An OB/GYN Shares Patients’ Top Questions — and Her Answers

female doctor answering common questions from a female patient

Dr. Dana Shanis is passionate about helping women understand that they don’t have to live with chronic pelvic pain. At her practice, VHealth & Wellness, in Philadelphia, she and her co-founder, nurse practitioner Catherine McGinty, make listening a priority. That’s the first step in what Dr. Shanis calls “a new approach to intimate care.”

A board-certified OB/GYN and a visiting scientist at the National Institutes of Health for eight years, Dr. Shanis worked for nearly a decade in group practice before opening VHealth & Wellness in 2019 to address the lack of accurate diagnosis and comprehensive treatment of common pelvic and sexual concerns. 

“Traditional women’s health is very pathology and disease oriented. So it’s about finding the cancer; it’s about finding the infection; it’s about proactively going in and doing surgery or procedures. It’s very much about fixing a problem that is easily identifiable,” she says. “And where I felt there was a lapse is with those patients who continue to have problems even once we’ve determined they don’t have cancer, and they don’t have an infection, and we can’t see anything that looks wrong — but clearly the patients are still in pain or having sexual dysfunction or something is off and we just don’t know what it is.”

The all-female staff of VHealth & Wellness uses evidence-based research and cutting-edge technology to heal patients — but first they listen.

To solve elusive problems, the all-female staff of VHealth & Wellness uses evidence-based research and cutting-edge technology to heal patients — but first they listen.

“If you let the patient talk a little bit more and tell her story, it starts to unfold not only what processes are involved but also how those processes are affecting their everyday life and how that effect could then be feeding back on the process,” she says. “That’s something that seems so simple to do — just to listen — but that is something that really, through no fault of their own, most healthcare providers don’t have the time to do.”

For Dr. Shanis, part of listening is creating a safe space for patients to ask questions about intimate topics. We asked her to share the most common questions her patients ask — almost all of the questions she gets start with ‘is it normal?’ — and a couple of topics she wishes patients would be a bit more curious about.

Common Questions About Sexual and Vaginal Health

1. “The No. 1 question that patients ask me,” Dr. Shanis says, “is, ‘Is it normal to have a low sex drive, to really have a low libido?” It’s a complicated question to answer, she says, because libido ranges in individuals. Some women have a naturally higher sex drive; some have a naturally lower sex drive. “We don’t consider a low sex drive a problem unless it’s impacting the woman or her relationship.”

2. Dr. Shanis also hears, “Is it normal to not orgasm from penetration, from intercourse?” She tells patients who ask this question that the majority of women do need clitoral stimulation in order to reach orgasm, but also explains that “there are things that can be done to improve the sensitivity of the vaginal tissue, to improve the level of arousal, so that you can improve the likelihood of orgasm through penetration.”

3. “I also get asked very often, ‘Is it normal to have pain during sex?’ and typically my answer for that is no. Typically pain from sex is a sign of some other issue going on. It can be a problem with any part of the sexual cycle. It’s not always the case that it’s an injury or something pathological. It could be that arousal is not adequate. It could be that there are pelvic floor spasms that are occurring as a result of a musculoskeletal issue or endometriosis.” Physiological processes also come into play, she explains. Women who have had pain in the past may unintentionally tense their muscles and brace for pain, which in turn creates pain.

4. A fourth common concern: Is leaking urine during exercise, with cough or sneeze, or during sex normal? The answer to that, Dr. Shanis says, isn’t so straightforward. “It is extremely common, but that doesn’t mean that it is normal,” she says, adding that “there are a lot of things we can do, such as counsel on pelvic floor exercises or procedures like laser and PRP [platelet-rich plasma].”

5. And finally, Dr. Shanis says that she is asked every day if vaginal discharge and odor are normal. “My response to that is it depends. The vagina is a self-cleaning organ, and discharge is the way the body prevents infection. Discharge contains a lot of bacteria, and even a healthy discharge might have a slight odor. And it also depends on diet and other conditions. But to have a strong odor or a lot of discharge when you don’t normally could be a sign of something wrong,” she says.

Two Things Your Doctor Wishes You’d Consider

Education is a big piece of what Dr. Shanis and her team do. Information empowers women, and there are several topics that they are careful to explore with patients. Among them are the psychological ramifications of their health concerns and the physical impacts of lifestyle choices. 

The majority of Dr. Shanis’ patients are women with chronic pelvic pain, and one thing she always takes time to ask a patient is how her mental health is affected by her physical issues. “A lot of women will say, ‘My partner is upset. My husband wants to have sex more. I am unable to date,’ without really identifying what that means to them. 

“I think there are many women who think that their sexuality is what defines them as a woman, and that can overflow into other areas of their life. This question is really to find out if they have sought the psychological help to process their emotions and be able to compartmentalize an underlying issue without it becoming pervasive in all aspects of their functioning,” she says. “I talk about being introspective and let them know that I will do my part to help with the physical issues but that they need to address what the problems have done to them psychologically.”

To treat a chronic pain problem and not address the psychological impact is not going to solve the problem — and vice versa.

Addressing mental health is part of comprehensive care, Dr. Shanis explains. “To treat a chronic pain problem and not address the psychological impact is not going to solve the problem — and vice versa.”

Taking care of one’s mental health requires a lot of heavy lifting on the part of the patient. So do lifestyle changes, which is another area where Dr. Shanis doesn’t wait on a patient to ask questions, because they won’t. 

“I have to offer up information about lifestyle changes,” she says. “People are seeking those quick fixes and don’t really want to know some of the harder changes that they have to make.” Over the years, the physician has learned to explain to her patients that there is only so much a doctor can do if the patient isn’t willing to optimize her lifestyle choices through adjustments in diet, exercise, sleep, and more.

“When I say we can get your pain down 80 percent, but if you’re still creating inflammation, we’re not going to be able to get you 100 percent there, when I present it like that, I think it’s slightly more effective than me just saying, ‘Cut out all dairy or cut out all alcohol.’”

And if there’s one thing that Dr. Shanis wants all women who are experiencing chronic pain to know it’s this: “So many are told this is how you have to live or that it’s not even real — it just adds insult to injury. We do have the treatments and we can help.”

To learn more about Dr. Dana Shanis, go to vhealthandwellness.com.

Photo: A.J. Watt

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