life change or a treatment decision prompts you to look for information and reassurance. You can also share the information across the generations in your family and among your friends. Women have instinctively been one another's "health buddies," confidantes, soothers, and healers since the dawn of human history. Now more than ever, as we are bombarded by information technology and hurried through our health-care consultations and procedures, we need to help each other by sharing our stories truthfully and becoming fully informed about our health as women.

Let's celebrate our bodies for the wonders of nature that they are. For one thing, they give us a statistical edge over men in the longevity department. They also give us the chance to choose to savor the pleasures of sex, to bring the next generation of babies into the world, and to nourish those babies with mother's milk. However, even if you are a woman who isn't willing or able to fulfill any of those biological functions—and I respect your life circumstances and choices 100 percent—you need to appreciate the marvel of your female body and learn how to keep it healthy. For example, the elderly nuns I treat as the primary care physician for the Cabrini Retirement and Nursing Home in Philadelphia need every bit as much care of their female organs and their "plumbing" as do women who have been sexually active and given birth.

Cabrini was the crucible of my crusade for patient power, in particular the need to collect your own medical records. When I first arrived there in 1981, the missionary sisters were overmedicated and their records were literally scattered all over the world, with most of the paperwork still in their mission countries. As I gradually gathered together what I needed to make accurate diagnoses and treat these women properly, I devised a method of record keeping that turned out to be the genesis of the Savard System I first made available in 2000 and which I continue to refine to this day. With the nuns' records well organized, I was able to help them benefit from the most alert, vigorous, and pain-free lives possible.

That's what I want for all of us. When we're healthy women in control of our wellness, we are far better able to sharpen our minds, pursue gainful employment, and just plain have a terrific time being alive with our partners, our children, our extended families, our colleagues, and our dear friends. That's why I want you to get past any reservations you may have about tuning in to your total self. I want you to do all you can to achieve optimum health as much as is possible for you. You owe that to yourself and to those who love you.

Let's start with a guided tour of the hidden treasures in your body that define your womanhood. . . .