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If you are a woman with multiple sclerosis, a gynecologist is an essential member of your healthcare team, one who can address preventative care as well as female health issues affected by MS.

In general, a gynecologist is a doctor who specializes in the medical care of women and their reproductive system, while an obstetrician is a doctor who specializes in the surgical care of women and their children during pregnancy, childbirth, and post-natal care. In post-graduate medical training, obstetrics and gynecology are often combined to form a single medical specialty known commonly as OB/GYN. Today, almost all gynecologists are also obstetricians, and most obstetricians also practice gynecology.

Your healthcare needs related to gynecology will differ depending on your stage of life and how MS has affected you, but discussing the following topics with your gynecologist will help you better understand how to stay your healthiest and the options available to treat complications related to MS.

Preventative care

Preventative care (stopping disease before it starts) is important for everyone. You can rely on your gynecologist to recommend screening tests that should be part of your preventative care routine. The U.S. Preventive Services Task Force, a group of nonfederal experts in prevention, has issued screening test guidelines. The entire set of guidelines can be found online. The tests include screening for:

• Cervical cancer (commonly known as the PAP test)
• Sexually transmitted diseases (such as gonorrhea, syphilis, HIV, and HPV)
• Breast cancer (mammograms as well as self-checks)

While age is a factor in recommending when and how often these and other screening tests should be taken, other risk factors are considered as well. A gynecologist has the expertise to assess and tailor your screening schedule according to your particular needs.

Changes in the female reproductive system

Beginning at puberty, hormones play a vital regulatory role in the female reproductive system. Few large-scale studies have been done to establish the affect of hormones on MS, and researchers report it is often difficult to differentiate between MS symptoms and those related to hormonal changes. But regardless of the cause, a gynecologist can offer advice and/or treatment concerning:

• Menstruation and premenstrual syndrome – Some women with MS notice MS symptoms worsen before or during their period. Also, some MS treatment medications can affect the menstrual cycle, though this can be temporary as the body adjusts to the medication.
• Contraception/contraceptives – You may first discuss your desire to have a baby with any member of your MS healthcare team, but your gynecologist is the one who can offer expertise on becoming pregnant. If pregnancy prevention is your goal, a gynecologist can help you choose the birth control option best for you.
• Menopause – The drop in hormones that accompanies the “change of life” has been associated with a temporary worsening of MS symptoms. Like other hormonal changes, this can be managed under your gynecologist’s care.

Sexual difficulties

Sexual problems can be an uncomfortable topic for some women to discuss with their doctor. If you’re one of those women, you might find it easier to talk about sex with a gynecologist.

If you’re having sexual difficulty because of MS, you’re not alone. Sexual dysfunction was reported by more than 60 percent of the women and more than 75 percent of the men in a survey of people with MS in northern California, according to information from the University of California San Francisco Multiple Sclerosis Center.

Women experiencing sexual dysfunction often complain of:

• Numbness in the genital area
• Diminished orgasmic response
• Unpleasant sensations
• Diminished vaginal lubrication

Your gynecologist can review ways to treat the problems. For example, water-soluble lubricants may be an essential aid in genital stimulation and sexual arousal. And vibrators may provide pleasurable and sexually stimulating sensations. Additionally, spasms, pain, spasticity, fatigue, and bladder/bowel dysfunction that contribute to sexual dysfunction are often alleviated with medications.

Most importantly, in all conversations with your gynecologist – as with every doctor – the more you open up and tell them about your problems, the better they can help you.