Having answered her final question, she placed her cell phone back into her purse and said, “Oh, also doctor I’d like a prescription for my bacterial vaginosis.”
“Okay. Are you sure it’s bacterial vaginosis and not something else?”
“Well, I’ve had it before, several times. It’s just an irritation.”
“Do you have an odor, or a discharge? What’s it like”
“Nah, I don’t have a discharge and no odor.”
“Okay, but how do you know it’s not another type of vaginal problem, another type of vaginitis?”
She said, “Well, it’s the only thing I’ve ever had problems with down there. Besides, I’m married.”
“Meaning to say that you and your husband are monogamous.”
“Correct,” she said. “Is there a problem prescribing the medicine for this?”
“Not really, if that’s what it is. But it’s sort of incumbent upon a doctor to make sure that what he’s prescribing is for the correct diagnosis. And I understand that you think you have bacterial vaginosis because you have the same symptoms as you’ve had in the past. But how do you know you don’t have a different problem?”
“Well," she said, "again, I’m married and I know I don’t have another problem. I’ve had this problem before.”
“Okay, so you you’re saying that since you’re married that this excludes the possibility of having anything else? Do you think nuns who are celibate never have a vaginal infection because they never have sex?”
“I’m not sure. How would I know?”
“Then how do you know you don’t have a co-infection – say with yeast, trichomonas, chlamydia, gonorrhea, or herpes? A vaginal exam will definitively reveal if this is the case.”
“I don’t think that’s necessary and I’d rather not. I think you’re being difficult now,” she said. “If you don’t want to write the prescription just say so.”
“Well, it’s not that I don’t want to write the prescription. It’s that I want to write the prescription for the correct diagnosis. I don’t want you coming back in here with continued or more severe symptoms than what you have now.
"Okay, so you’re reluctant to have a vaginal exam. Based on your history, I’ll go ahead and write the prescription to treat presumed bacterial vaginosis but I don’t want you to be disappointed if you return in several weeks with more symptoms or discomfort. Because if you do then we will definitely do a vaginal exam – as we should do today.”
"Fair enough," she said.
As I wrote the prescription I asked, “Does your husband have any symptoms or complaints? Is he circumcised?"
"No, he has no complaints, and yes, he's circumcised. Besides, why would that
matter?" she said, as she lifted her purse to leave.
"Well, women in a relationship with an uncircumcised man are more likely to have a recurrent vaginitis compared to women married to men who are circumcised. I'm just trying to cover all bases."
“Well, let me say this. If he ever comes up with something he ain’t suppose to have and he’s giving it to me then it wouldn’t really matter, going forward, if he’s circumcised or not.”
“What you’re saying is he would be wishing he’d never met you?”
“Ok, here’s your prescription. Call me or come back if you have any questions.”