A typical ob-gyn visit might fall somewhere between merely uncomfortable and absurd — the stirrups, the speculum, the scooching forward with your paper gown open in the front. If you’re getting a routine pelvic exam or you’re due for a Pap smear, there’s just no way to avoid these indignities. But they don’t need to be part of every ob-gyn appointment. In fact, a lot of gynecological and obstetric care can be accomplished through video visits.
“This is not replacing in-person care but augmenting it,” says Dr. Nathaniel DeNicola, an ob-gyn and chair of telehealth at the American College of Obstetrics and Gynecology. “It’s a way for doctors and patients to connect between visits or when in-office care isn’t possible. And many kinds of traditional gynecologic care lend itself to this.”
Services that can be done virtually include adjusting and refilling prescriptions, following up on existing issues, going over birth control options, managing PMS, talking about vaginal discharge or itching, reviewing lab results and discussing menopause. These types of visits are typically talk-heavy and may not include any type of physical exam. It’s very easy to conduct a thorough history-taking and counseling session over video, DeNicola says, and also to discuss any changes in medication.
Obstetrics can be harder to do remotely; during prenatal checkups, the doctor needs to check the fetal heart rate, the baby’s growth and the mother’s blood pressure. But unless any labs are needed, the doctor spends the rest of the visit asking the mother questions — about issues such as sleep and mental health, whether she’s had abdominal cramping or noticed fetal movement — and answering any questions she has. So, DeNicola says, “during this time [with COVID-19], some alterations of prenatal care have been made.” For example, some ob-gyns are encouraging patients to purchase fetal heart rate monitors, which may allow for less frequent in-person care. If a patient has a scale, a blood pressure cuff and a way to take her pulse, she can share these vitals over a video checkup too.
Additionally, glucose monitors allow pregnant women with gestational diabetes to avoid coming into the office, and research suggests this type of treatment works just as well as in-office care.
Once a woman gives birth, a doctor may also do some postnatal video visits, including ones focused on postoperative care. For example, a patient who delivered via C-section could take photos of her scar, or just show it to her doctor onscreen during her visit, to make sure she’s healing properly. A doctor may also ask a postpartum patient if she’s experiencing pain at the surgical site, changes in body temperature or vaginal discharge, adds Dr. Mary Jane Minkin, an ob-gyn and clinical professor at the Yale University School of Medicine.
Screening for postpartum depression can also take place virtually. “Typically we use a questionnaire with a scale,” explains Dr. Tamika Cross, an ob-gyn at Memorial Hermann Health System in Pearland, Texas. The doctor can ask these questions during a video visit or even a phone call, and use the results to determine if a patient needs further follow-up treatment, which a therapist can also provide remotely.
Lastly, if a couple wants to get pregnant, now is a great time to use telehealth. “The first part of a fertility consultation is discussing the woman’s health history and, if the couple is having trouble, laying out treatment options and timelines,” DeNicola explains. Once a doctor is familiar with a patient’s relevant medical history (e.g., health conditions, current medications, previous fertility treatments), they can recommend lifestyle changes, such as quitting smoking or taking a prenatal vitamin. If a woman is having problems with ovulation, a doctor may prescribe a drug called clomiphene citrate (Clomid) during a telehealth visit. Lab work and physical exams are required for fertility treatments such as IVF — but it’s worth noting that many doctors are postponing IVF treatments for now because it’s considered an elective procedure. In the meantime, a couple interested in IVF could still talk to a doctor about planning ahead and continue trying to conceive naturally.
When telemedicine might not work
Some gynecological issues may be diagnosed over telemedicine, but it depends on the doctor. When it comes to diagnosing urinary tract infections and yeast infections, many doctors already rely on patients describing their symptoms on the phone or in a secure email. However, research suggests women are only 56 percent accurate at self-diagnosing bacterial infections and 69 percent accurate at self-diagnosing yeast infections, so some doctors will only prescribe antibiotics or antifungal medication after performing a urine culture (for UTIs) or vaginal swab (for yeast infections). But given the extraordinary circumstances, those doctors may be willing to bend their rules for now.
If the prescribed treatment for any condition doesn’t work — e.g., if you think you have a yeast infection and get a Diflucan prescription from your doctor, but your symptoms don’t go away — then you’ll at least need to go into a lab for tests. Afterward, you could make a video visit to discuss your lab results with your doctor and get a treatment plan.
If you really don’t want to venture out, at-home testing is an option for conditions including UTIs, yeast infections, bacterial vaginosis, and some STDs and STIs. “You can consider them,” Minkin says. “But a lot of UTI tests won’t tell the specific organism, only if you have something bacterial or not. And while STI panels look at antibodies and some are reliable, they’re not as reliable as in-office tests.”
DeNicola says it comes down to who the patient is and what kind of test they need — and he recommends always using telemedicine to discuss test results. “You still want some trusted healthcare professional to walk you through the results,” he says.
If you want to try an at-home test, tell your doctor. They may be able to recommend a specific brand of test. If they don’t think a DIY test is a good idea, they’ll explain why. And if you decide to order one anyway, they’ll still look at your results and try to use them. “Getting some information is better than no information,” Minkin says, “so at-home tests can help your doctor advise you.”
How to prep for an ob-gyn video visit
If you’re interested in using telehealth for an ob-gyn consultation, first check with your insurance to see if they’ll cover it. Many will, but this varies widely from company to company and state to state.
Then come prepared: Make sure you have a strong Wi-Fi signal for video calls. Find a quiet space where your doctor will be able to hear you and where you’d be comfortable showing any body parts necessary for a diagnosis. (Or you can take clear photos and send them to your doctor ahead of time via a secure method like a patient portal.) If you had any lab work or at-home testing done, share that with your physician before your visit.
Consider writing down your symptoms in detail. Since your doctor can’t do a physical exam, they’ll be leaning on you more than usual for information. “When did your symptoms start? What do they feel like? What does it smell like? What’s the color? How long does it last? Is it associated with doing a certain activity, or more painful when you do certain things?” Cross says. “Be as specific as possible, because your doctor is going off what you can tell them.”
If you’re doing a prenatal visit, it’s ideal to have a fetal heart monitor and blood pressure cuff so you can report those vitals. If it’s a post-op visit, your doctor may want to see the incisions to check for any signs of infection, so wear comfortable clothes that make it easy to view your abdomen.
Lastly, have your insurance information handy when you schedule the appointment so you don’t get any surprise bills. “Every insurance company is doing this a little bit differently, and it’s changing day to day,” Cross says. “That will change how we bill for your visit.”
Moving forward, telehealth may be the way to go for healthcare visits that don’t require physical exams — including some ob-gyn care.
“Patients who are using this are really enjoying it. They like the convenience and keep asking to do this,” even after office visits become a viable option again. DeNicola says. “I think we’re seeing that healthcare isn’t either-or; it’s a hybrid of in-person and telemedicine. And it’s more beneficial to offer this. It probably reaches more people at the time they need care.”