Understanding the menstrual cycle is not just a girls' problem. Episode 2

Monika Rachtan
The doctor is a travelling gynaecologist and runs a practice in Slupsk. Apart from the fact that he treats. He also tries to educate, educate, educate the public. Through lectures at the University of the Third Age. The doctor also gives lectures simply for ordinary people, he tries to talk to them about this health. He also gives lectures to students. By day, he is a husband and owner of a wonderful eight-year-old Ustka. He loves Polish literature and reads it while listening to Polish alternative music. Additionally, he loves painting and is able to travel halfway around the world for a particular painting. Does it all add up, doctor?

Dr Kamil Cichy
Exactly. I've just recently been to Amsterdam, where there is the largest Vermeer exhibition, which I encourage you to go to. Brilliantly prepared there is a beloved painting of mine.

Monika Rachtan
Czarek Well, yes, the holidays are coming soon, so maybe this will be an attractive destination for our listeners. Doctor, it's the first time I've seen you during our conversation today, live, face to face. We have spoken two or three times on the phone. And it's not a rule that I invite guests to the programme whom I don't know that well, because usually the experts who appear here are experts with whom I have already had many of these conversations. But when I spoke to the doctor for the first time on the phone, I heard something in the doctor's voice, more in the approach, which told me yes, this is the doctor I want to communicate with to patients, because he knows how to do it. Well that's right, and let's face it, every doctor knows that, because you are not taught that at university, are you?

Dr Kamil Cichy
Firstly, thank you for the invitation. Secondly, I in my studies have no such thing as public speaking at all. And I will give such an example of a recent gynaecology conference. One of the professors had a laptop connected to an overhead projector. Somehow this laptop went out for him. Neither the moderator nor the professor reacted. The professor, with a respectable yet rumpled expression, turned his back to the audience and read with his back to us. Well I think it's safe, but it's unclear whether this is due to the fact that he's not at university, or whether it's due to his upbringing at all. Fortunately, this rarely happens. More and more professors are doing very well. There is also such a young wave of professors in gynaecology or associate professors who are doing really well and modelling these speeches very well. However, there is still room for improvement.

Monika Rachtan
Doctor, and I will come back to my question, because I also asked about whether you teach them at school to talk to the patient. Because I think that I remember those conversations even 5 or 10 years ago, where a patient would walk into that doctor's surgery and be very afraid to ask anything at all, because they were afraid that the doctor would be in a bad mood and wouldn't answer them, or would think something bad about them. And this was not necessarily because the doctor had ill will. It's just that this doctor may just not have been able to look at this patient in a way that he needs this conversation, like we came in today to have a bit of a chat and someone wants to listen to us. I hope. Yes, this patient also in this doctor's office needs this conversation.

Dr Kamil Cichy
Far too little in terms of such patient contact psychology. There were three classes, I remember that. We happened to have a great psychologist who was able to get us interested in her subject, but the classes are practically non-existent. Something like that.

Monika Rachtan
And especially in gynaecology. It's very important to be able to lead such a conversation, because the topics are difficult, Embarrassing, often for women.

Dr Kamil Cichy
There are different topics, there are sometimes very joyful ones and then it is very simple to have such a conversation. But there are critical situations, there are very difficult situations, including death, There are situations where you have to take a very psychological approach to it, because every bad linguistic bump can cause the patient to shut down, to not want to continue trying to have a child, for example, in fact here you have to have that feeling, a kind of emotional intelligence.

Monika Rachtan
I also think that it is the attitude towards visiting the gynaecologist. A doctor, for example, with one meeting with a young girl, can change a lot, can spoil everything, because it is very important that the beginning is good, that the girl learns about prevention, that she understands that she has to look for this gynaecologist and that she also wants to. And when this first visit is in a bad atmosphere or in an unfriendly atmosphere for this girl, all this can already change in her mind and she can simply be afraid of this gynaecologist. And it can happen that this first visit is the last visit she will have until she gets pregnant, for example, because she will simply be afraid to go to this gynaecologist.

Dr Kamil Cichy
This is true. And there are some patients who don't come in for years after their first appointment, for example, and only turn up afterwards. Sometimes efforts to get pregnant don't work out. This happens and then they say that they have simply been traumatised. Most often they talk about being treated objectively. Actually, they do not talk about the pain, which can also occur during the first gynaecological examinations. Rather, they talk about psychological trauma.

Monika Rachtan
I understand, doctor, in the beginning I started with the doctors, as usual because I usually interview doctors and the work of doctors, and now I would like to go even more to the patients. And I remember that when I told the doctor that I was planning such a programme, the doctor told me that it was a very pertinent activity and very much needed. What are your doctor's observations? Do we women know much about our own women's health? Should we know more? Where are the biggest educational gaps?

Dr Kamil Cichy
Well, not just women. Men also know very little about women's health. In general, there is a very low awareness of women's health. This is changing in this group of the youngest girls, probably through access to the internet and social media. However, in the group of female patients 35+, and even more so after the menopause, I actually feel that I am talking from a biological basis.

Monika Rachtan
Doctor, what do women not know about their health? What was the most memorable question asked by a female patient to the doctor?

Dr Kamil Cichy
Girls don't know, even detailed ones. When it comes to the menstrual cycle, there are little things like that. The annoyance of minor delays in menstruation is that it is very common. I completely don't understand to which point she can shift, to which she can't. When you have to point out that something is going on, it's very common. When it comes to the strangest questions, it's usually about whether maybe this is one of the memes. The question of whether fertilisation can occur through intercourse. This is a question that has come up several times in my professional life. It surprises me every time.

Monika Rachtan
I understand, doctor, we'll talk about that too, because these relationships have changed, they've become more common. Or maybe it's not about pregnancy, but very other risks that I will want to talk about with the doctor? Definitely yes, But it's about that, about that in a moment. Exactly, doctor, and I'll also ask you what question every woman who goes to the gynaecologist should ask her doctor. Well, it is often not asked.

Dr Kamil Cichy
I think that there is no such question here. The patient has to feel with her body, with her endocrine system, with her menstrual cycle. Simply well. And if something is going wrong, the question is to target what is going wrong. If it's abnormal bleeding, the question is supposed to be about bleeding? If it's no libido, it's supposed to be a question about that libido. Here, there is no one question that the patient has. Each of you is different and each of you has completely different problems and different needs. And so we as gynaecologists I don't know if all of us do, but that's how you have to approach it. It's like at the entrance the patient in the surgery first of all has to open up. Sometimes there are follow-up questions on our part. I always apply. Sometimes girls are ashamed to say certain things, and I can already see during the examination that something is occurring. In general, however, I would like it to come out of the patient in such a conversation, because then she proceeds differently in her diagnostic and therapeutic process.

Monika Rachtan
I understand, Doctor, we have said that these educational gaps, as far as women are concerned, but also men relating to women's health, are very large. Who, doctor, should be responsible for such education? The school of the parent, the doctor? How should this be organised so that it finally works? Because again, there is a lot of talk in the media about this in Poland, that this education in general in the whole area of human health, let's not hide it, simply lies. And how should it be organised so that it finally starts.

Dr Kamil Cichy
Act Education is equally all parents, school, health care whether doctors or midwives. Health care. Like a system should be set up. There can't be such a thing that in school a girl doesn't understand her menstrual cycle. Or that we have to create a pink box campaign in the country because girls don't know what happens on their first period. Yes. Or they don't have access to hygiene products. This is not acceptable at all. But you have to start educating these parents more. That's why there are these interview sessions, that's why there are meetings with the psychologist, with the school bookseller, so that first the parents, then the parents will translate it to the children, and then still the children. Yes. And it should be well in advance, not that half of the girls are already long after their first period and the topic of first menstruation at school comes in. After two years it doesn't make sense at all then either.

Monika Rachtan
Doctor, I'll elaborate further, because I was just thinking about how one word you saw the interviews. I used to have such a plan. I still have it, I just have yet to implement it, to just hold meetings with women on the runs and educate them about breast self-examination. Because I think it's such a great moment when you can get all these women, because usually mums even go, that this has changed in Poland. With me it was usually that my mum would go to the interviews. And so I think those 15 minutes to have that kind of conversation, to have that kind of meeting with a gynaecologist, that would be nice. Are you familiar with such activities, doctor? Is it not a big place in Słupsk? Is something like this being carried out? So I can be a nipple pioneer?

Dr Kamil Cichy
As far as breast examination is concerned, such preventive programmes are more likely to be within the scope of medical picnics on festive occasions. On the other hand, there are certainly no general such activities in schools.

Monika Rachtan
This is the kind of place we have to come to, as it were, and there is a very good chance that these women of that age, say twenty, not twenty maybe not, but 30, 45 will meet and that we will talk to them about it.

Dr Kamil Cichy
As there will be fathers, too. Well that's right, the father also has to see what it should look like and then send his partner, if not his partner, the mother of his child. And for the sake of that child too, just like a healthy mother, a healthy child is kind of his upbringing. And here as simple as possible it is. It's as simple as building a cepa, but unfortunately it's limping, it's limping the examination itself. Quite often I also find in the practice that the patient simply does not know how to examine the breasts. It will simply show.

Monika Rachtan
But also this man can carry out such an examination. Of course he can carry out such an examination. And what then should you pay attention to?

Dr Kamil Cichy
First of all, for palpable changes. The breast examination itself is a great prophylaxis, but it is not perfect, because if it does not detect a permanent change, this is what breast ultrasound is for. On the other hand, the very fact that the patient or partner will get to know this organ and notice even nitro changes in the meantime with regular examinations will first of all make it possible to catch, diagnose and, above all, prolong life.

Monika Rachtan
Doctor, now let us perhaps go through this woman's health in such stages. When she becomes a woman, or a girl who becomes a woman. Doctor, when should a mother take her daughter by the hand and say Honey, we are about to visit the gynaecologist's office. Is there any such key moment, any age, something we can hint at here.

Dr Kamil Cichy
How I think. 12 15 years old is the first visit necessary first of all prevention. The girl simply needs to be explained what is happening to her body. Evaluate such a body whether there is a hairy scale, whether there are hormonal changes, ask her about the regularity of these menstrual periods, explain, look for, possibly diagnose abnormalities at this early stage. Another matter is vaccination against HPV. It is necessary to discuss this with this mother or parent and with this patient. Another issue is girls who have intercourse at 15 years of age, so you also need to consider the method of contraception.

Monika Rachtan
The doctor answered my next question about the first visit. Please tell me if this first visit always has to end with an examination because these girls are scared? If they are not having intercourse, I think they are very scared of this examination.

Dr Kamil Cichy
The examination is necessary when we want to catch any pathology. If we suspect that all is well, then this is the general assessment we make. I always perform transabdominal ultrasound in my practice, although as far as I know it is not in the standard of any representative or our Polish society. On the other hand, if there is pathology, we examine it and here it is less pleasant. What should we set the patient up for? For this examination? Yes, if it is a 15-year-old. I try to do a transabdominal ultrasound and capture as much as possible from it. If there is a problem, I send for an MRI. I also not infrequently use a transrectal examination. On the other hand, this examination is also in the recommendations. If a girl is having intercourse, then this is the first examination normally with the head before the manner. However, it is not pleasant. It is necessary to approach such a patient very gently. I always explain everything first, show the chair, we joke a little about its appearance, shape, show everything in the air. What does it look like to verify and take cytology? Having a conversation like this to show what it looks like in this office and not like on instructional videos is much more fun.

Dr Kamil Cichy
I always warn them that we use a lube on all the equipment to minimise this discomfort. And we always inform the patient that if anything doesn't suit, just say stop, we'll back off, we'll talk, we'll explain.

Monika Rachtan
And it happens that the girls start crying in the office or they get scared.

Dr Kamil Cichy
The last 5 year old girl with an infection, but was tested in the position on her mother. Here we chose the culture. Really. And so great. We did it with the help of our registration lady and with the help of mum, that actually the girl didn't even stress if it was not visible. Maybe so, because it was certainly stressful for the girls.

Monika Rachtan
I understand. Doctor, and what are the symptoms that should direct a mother that it is the five-year-old who needs to be carried out already? These are a few.

Dr Kamil Cichy
Above all, discharge, discharge, possibly for growing labia. This also happens. Whether for some underdevelopment of these parts of the reproductive system, that the mother would see that something is wrong with the development of these parts of the body, then not necessarily. And here I, of course, if it's a minor infection, she treats it. But if it's something more serious, there are paediatric gynaecology specialists in big centres and that's where these visits should be dedicated. So that also directs parents there, because, however, it is more experience, more work, mainly with children.

Monika Rachtan
And when such symptoms appear, does it even make sense to visit the paediatrician? Does this one sort of delay this diagnostic and therapeutic pathway?

Dr Kamil Cichy
It all depends on the paediatrician.

Monika Rachtan
OK, I understand.

Dr Kamil Cichy
Because a paediatrician also has a tough job he has to know the whole cross-section of these kids' diseases. I wouldn't have dared to become a paediatrician in my life. I wouldn't even dream of such a thing. On the other hand, if you are trained and have at least a little training on the principle of such quick signals and what to do, well, in fact such a visit to a paediatrician can be super beneficial. However, I most often encounter this first contact, whether with a paediatrician or a doctor. There is always a problem. Either they won't vaccinate the pregnant woman, or they just won't do something to the baby. As if such a method from psychology is a difficult subject.

Monika Rachtan
It is.

Dr Kamil Cichy
This. It is, however, a healthcare organisation.

Monika Rachtan
Yes, but I think the education of both paediatricians and GPs, primary care doctors precisely in terms of the different specialties is very important. That is not what I am talking about today. But I am trying to do it and I am also trying to help, to support, because it seems to me that this doctor is such a person, not a doctor, a bit more for the patients, who is close to them, to whom they are able to devote much more than to a specialist, to whom they come for a long-awaited appointment 2 months written in the calendar. However, this is the kind of doctor who is close to the family.

Dr Kamil Cichy
Well, that was the idea of that health care change in 99, that it was to be a family doctor. I remember that in my family home, my grandparents and my mother had their own family doctor. I chose a different one because of the pain. It was known and Dr Robert. That's what we called him. He just knew everything about the family, as if it wasn't a problem. Contact. There was no internet, there were contacts only by phone or in person. As if he knew perfectly well where to grab, how to manage diseases. He knew what the family was facing, so he was also able to make the right diagnosis much quicker. Well, but that is such an unmatched ideal. I know that Dr Robert is still working in Turek, I also say hello.

Monika Rachtan
This is me also saying hello to my paediatrician, Dr XY, who is also still working, and I remember when she was my paediatrician she already said she was retiring soon. As I found out recently that she is still practicing despite various health complications, she is still seeing kiddos. It brought a tear to my eye and I thought to myself that one day I will, I will be in my hometown then I will definitely visit her with my daughter. Because yes, she was a real doctor. This is a real doctor and we wish you all such doctors. Doctor, and a lot of mothers bring their daughters to the gynaecologist's office. Is this first visit often accompanied by the mother, the closest person, or do you encounter situations where, for example, mothers refuse to allow their daughters to visit the gynaecologist and when they reach the age when they can come to the surgery on their own, they only come in, for example, and tell the doctor that I've only just come now, because only now could I come.

Dr Kamil Cichy
How often does this happen? It's a difficult topic because I don't know. In the statistics it certainly happens that we have to bring, but unfortunately there are also such visits or the patient comes registered online and we can already see by the pesel that there is something wrong, that she is under 18 years of age and she passes by herself? According to Polish law without parental consent after 16 years double consent before 16. Parental consent for the examination must occur and here simply such a patient is not admitted for legal reasons. Although I would very much like to do so, it will not do.

Monika Rachtan
The doctor then informs this patient whether he will accept or.

Dr Kamil Cichy
We give such a ready-made paper printed to communicate to the mother why this mother is necessary. Some come back with a parent, some never turn up again. When it comes to visits with a parent, it is always the mum. It has never happened. Dad is the first one and it varies. Some decide, for example, to use contraception when their daughter is cohabiting, some don't And unfortunately there is nothing I can do then. I try to explain, to educate, that it is not harmful. However, there is a very big trend. I wish it was not hormonal. I both ask myself sometimes if this mum has used it aggressively, a lot of aggressive Answer that it is not her visit is not my problem. As if I shouldn't be talking about it at the moment. It happens less and less fortunately, but it does happen.

Monika Rachtan
Doctor, and did you see any sense in bringing boys to the gynaecologist's office? Because the doctor said at the beginning that it was the woman's health that was important not only for girls but also for boys.

Dr Kamil Cichy
So much for the surgery, eh? I think all boys should be at gynaecologist appointments and in schools, for example. It is without question here the HPV vaccination. Why should boys be beautiful? It's not understood to us at all, that's firstly. Secondly, they need to understand where the menstrual cycle comes from. They need to know why these girls have worse days, why all of a sudden at gymnastics they see these breasts growing and something is happening, Why does some extra hair appear on their female colleagues? It's all worth explaining. This then makes it all become in the mental sphere as knowledge, rather than experiencing something next to it from an emotional angle. And you can make a break fun of it. You can just move away from it. And yes knowledge builds a good relationship between even 3 classmates.

Monika Rachtan
Well they can be such a support for these girls. And again, I remember from my primary school that there was rather ridicule, there was rather mockery of these girls, and these girls were really going through. We were going through difficult, difficult moments for us. There was once that embarrassment. I remember the first period I experienced at school was tying my blouse around my hips so that no one would accidentally notice, because if someone saw, what would it be?

Dr Kamil Cichy
The blouse symptom? Yes, this is still the standard today in schools.

Monika Rachtan
I didn't know that.

Dr Kamil Cichy
For the symptom of the blouse, yes it is very common, and in general the sheer battle of hormones in this body is already causing states such that this girl sometimes does not want to leave the house, let alone the reaction of this immediate community with whom she meets every day. So often the negativity is a drama. But as long as there is no education of these boys also or other female friends, because it's not always on the side, only of the PO wców, this reaction.

Monika Rachtan
The girls also laugh at themselves that.

Dr Kamil Cichy
Exactly, and very much so. I've heard stories like that too, that a patient's friend has to be a friend, so she's ridiculed. Exactly. Well, it's a very big shame to go to a newsagent and buy hygiene supplies. Whether money is available is a separate story. For these particular hygiene products.

Monika Rachtan
That is, it is the girls who are afraid to ask their parents to be afraid.

Dr Kamil Cichy
To ask or parents don't have, because there are also children from poor families. Only there are happy families.

Monika Rachtan
Yes, the doctor also mentioned the pink box campaign. I just had the opportunity to meet the girls who initiated this action. One of them was also from Wrocław, so we had the opportunity to talk.

Dr Kamil Cichy
Very important. I think it's one of the key, I think, in terms of gynaecological action in recent years.

Monika Rachtan
I can see that even here in Wrocław they are in such different places. I want to and there it is.

Dr Kamil Cichy
Mainly in schools. Yes, yes, for example, in our office there is always such a box, she is not pink, as the patient needs to pass.

Monika Rachtan
But it's such a trend, isn't it? Because I also see boxes like this in the kind of places I go to with my daughter. The speech therapist's office. I see things like that prepared for the patient.

Dr Kamil Cichy
And that's how I think it should be, if there's a place for babies at all, where the mother will come. Yes it should be such a place in general, without a doubt, where a woman can be in another pregnancy, she can have a hormonal problem. Yes, she might just be destroyed by this motherhood in such a mental and physical sense. Not everyone has one child, is a great functioning woman, not everyone can just cope with the problem. She needs to have that place of respite, when, for example, the baby, the speech therapist takes care of the baby and there is something going on at the time. The bleeding has to be for some comfort. I think that should be the standard. Because it's like in restaurants there has to be a toilet, So there should be a provision that there has to be, there has to be, there has to be access to hygiene products.

Monika Rachtan
Doctor, I'll go back to that first one, that first visit. And what does the doctor think of such an initiative on the part of maybe a midwife in the outpatient clinic? I think it used to be called still speaking.

Dr Kamil Cichy
That there is a guide.

Monika Rachtan
That's right. And I imagine it this way, that such a midwife or a registrar prepares the medical records of a patient, a woman, a mum, who is supposed to see Mr. Dr. And you know what? This lady Kasia gave birth to a daughter 12 years ago. So I'm going to leave a card like this here for the doctor or she'll come to the registry herself. I'll say, Mrs Kasia, maybe it's time for you to bring your daughter to the doctor, just to talk about her health. Well, just what? Mr Doctor of the Library.

Dr Kamil Cichy
I think it would be a great idea, only there are a few obstacles of course.

Monika Rachtan
Who will pay for this?

Dr Kamil Cichy
That is one question. It is in the health care system that I think there is money, it is badly distributed. This is my private opinion. Kamil Cichy None here. I don't want to get into politics here. However, there is another problem. Midwives are divided into midwives who have a university education and midwives who have a secondary medical school education. And while in a large centre such as Wrocław, for example, there is a majority of midwives who are well-educated, when it comes to a small centre such as mine. The vast majority of midwives have not graduated from university. And this is where I think there can be a problem even on the basis of basic knowledge. I don't want to be misunderstood, because I know that midwives who can do harm may feel offended. On the other hand, there is a difference between the grounded knowledge of girls who have graduated from university, MA or BA.

Monika Rachtan
5 years of learning something there.

Dr Kamil Cichy
There is a difference between medical high school? The more so because the knowledge changes firstly, it is dynamic. Here in gynaecology you have to be up to date all the time. And the second thing is that these litanies were more to educate a person who takes birth very well, who will take care of such essential things. At the time, this was thought to be the case, because there were a lot of births. Today we know that prevention, education is the most important thing, and here the transfer of knowledge is key. And I would say that it varies. It's not that everyone does. I would not like that. I would like this to sound like a criticism of the midwifery community. Yes, absolutely not. On the other hand, it does indeed need to be improved.

Monika Rachtan
But so is diabetology, and so are those diabetology nurses who used to graduate, graduate or graduate from medical school. It's difficult to have the latest knowledge about medicines, which even doctors or diabetologist don't always have. But again, let's get back to our tracks. Doctor, we are looking online for information on what percentage of visits to gynaecologists are carried out in private medical practice. I have not been able to reach such data, but are you doctor able to estimate from your own experience also to tell our listeners why this gynaecology has become so? Commercial. Why are there more of these private visits in my opinion? Because I don't have any friend who goes to a gynaecologist on the NFZ, and I only checked the appointment in Wrocław for 2 months to a gynaecologist.

Dr Kamil Cichy
He was to us practically 2 months privately. It's not a problem with the availability of doctors either, but there are two issues of valuation of services. There is a very low valuation of services. When I started working as a resident, I also worked in an outpatient clinic for the National Health Fund. There, there were 120 NFZ points for a gynaecological visit and cytology, where the ratio was almost one to one. Cytology alone, how much does it cost for the midwife service, electricity, water, depreciation of equipment, etc.? As if the pricing hasn't changed, probably to this day or minimally. As a result, both doctors and clinic owners drive and patients to take in as much as possible, to make the point total match, to get out of it financially, and this is reflected at the expense of quality. Not enough time per patient? To this day, I still hear from patients that she has been to a NFZ appointment that lasted 10 min. In 10 minutes. With us, my appointment lasts 20 minutes officially, but we always leave as much time as needed for the patient. For the pregnant woman with half an hour. Prenatal examination 40 minutes minimum. Well, it's not possible otherwise. It's just not technically possible.

Dr Kamil Cichy
Well, unless someone is already such a super champion, I don't know.

Monika Rachtan
Is it not your ill will that you do not want to take patients on the National Health Service.

Dr Kamil Cichy
It's just the public perception that he didn't want to admit me and I was bleeding. Yes, but it was his 50th patient that day. It's me who can't imagine that after twenty-five a patient is still admitting someone with a hormonal problem for example, because what level of thinking I have, then yes that's zero at all. It's also a pity for this patient, because the fact that I will make a profit is fine, while I may harm the patient or not complete her diagnostic process, where, after all, a human being is only human and can make a mistake with a fresh mind, where it is fresh in the morning, let alone with a 30th patient. It is impossible at all to think rationally and with common sense.

Monika Rachtan
The doctor must have seen the film Gods, and I think that people in Poland still treat doctors as such gods, who can still stand 12 hours at the table and accept everyone with such freshness. And even though it was the 50th patient, I can manage. And the doctor is a normal person who goes home, who also wants to eat the lunch that the doctor makes. Shopping at the market.

Dr Kamil Cichy
I do sometimes, I do more often now.

Monika Rachtan
Well, that's how you have a normal life too. You also want to live a normal life and it is not your ill will.

Dr Kamil Cichy
I want to be able to unwind at the gym.

Monika Rachtan
That's right.

Dr Kamil Cichy
We think. It's also this. It's a high C job all the time and you have to think high all the time, collaborate with the patient all the time. Working with a pregnant patient is not an easy job. A pregnant patient requires an extra approach, more empathy. These conversations are sometimes followed by endocrine disorders on different tracks. It all has to be patiently explained. All this requires such intellectual dedication and this is our job. And this has to be unwound somewhere. We cannot overdo it. In a situation where there is a shortage of doctors on the market, you can actually not leave your surgery, someone will always come. There has to be a limit somewhere, there has to be, there has to be common sense. That is simply my view in all of this, and in every area. On the other hand, what you say is also such a sad statement that it is the fault of our medical community that we have been chasing each other for years. Yes it is, now it's not, but one day it's just 8, 9, 10 on-call through the system will fall. So if you don't take it, it was frivolous. I wouldn't want to be that patient to us 50m on-call in the morning when I've finished and she comes in with some sort of path of situation.

Monika Rachtan
Doctor prepare for the first visit to the gynaecologist, What to look out for, how to prepare this daughter? Or as a 17 year old listening to this podcast and going to the gynaecologist in a week is here. How do you prepare yourself?

Dr Kamil Cichy
First of all, to know what the monthly cycles look like, when was the first one, when was the last one. And secondly, are there any co-morbidities? Know your family history, especially if it's breast disease. And that's basically it. The rest is for the patient to see when standing in the mirror if everything fits her. Do you know if she has excessive hair on her face, on her breasts, on her abdomen? Does it bother her? Such things, however, nothing more. The rest must be led by the gynaecologist at this first appointment.

Monika Rachtan
So it all depends on the doctor.

Dr Kamil Cichy
A bit like that, because the patient has the right not to know at all what to ask. That first visit is that most important information. These are the three things family history, menstrual periods and that body appearance. The rest of it has to be led by the gynaecologist. It's not another appointment in life. It is nothing. We here have to search for these needs of the patient, find this subject, whether she is cohabiting or not cohabiting, whether she intends to cohabit in the near future. This history of preventive health care is everything. We have to direct the conversation so that.

Monika Rachtan
Patient a little.

Dr Kamil Cichy
Then she opened up. On the other hand, I think myself, I don't know how much a 13 14 year old, how and how to express her needs. It is extremely difficult still to a stranger in the office.

Monika Rachtan
Yes, that's right, doctor. I know that with the local government and the party. Okay, all right. That's an important piece of information these days, especially at this time when we are, we are now, which is before the autumn elections. Doctor and are you fighting for HPV vaccination? And I'm going to ask you if you're very annoyed when your doctor comes into the surgery at us with your daughter, they ask your doctor for contraception and great they ask. But the doctor then says Listen girls, and you are vaccinated against HPV. No, no, no. What's the deal with HPV? The doctor explains that it's so important and the question is, is it reimbursed? Well, it is. Well, but the vaccine that is reimbursed, well, maybe not necessarily, maybe the extended one would be worth it. And what is the cost? And then the amount is several hundred zloty as far as I know, and it is too expensive. We will ask only for this contraception. Very pissed off doctor.

Dr Kamil Cichy
Annoyed no, because I don't get annoyed at work. On the other hand, I actually try to explain what the benefits are. It's firstly I talk about it all repeatedly, I repeat, I say that this mum can also get vaccinated if there are no contraindications. I sort of try to educate all the time. However, I work in a very small community, it's a province, and when we do lectures on HPV in primary schools, such rural schools, first of all, the attendance was negligible, and when it was, there were also challenges, that what am I urging these daughters not to make payments. This vaccine was supposed to cause sexual promiscuity. It is so hard to explain about this HPV. Really? It is a very difficult subject. On the other hand, I can boast as a local government member that it wasn't easy to introduce either, because as a non-partisan it's very hard to push anything through. However, in the seaside town of Ustka, where I live, boys and girls are free and cats too.

Monika Rachtan
Doctor, I would like to ask why girls are vaccinated and why boys are vaccinated. Exactly, could the doctor now give a short lecture on HPV? Briefly.

Dr Kamil Cichy
HPV is a virus like, say similar to herpes. Anyone can catch it in their lifetime. As 5 out of 50, 80 per cent of us have come into contact with the human papilloma virus. It is most often transmitted by the key route. Well, most of us have this virus, but it does not cause any diseases. If we are healthy, get healthy, have a healthy lifestyle. Probably our body will eliminate this virus within there few years. However, there are people who are under constant stress, have hypothyroidism, Hashimoto's disease or other burden. Well, that's when this virus kicks in. Just like herpes. If you have a cold sore, you get herpes, and HPV, unfortunately, once it appears, it's a topic for a long time. Well, because it can cause cancerous changes, for one thing. And that's what we fear the most, but also skin changes in the form of cin, which are simply an inconvenience in the intimate areas, but not only in the intimate areas, because also on the skin.

Monika Rachtan
And this is not just a cosmetic, aesthetic defect, but it is also something that can be very troublesome.

Dr Kamil Cichy
It can also define if it is on the cervix, where a natural birth or caesarean section is to take place. Well here it implies a lot of problems, and often it is pregnancy as a period of weakened immunity that can trigger these HPVs. There is what I would like to convey. HPV is very common, just like herpes. Everyone has been in contact with it and to prevent cancerous lesions or just new ones, we can simply vaccinate ourselves.

Monika Rachtan
What about those boys?

Dr Kamil Cichy
Because when it comes to boys, this HPV can cause penile cancer, anal cancer or craniofacial cancer. And first of all, that we are carriers of this virus, so if we are vaccinated, we are also less likely to pass it on to patients, to women, and then they will be protected from cervical cancer, and at the same time we will be ourselves.

Monika Rachtan
Doctor, if I may, I would now like to move on to older women, but not yet so old, as those just about to become mothers. What educational shortcomings affect this group of patients?

Dr Kamil Cichy
So here we go, alphabetically. First of all, once again, no knowledge of the menstrual cycle.

Monika Rachtan
Gosh, is this really such a serious problem?

Dr Kamil Cichy
Patients come in, say they've been trying for a year and can't get pregnant. And of course the doctor's inquisitiveness. We live in a coastal area, so very many husbands are just sailors, fishermen. Half the time they are away, so the simple question is how often does intercourse take place? My husband comes home every 4 6 weeks. Well, and that's a year's worth of trying for a baby. That's already the first issue, so we have the education stage. The second thing is civilisation issues, unfortunately, like the obesity epidemic, diabetes, insulin resistance. Here all these changes, which are hard to even explain to the patient, that we don't have to do much of anything here. All we need to do is to take care of our hygiene in life and we can bring about ovulation. Sometimes one is faced with the indignation that, what do you mean, why doesn't your medicine help me? There are many such topics, while the most common is the lack of knowledge of the cycle.

Monika Rachtan
Still what the doctor just said about this hygiene. I talk about it very often, that it is a disease that the doctor can diagnose in one second, the moment the patient is even standing in the register. It is obesity and overweight. And doctors often overlook this problem because they don't know how to talk to these patients. Or they don't want to, because how much can you tell a lady to fall down? But to help this patient a little bit. Because it seems to me that the course of pregnancy for a woman who has a normal weight and then the birth is much easier than for girls who are overweight.

Dr Kamil Cichy
This is already in general when we get to pregnancy. It's definitely scientific research that clearly says a Mediterranean mindfulness diet three times a week of 50 minutes of exercise during pregnancy is the basis to protect yourself from projection, from and other disorders like not placenta. Many other things it is in general a super topic. Prof Nikola Ida from King's College. She does great research on this topic. However, when it comes to obesity, well no, telling a patient that she is obese. It's a bit like laughing. Two alcoholics are funny after fifty vodka. It's the same as if it's a disease. We can't take it lightly. We can, after all, choose our words. The Polish language is so rich that it's not like in English that we can just say calorie supply or a million things we can find that you don't have enough of. We can lead this conversation with questions like how often do you run or how often do you go cycling. It is known how the answer will be Yes, this obese lady usually has joint problems, so she is still in pain, so she is definitely not undertaking physical activity.

Dr Kamil Cichy
Well, it really can be done in different ways. But it cannot be ignored. Well, it is not acceptable at all, I think. Often on discharge from an appointment there is weight reduction and diet. Is it not therapy. And I send to dietitians, because I think that's what so many trained dietitians are for, to guide such patients with diet, therapy. If nothing helps then, as a last resort, Beria tragic surgery remains. On the other hand, I think that without trying to change your lifestyle it is pointless at all.

Monika Rachtan
Doctor, while we are on the subject of pregnancy, I would also like to ask about a popular topic, because in Poland, cuts are carried out on request and there are actually quite a few of them. Is it really the case that women wish for these cuts and doctors agree? Do so many women have indications for a caesarean section.

Dr Kamil Cichy
And do the doctors agree? I do not agree. I would say yes to avoid cuts on request. But what I notice in my practice, I don't know if it's because of my attitude at work for so many years, or if it's just that more and more girls want a natural birth, They want to avoid cutting. And this is a trend I notice.

Monika Rachtan
And is it dangerous?

Dr Kamil Cichy
Of course it is, it is, it is an operation like any other, and I would even say less pretty. It involves tearing tissue rather than such surgical cutting. Unfortunately, severe complications can occur, including death of the patient. Fortunately, this is rare, as medicine today is so well developed that we can predict many things in advance and apply appropriate treatment. On the other hand, any operation can simply go wrong.

Monika Rachtan
You said that there is a trend that women are just going back to nature, meaning they don't want hormone therapy and they prefer natural childbirth and I think they are also breastfeeding more often or they know that this breastfeeding is not only good for the baby but also for them because it protects them to some extent from getting breast cancer.

Dr Kamil Cichy
A couple of degrees ago I think it was in a scientific study that each total, adding up each six months of lactation extension is 2% less chance of breast cancer. And the population doesn't I think it's 20 30%. The risk of breast cancer decreases through lactation.

Monika Rachtan
And the doctor uses such an argument always.

Dr Kamil Cichy
But there is always such a thing as the European Cancer Card and there were these studies actually done and this impact of these oestrogens and so on in pregnancy and in lactation is less, so there is less of an echo of this abnormality. It's prolonging, it's reducing the chances of cancer, but not just breast cancer, because there are small studies as well. On the other hand, minimal risk for ovarian cancer also less risk and there are also small studies. Regarding endometrial cancer.

Monika Rachtan
Also worthwhile.

Dr Kamil Cichy
And these are studies not only about such young ones, right after lactation this was studied. Patients have been studied across the lifespan, including after menopause. But to make it a long study.

Monika Rachtan
Doctor, are there any other ways to protect yourself from breast cancer? Such a bit of a controversial topic, because we know, at least I know. I think some patients know it too, that there are certain mutations that can dispose us to get cancer. Well, there was a topic in the media a few years ago, I think, precisely that of preventive surgery to protect against getting cancer. I'm going to ask if that makes sense, but before that, maybe I'll come back to these simpler methods.

Dr Kamil Cichy
Here this molecular method, to test if we are carriers of a gene. I believe that if someone in the family has had cancer, to absolutely perform and I also recommend this to patients. There are patients who cannot afford it. Fortunately, in Pomerania there is Professor Lubinski, in Szczecin, who. There, you have to fulfil the conditions within the framework of scientific research and the National Health Service here does this examination.

Monika Rachtan
That is, an important address. If one has such a problem, it is worth seeking out a counselling centre.

Dr Kamil Cichy
Patients are always given this information, if not, it can even be done with the help of a courier who will bring a package to be examined and unfortunately it is paid for. If there would be a family history of cancer then by all means this is the first method. The second method is the breast examination itself after each menstrual period. The third is an examination at the gynaecologist. But for me the most important thing is the breast ultrasound and mammography.

Monika Rachtan
Doctor, there has been a prophylactic screening programme for breast cancer in Poland for years. It would seem that this information is common knowledge, as I remember for years. Letters of invitation used to come to my mother, and I don't think I know what you have to do not to know that there is such a programme. Well, but it turns out that only 30% women, thirty-something change, a little less. Now maybe it's back. I am doing this kind of research. Who is this programme dedicated to and who can do such a study and where can I look for information on these studies?

Dr Kamil Cichy
As far as mammography is concerned, it is between 50 69. However, I am getting lost here, because throughout the European Union, in the countries of the European Union, such medical consensus is, however, 45 75 due to the increasing incidence of breast cancer in society, and here in Poland there is still no verification of this problem. Will this happen? Here it is also a question of policy, funds in health care, etc. However, it should definitely be lower than 45 75, and I recommend this to patients.

Monika Rachtan
Doctor, and these are the kind of buses that stand at various occasions and actions, is this a good place to do such an examination?

Dr Kamil Cichy
Any way to prevention is any way and that is preventive screening, screening, screening, mammography in mamom. There will not be 100% findings, there will be a certain high percentage of easier, easy availability and high percentage of detection. On the other hand, such a screening with mamom needs to be confirmed. A mammogram already diagnostic or an MRI depending on what comes out or a breast ultrasound. On the other hand, I think that it is actually like in my provincial environment. Here I would give to every indulgence under every parish. Of course it's a good place to be, but I think socially it might not have been acceptable often still I think absolutely yes. Similarly, cytology.

Monika Rachtan
I. Doctor, we skip a lot of topics because we only have limited time. But I'm going to ask now on behalf of the patients, in a situation where on this result of a preventive screening test, i.e. mammography, does it say that further diagnostic imaging is needed? Usually in parentheses it says to do an ultrasound. And now the patient goes to the clinic and what does it look like? She now has to take a referral or to the gynaecologist, that is, wait those 2 months, say in the queue, take a referral. How is this arranged? Is the doctor going to say categorically girls, there is no point, you have to go and do this ultrasound privately because it is a priority and every day matters.

Dr Kamil Cichy
I cannot say that they have to go privately because the state provides them with direct access. On the other hand, if it concerned me on the second day in a private practice without 2 days. Another problem. First you have to get to that GP to get a referral. Then you have to wait In offices on the National Health Fund very rarely do gynaecologists perform breast ultrasound. Yes, this is true. So there is no way.

Monika Rachtan
In general.

Dr Kamil Cichy
Equipment. Exactly. They don't have a head, for example, a linear head for the breast, as it were, and at the cameras they're out of it. And the doctor will say well cool, well then I'll give you a referral. And it goes on and on and on. ULTRASOUND. We could really talk for hours. I'm fascinated by this technology. There is no simpler thing to use, you just need good educators and to train these skills all the time. We have some really great ultra-racists in Poland. A gynaecologist of both the breast and the foetus, who really only needs to be willing and go to these trainings regularly. Access is easy. It is very easy to find such a lesion in an ultrasound. If something already comes out in mammography, we already know more or less where it is located. We can estimate it and we can offer it to the patient in the environmental clinic, whether it be a fine-needle biopsy thickness, head. This is supposed to accelerate this diagnostic process in numerous ways.

Monika Rachtan
Doctor, actress or family of gynaecologist, you invite members of your family to your office.

Dr Kamil Cichy
Sometimes the wife comes, sometimes with my patient for some preventive examinations, cytology. The man is practically pregnant at the moment, but the attending doctor is Dr. Jacek Do Marcin, whom I greet and he takes care of him here. I only do it on an ad hoc basis.

Monika Rachtan
I see. So the doctor will not be picking this up?

Dr Kamil Cichy
Absolutely not, absolutely not. I'll just be on the sidelines and so I'll be stressed.

Monika Rachtan
Doctor, I would like to address these older women further.

Dr Kamil Cichy
Here you have to turn off that emotional factor at work, because at work an obstetrician can neither be helpful. Here you have to be tough, calculating, you have to have a very high level of patience. I can't imagine I would have achieved such patience when giving birth to my own child. Well, any wiggle in the KTG recording that might be physiological at all. I will just be nervous and the whole environment and staff will see it and may also make that decision because of it. That is why I do not recommend it absolutely. On the other hand, I certainly show such patience. I answer all questions, about the composition of cosmetics, about everything, and I am also already familiar with every ingredient.

Monika Rachtan
Doctor, if you please, we will move on to these older women. I would like to ask how does the menopause affect the functioning of the whole female body? Because it does.

Dr Kamil Cichy
Of course. Of course, here as far as the menopause is concerned, it is primarily the lack of these hormones, the stragglers, the progesterone. They're the ones that cause these neuro transmitters in the brain to switch off or they're reduced. That's sort of how to explain it. The neuro transmitter is the kind of courier that brings a parcel of your favourite dress from the warehouse to our house. And imagine we ordered it yesterday and it arrives a week, a second week, a third week. The most important event in our lives has just passed and this dress was not there. And the same thing happens in the menopause. It all starts to annoy these patients. There starts to be a lack of energy, a lack of life drive, a lack of oxygen, a lack of serotonin, that hormone of happiness. Or it's there, but it's a slowed down transmitter of it that causes the mood to start dropping. Explosions, hot flashes of osteoporosis, subsequent femoral neck fracture or compression vertebral fracture. As if so skin, hair, wrinkles, As if a gynaecologist is just one small pathway that can help with this. But menopause is a general, holistic problem.

Monika Rachtan
And you will take one step. Can the menopause cause depression?

Dr Kamil Cichy
It can. And to a very large extent. Just what I have already said. That courier who doesn't arrive is already the first reason to cause depression. But just imagine when it gets to. Vaginal dryness and lowering of the counselling organ, spoiling the relationship with the partner, often pain during intercourse, incontinence and hyperactivity, bad relationships with family members. The menopause also often overlaps with the time when the children come out of the nest. This can additionally make this woman feel totally unnecessary, as if it is additionally a patient who is peri-menopausal or in the menopause the gynaecologist cannot look at her only in terms of a gynaecological problem. There is a complex problem here. This depression is. It seems to me that I would even say frequent, because even when I watch my patients, after all they have known me for so many years, and I see how even this visit always goes and this moment comes in, it is a completely different patient, it is a put out patient, grey in inverted commas, without this verve, without this sparkle in the eye. And there you can already see that practically these hormone tests are just a confirmation so that we have on paper that we are already dealing with menopause, because you can just see it.

Dr Kamil Cichy
And I think that's just where that depression absolutely says it. I say I, I'm glad I'm not a woman. To go through these endocrine disruptors so many times is really. I think that and that's where you really need understanding and that education, as we talked about at the beginning.

Monika Rachtan
Doctor, should a post-menopausal woman remain under the supervision of a gynaecologist? And how often should such gynaecological care be used.

Dr Kamil Cichy
Necessarily once a year? Please remember that metabolism slows down after the menopause. Here the risk of cancer does not increase. This is the basis. Cancer does not hurt. When they do hurt, it is already very bad. So an annual visit is a definite yes. As we said, preventive mammography, breast ultrasound, cytology, gynaecological examination, hormonal requirements, protection against the loss of this calcium in the bones is everything. In addition to this, a gynaecological physiotherapist must be taken into account, incontinence, improvement of the quality of intercourse, the use of methods of aesthetic gynaecology, sometimes laser, sometimes fillers, so that the quality of intercourse is greater, so that she can continue to enjoy life to the full with her partner. There are many factors that must be taken into account here, and I would even say that of course every patient must undergo this procedure every year, but this post-menopausal patient has a mountain of problems that build up extremely quickly.

Monika Rachtan
Doctor, there is one more thing I would like to ask, if you allow me, because post-menopausal women, women who just their style of intercourse maybe and not so negative, just positive things happen in their lives and can they get HIV and is this a common problem?

Dr Kamil Cichy
Of course, HIV can be contracted in any situation of unprotected contact with a condom and this is also known. A condom is not 100 per cent effective either. Of course it is. But in the practice that I run, I don't know the national statistics, but we have one case where I don't have HIV per year and it doesn't always involve post-menopausal women.

Monika Rachtan
I understand, of course, as much as possible, but I also just wanted to point out that this protection, even when these risks of this pregnancy are no longer diminishing.

Dr Kamil Cichy
Education is always a part of this, education is always a part of giving contraception to young girls, and I always make it clear that in this case it only protects against pregnancy and sometimes solves hormonal problems, but I always explain here, when we switch to hormone replacement therapy, that it only improves her health, but it does not protect against disease, it does not protect against anything.

Monika Rachtan
So doctor, in my opinion, practising as a gynaecologist requires a doctor to be empathetic. On the one hand, the doctor participates in those most beautiful moments, when babies, patients, are born, but on the other hand, there are also probably very difficult situations. And please tell me how the doctor manages this job and what is the biggest challenge for the doctor.

Dr Kamil Cichy
As for liking them. I will assess whether I have it or not. Just who is it? And when it comes to births, I get worse, I always do. Not that I cry, because I rarely do. But it's always such a moment that, well for me, it's a great thing to watch at all, and as many years as I've seen it, it's the same every time. Sometimes there's also the stress of crisis situations, when you have to make a difficult decision, when there's a life-and-death situation. Well, this is where completely different emotions come into play. There's an adrenaline rush and there's no time for that emotion. And there are situations like this. How do I deal with this? Well, mainly I go to the gym to get these emotions out of me, because that's it, you can't control it. A very good solution is psychotherapy, which. It allows you to.

Monika Rachtan
Doctors go to psychotherapy, they get sick.

Dr Kamil Cichy
You don't even have to be ill, it's just to be able to work with those emotions. It's difficult, It's not easy. Maybe. I don't know if it's going to be so chauvinistic or not, but it seems to me that it's easier for women to experience emotions than on. I think so, because those though.

Monika Rachtan
Hormones adapt us to this.

Dr Kamil Cichy
The very fact of motherhood, which I will never experience, is one thing. Well, and above all, the kind of backlash that is created in home life. That is the basis. A healthy home, a healthy job.

Monika Rachtan
Doctor, and I'll ask you one more thing, because I ask all my visitors this How do you understand the concept of the humanisation of medicine in terms of your speciality? Well, exactly.

Dr Kamil Cichy
And in general it's a question that I don't know how to answer, because when I was choosing my studies, I told everyone that I was going to study humanities, to study medicine.

Monika Rachtan
It's interesting why.

Dr Kamil Cichy
It is so one and this biologist is just a method. Yes. Is medicine in itself, biotechnology etc. just a means to an end? It's not, I've always tried to be a partner with patients, to talk. I always tried to understand their problem. Always the questions that were asked I understand, but why did I ask? It was never that I took a strict approach. Maybe there were a couple of times that at three o'clock in the morning on call I wasn't very contactable, But, But I always tried to be, however, a partner to this patient in the relationship of the doctor partner and not less like a doctor. Also, I never made that boundary in the office. Anyway, the patients can confirm this. He always builds up such slack as far as possible with the patient, of course, because not every patient wants this. However, the subject of humanisation is, for me, not relevant, but I know, because I have also been a patient myself and I know that this is a big problem. It just, as I hear, comes up.

Dr Kamil Cichy
Rather, whoever approaches, I approach, you approach, whoever approaches is such treatment. The only thing still missing is such a shepherd with electricity to make this string of patients go. It's just that. But I don't know what it comes from. Well, they certainly didn't teach us that at university. Is there some form of emotional intelligence? Because it's what you get out of the home, in my opinion these relationships.

Monika Rachtan
Doctor, I think I would like to sum up our conversation today. We are now going to move into a cycle like this. I have questions from female patients that I collect from different groups. Of course, I am not going to ask for a diagnosis from you doctor, because that is not the point, but we also want to give a nod to the patients here to do the answers to these questions. On the other hand, doctor, I would like to sum up today's talk and last words. The most memorable thing for me was that when we women are looking for a gynaecologist, we should look for a doctor who will look at us as a human being and who will be a human being. And then all these other problems of education, shame, everything, everything that comes up, They will be there somewhere, maybe they will come up, but they will be solved quickly, because there will be a relationship of a human being and not a doctor. And it will approach, it will approach. Yes, I think that is important. So, let's look for a doctor who will be a human being and who will see the human being in us, and then all these problems of women's health can be solved for sure.

Dr Kamil Cichy
Which is what we wish for ourselves and everyone.

Monika Rachtan
Doctor.

Dr Kamil Cichy
Because we will also be patients.

Monika Rachtan
Because if you live to see us, we'll be, we'll also be patients one day and soon the doctor will now accompany the patient. Sure. Probably here a colleague will take very good care of you, but also we all benefit from this health care. Doctor, so it's not from our viewers, listeners. I lost a pregnancy a few days ago. The doctor says that use is not needed and everything should clear up on its own and you have to wait. I have concerns that something could happen AND what symptoms to look out for when I can try for a pregnancy again?

Dr Kamil Cichy
In fact, up to the 49th week of pregnancy I try not to use if much ni at all. It is also possible to use a simple one, but everything should clear up on its own. On the other hand, when you don't know it, nothing should happen. There is very little scientific evidence of any infection or anything that could cause complications in getting pregnant in the future. On the other hand, when it will happen, we don't know. What is to be feared, feared, is excessive bleeding. Yes, if this bleeding exceeds a certain limit, causes fainting, is too much. The patient must then be taken to a gynaecologist and then to hospital.

Monika Rachtan
Is quantity too much? Then how much?

Dr Kamil Cichy
These are large blood clots, the kind that cause weakness. Significant? Yes, because the bleeding will be increased here in this patient's case. On the other hand, it cannot be a one-off bleed. On the other hand, when she can try for another pregnancy, if there are no other medical contraindications, is from her next menstrual period.

Monika Rachtan
Doctor, I took out the hormonal spiral last week. How long do we have to wait after trying for a baby? Zero.

Dr Kamil Cichy
Please apply right away.

Monika Rachtan
Is it not necessary to do any research?

Dr Kamil Cichy
I am guessing that the patient, in preparation for her pregnancy, did her research 3 months before the removal of the coil and used supplementation. Yes, because that is what I am assuming. OK, that hurts, because any contraception should end 3 months beforehand with a gynaecological visit and preparation for pregnancy. And then after three months we remove the IUDs. You can then make an effort.

Monika Rachtan
Doctor, my husband and I have been trying to have a baby for two years. Everything indicates that in vitro will be necessary. We are from a small town, In our country such things are not performed. Plus the cost. So far we have done everything on the National Health Fund. There is a chance of some funding for this in vitro and all these tests. I would also like to ask where to look?

Dr Kamil Cichy
Unfortunately, in Poland in vitro, mainly privately, there are of course local governments that subsidise. Słupsk does too. In fact, however, availability is very limited. However, it is the local governments that make a nod to these couples, but they also count their own costs. Certainly more, perhaps more. And sometimes there is also the option that such couples can't decide where they want to live, whether in this small town or maybe to change their lives. I would then recommend maybe Wrocław.

Monika Rachtan
A very, very nice city where.

Dr Kamil Cichy
There is a better chance of obtaining funding, whereas even a semen test does not work at all. For the National Health Fund.

Monika Rachtan
Let's hope that this will change soon in our country. I am keeping my fingers crossed. Doctor, I am six months pregnant. The birth is supposed to be natural. I am very scared. I read about perineal rupture and stoma. What was it like for you guys? I guess this is a question for the groupies, but maybe your doctor can say something about it? How do you avoid this rupture? And if I do rupture what next? I've enrolled in a birthing school, but I think it's just a theory. I'm scared that after the birth I'll be left alone with it all, the baby, the wound and the pain.

Dr Kamil Cichy
Firstly, there is no such thing. A routine incision. That's the first thing. I'll elaborate on that right away, because it's a topic we also roll out in surgeries. There is no such thing as a routine perineal incision. The perineum should not be incised and then it breaks at the points of least resistance. And this is a minor rupture. Then there is a poor chance that we will have anal sphincter damage And then there are those stomas. This is a very negligible percentage. On the other hand, what can be done to avoid this rupture? It is physiotherapy uro gynaecological during pregnancy. It is yoga, it is Pilates, it is proper massages. Yes, using the right oils is what we have in the sixth month, yes, as far as I remember. She still has time to prepare herself. This will minimise her risk.

Monika Rachtan
Just focusing on yourself, a little bit of yourself.

Dr Kamil Cichy
Because this is pregnancy precisely, Because you have to focus on the very, be selfish. That's what I encourage patients to do too. It's supposed to be passionate health. If the mother has a health problem, the child will not grow up in well-being. This is also a matter of the future upbringing of the child too. So here I encourage birthing schools. Is it just theory, There are different birthing schools, So I encourage you to choose birthing schools. But where there is a gynaecological physiotherapist, where there are yogis, where there are people who encourage physical activity, because they make you less likely to have ruptures and injuries during childbirth and also increase your chances of being effective by nature in general. In general, I would encourage you to choose such birthing schools here. I would be reassured.

Monika Rachtan
Doctor, so the next question And you have already answered that question. But let's go back, maybe let's go back to him yet as far as this patient's question is concerned, Some time ago I asked my mother to go with me to the gynaecologist. I've met a boyfriend, we're together and I'd like to get permanent protection, because every sex is a big stress for me, whether there will be a period or not. But my mum said I'm too young for the pill. I'd like to add that I'm 17, I can go by myself to get the pills and ask if there's a chance that the doctor will prescribe me something cheap, because I'm unlikely to get money for them from my parents.

Dr Kamil Cichy
A 17 year old girl has to have a double consent according to Polish law also here alone when she comes will not get such contraception. As far as the selection of contraception is concerned, it has to be selected with a view to safety. It must be tailor-made, it cannot be anything absolutely random. And unfortunately, sometimes contraception for this particular patient may be beyond her financial possibilities.

Monika Rachtan
I understand.

Dr Kamil Cichy
This is a difficult topic here. Yes, unfortunately there are countries in the world where contraception is available without a prescription, and I think that nowadays it is safe enough that some things could actually be allowed to circulate, even without a doctor's opinion. On the other hand, wouldn't that in turn have the opposite effect, that patients wouldn't come in at all?

Monika Rachtan
Well, precisely, because this visit for contraception is also a pretext for prevention, right? The patient comes, the doctor invites and then, and then this examination takes place. Doctor, thank you very much for that.

Dr Kamil Cichy
I thank you very much.

Monika Rachtan
I was also very pleased. Thank you very much to the doctor. Thank you very much for your attention and we will hear from you in the next episode.

Dr Kamil Cichy
To be heard.