The Habit of Women's Health with Dr. Andrea Campaigne

Jessica Honegger [00:00:04] Well, this is a special episode of Going Scared because I am actually recording myself live, walking into the OBGYN. I'm walking here into this hospital building to see the OBGYN for the first time, and I can't remember we're going to find out. It's probably been eight years. I had home births and I have a strong aversion to hospitals and I don't know where that comes from. I haven't fully explored it, but even walking in here, I just get a bad feeling. And I'm sure it comes from spending a lot of years in the hospital when I was little and my granddad was really sick, my brother had an emergency in middle school, so I probably just have something stored in my body that's just like, This is dangerous. This is bad. This is scary, and therefore yours truly avoids it. So we're going to talk, we're going to talk about women's health. We're going to see how often are we really supposed to come get paps because I know they change that a few years ago, and I'm going to be brave and I'm going to go do the thing I don't want to do, and I'm going to bring you along for the journey. So here we go. I'm in a waiting room filling out paperwork. I literally have butterflies in my stomach, probably because I know I to have to get on a stupid scale, which is probably the reason half of you all don't do this regularly. I have a plan. Don't look at the number because that number really doesn't give me any information about myself or really even my health. Just called my name. OK. Yeah. Thank you. OK, great.

Nurse [00:01:42] Go ahead and step right here to get your weight.

Jessica Honegger [00:01:43] OK, OK, right here.

Nurse [00:01:44] If you want to hang your purse,.

Jessica Honegger [00:01:45] OK, should I take my shoes off there? And we have like five pounds? Yes, they are. OK. All right. Well, that was a lot better than I thought it would be and really relatable. And I did find out I have to go get a colonoscopy. And that's not fun, but I'm really looking forward to interviewing Dr. Andrea Campaigne. And you hear that coming right up because I'm just curious why women need an OBGYN, what the rule on a primary care physician. Can I get any of my care there? Can I just have a midwife? Because that's all that I would prefer. That is what I would prefer, but I feel empowered today that I took a step towards health and asked questions that I needed to ask and feel like I'm OK. Dr Andrea Campaign, who is also my cousin. Welcome.

Dr. Andrea Campaigne [00:02:57] Thank you for having me.

Jessica Honegger [00:02:59] It was wonderful to visit your practice a couple weeks ago for the first time, and I think it was five years.

Dr. Andrea Campaigne [00:03:07] That's true for a lot of women, don't you worry, OK?

Jessica Honegger [00:03:10] Because that's where I wanted to start. This seems like a no duh question. But what role does an OB-GYN play in a woman's health journey?

Dr. Andrea Campaigne [00:03:21] I mean, I could probably talk for more time than we have passionately about answering that one question. I will say that I personally, as a women's health advocate, am somewhere between what I like to sort of say is the older fashioned model of the annual exam being a kind of ball and chain, a sort of scary mandated experience that we get a nasty postcard or email reminder, and we quote unquote have to go do. And something that is more on our terms, more empowered and that we advocate for ourselves meets our needs better. [00:04:07]So I do like for women to have a wonderful two way dialogue with a women's health advocate like their OBGYN who knows them in multiple dimensions and takes care of them in multiple dimensions. I think women who have access to the health care benefit called an annual exam should try to make that visit more on an annual-ish basis. But I think we are there as a woman's OB-GYN to help meet the needs of her in different seasons. And so the frequency of that visit and exactly what's covered at that visit, by the way, is going to vary over time. For a woman, an annual exam and a visit to your OB-GYN does not equal a pap smear. [43.6s]

Jessica Honegger [00:04:51] Yeah, that is a really good distinction. And speaking of that, I know I remember hearing a few years ago they it used to be OK, you got to get a pap every year and now they've changed it, I think, to every couple of years. That's right. So, yeah, tell us sort of the minimums.

Dr. Andrea Campaigne [00:05:09] So that's a great point. It's resulted from a lot of different things. The pap smear was a test developed, gosh, about 50 years ago now, and it's a wonderful screening for cancer. It gives us access to detect something you know that that we were leaving undetected in sort of past generations. But I would say when it came to pass and we started to apply it widely, we didn't know how to refine the plan for it. And so I would say over the last, like 20, 20 years of practice, we've gotten better at the technology with the initiation of HPV testing that a lot of women understand is kind of happening either in the background or in the forefront of their conversation with their OB-GYN. And what we know is that almost all of the reasons for abnormal pap smears result from the presence of something called the HPV virus. And so an era of making the pap smear couched in the presence or absence of a woman's HPV virus detection is now a better form of interpretation of the pap smear screen. And so all women really don't need a pap smear, except on a screening basis about every three years. Some in the lower risk categories can go up to five, and obviously all of this is changed. If your doctor says based on your pap smear, I want to check it again in six or 12 months, which is still sometimes the case for certain diagnoses.

Jessica Honegger [00:06:47] OK, that helps. So what is the difference between a primary care physician and an OBGYN?

Dr. Andrea Campaigne [00:06:56] Yeah, that's wonderful. I mean, the main answer is our training, and I don't mean to say because my heart is deeply in it, I kind of pretend to be a primary care, but just for all of your audience. I personally went to medical school 100 percent intending to be a family doctor, a primary care doctor. It's where my heart was. I was touched in my life by a wonderful family doctor who saw three generations of my family and I thought kind of guided us and knew us in all the right ways. And so when I went to medical school, that was the only default. That's what I thought being a doctor meant to people. I was lucky then to find women's health, which offers me personally and professionally kind of a lot more things than primary care would have that suit my personality and skill set. [00:07:45]But the core value of primary care, I think, is to kind of be there for people in many different ages and stages, and to be able to talk through how the health care diagnosis impacts their kind of home life for lack of a better term, I think primary care also has a focus on wellness and not just illness. And I found a lot of these values present in my view of women's health. I like interacting with women at all different ages and stages. I have a real whole woman focus. I don't only concentrate on kind of what you might think of as disorders of our reproductive tract, so to speak. I really see women for their whole person and like to think about their whole health. So it's not that there's no difference, but I want women to know that they are strongly encouraged to get care really, wherever they have the best dialog, the best listening, the best access. [60.5s] And I tell a lot of my patients who say, you know, I respond well to you. You do treat me as a whole person. I want some of my other health care to kind of reside in your office that I never mean to replace the relationship that they might want to have with a good primary care doctor for their asthma or their bronchitis, or some part of their family history or their autoimmunity. But that I also don't want care to be redundant. You know, they don't have women don't have to see both of us all the time in parallel, but we can have, I think, complementary roles.

Jessica Honegger [00:09:23] Yeah, because I think for me personally, what happened is I stopped having babies. Mm-Hmm. And well, anyway, you know, I had midwives anyway, so I don't have a relationship with an OB-GYN. I mean, I have a relationship with you, but I kind of wanted to keep family. Yeah, I didn't really want you doing my paps, even though we could handle that. No big deal. But I think what led to confusion for me, like, do I need to go to the OBGYN still? I don't have a history of cancer. How often do I have to get a pap? Is this just the insurance company doing this?

Dr. Andrea Campaigne [00:10:00] No, those are all really lovely points, and it's so funny as I was preparing for this conversation and kind of organizing my thoughts, my little like working list was that obviously most people know us primarily in our like quote unquote number one capacity, which is to help women in their reproductive life. But in my humble opinion, what shortly follows is a relationship that's based on cancer screening and prevention, by the way, which I'd be happy to talk a little bit about. Preventative health, you know, everything from wellness, you know, diet and exercise. Sometimes we're the first line of discussing sort of smoking or marijuana use with women, everything about like safety at home. Sometimes we were a good advocate as a safe place to discuss that, you know, STD screening, things like that and then the other areas that mean a lot to me. And I think sometimes women don't bring these up to other quote unquote doctors, you know, is the mental health, women's mental health and sort of the acceptance around either disclosing challenges with mental health in life transitions or parenting or relationally interpersonally with your intimate partner or family members. And then also sexual health, very frankly. You know, that's an area, obviously that I have very plain language for and like to advocate for and talk about every day. But I think sometimes that gets overlooked or understated in other health care avenues.

Jessica Honegger [00:11:40] Well, that's what I was going to ask, because it is very natural to talk to your OB-GYN about sex, but how prepared are OBGYNs to talk about sex?

Dr. Andrea Campaigne [00:11:50] I mean, we talk about it every day. So obviously any health care experience is going to come a little bit with the experience and then also the sort of biases, if that's an appropriate word of the doctor, you know, I mean, we're human. But like in my practice, I mean, in my practice, I talk about sex I would say with about 50 percent of patients in a day, obviously, most of that is the women on some kind of information seeking this mission, you know, not feeling their questions have gotten answered in either the media experience or their friendship relationships or, you know, wherever else they're seeking answers or advice. They want a different authority on that. Not to over medicalize it, but to have someone who can maybe speak, speak in plain language to sort of normalize the experiences that some women have.

Jessica Honegger [00:12:46] And is a lot of questions around? I was going to say sexual dysfunction, but I don't want a label that.

Dr. Andrea Campaigne [00:12:52] That's one word. Yeah, I don't like words that have tone, but you're right, there are various forms of sexual dysfunction that obviously are treatable conditions, you know, in the women's health sector that we sometimes become involved with there's also patterns of intimacy I would say, you know, libido and sexual frequency, different things in both long term and short term relationships where women feel sort of mismatched to their partner. That isn't strictly speaking like a physiologic issue all the time. Sometimes that's more of like a mental or relational issue that we get into. There's a lot of issues. I mean, there's a lot of issues around body image consciousness. You know, there's been a lot of modern movement on, you know, saying the word labia and a lot of modern imagery around it because women are very shy about their anatomy. And a lot of us don't sort of don't think it's pretty, so to speak. And so just a positive dialog around our anatomy even can sometimes be something that I think we break down. And that might be something that I guess is missing from, like some primary care visits.

Jessica Honegger [00:14:06] Let's talk about labia because we're going there. Yeah, it's everyone's labia different? Labia, whatever you call, you know.

Dr. Andrea Campaigne [00:14:14] And pardon me for dodging the answer to that just got [00:14:17]my kind of categorical worldview of the way they see the world both as a human being and as a physician is that we, as women, we as human beings but what I advocate for is that we as women should represent a bell curve, right? I don't like women to say is my normal, as if there is one golden form of normal and everything that strays from that is somehow categorically abnormal. Does that make sense? But that is sort of the standard that everyone asks me to measure them by. [29.1s] And so I dodge this question a lot, which is to say that like there are not a whole lot of like disorders of labial anatomy, if that makes sense. So when one woman thinks that hers are abnormal, it is probably that they fall very much somewhere on the bell curve of what we've seen before. Does that make sense? And really, it's a lot about her knowledge of that or her acceptance of that information.

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Jessica Honegger [00:16:35] You know, as we're talking, there aren't many safe places that a woman can go, and so many of her feelings around her body and around her sexual life are hidden inside of her, which is where shame grows. Shame grows when it's not named. But Andrea, you are a special snowflake, and I've had unsafe experiences with OBGYNs that my very first OBGYN experience, as you know, I was like, prudish, prudish for getting married. Zero sexual history. I get married. First of all, I didn't know that you weren't supposed to have sex before getting a pap smear. So we had some things inside of me before getting a pap, so I got an abnormal pap. My OB-GYN who did not know me from Adam, the very first thing she said was, Tell me about your marriage. Well, and then I said something like, Oh well, we just got married, and we're both super committed to each other. And she goes, Well, it's easy to say that about you, but you never know about your partner. Yeah, that was my very first experience in my early 20s with an OB-GYN that did not feel safe. Then, as you know, I decided to go with an OB-GYN for my second pregnancy midwife for the first. And then at 36 weeks, my OB-GYN, I didn't realize this was going on maternity leave. And so we had to do a switch out with a man. And I remember talking with him through my fears about having birth in a hospital. And it was like Gaslit wasn't heard. And I walked out of the office bawling and went, got a midwife and ended up having a home birth four weeks later. So that's why this is hard, you know? So I mean, I guess, how do you find OB GYNs like you?

Dr. Andrea Campaigne [00:18:27] I get so I wake up every day and know that my role is just to serve any one woman who has an appointment with me. I don't find it my mission to sort of speak broadly to the medical community and say, Damn it, why aren't you watching your words? Although I think that in my head often too. [00:18:48]What I do want your listeners to know is that health care is a two way street and they should search, you know, I think I mean, every day that I get a new patient, the new patient says, Oh my gosh, so and so and so and so and so and so all told me that you were fantastic and I was like, Bingo, you crowdsourced the information, and now you're coming in with a moderate degree of confidence that we're going to be a good fit for each other, right? So I don't think women should put up with a sort of subpar. I am sad for women who have outright trauma from the medical system. I just want them to know it is not all like that, and I don't want them to write off future doctors based on one bad experience. Just like you wouldn't, you know, shut off from your future husband based on one shitty ex-boyfriend. So I want women to sort of persevere and advocate for themselves and go crowdsource and find information on a doctor that they think they can have a good ongoing dialog with. Because we're worth it. [60.4s]

Jessica Honegger [00:19:49] We are worth it. And I think to not be afraid to walk away because I walked away at 36 weeks. Yes, because I realized this is not going to be a good fit. And I think and you're aware of this. I mean, I'm in a leadership position too, and I have to remind myself my voice carries a certain level of authority and power. Yes. And that's just being a doctor. You've got the D.R. period in front of your name and you carry a certain level of authority and power. But what I want to remind women today is you have just as much power. I agree you don't have less power than a d.r period.

Dr. Andrea Campaigne [00:20:26] [00:20:26]Every day I think health care is a two way street. I do not feel like I have all the special answers and it's my job to bestow those on women. I feel sometimes I say doctors don't own patients. Doctors serve patients. It's my job to help translate the special files of information that I do have and the experience that I do have to meet the needs of a woman. And I can't do that if I don't sort of get to know her and meet her where she is at right to help figure out how the nuances of the conversation that I need to have with her. But yes, women do have the power. Their side of the health care relationship is very much a two way street, you know, something that I need to advocate for. [48.4s]

Jessica Honegger [00:21:15] Is it possible to interview a physician before you're like, here, do my pap?

Dr. Andrea Campaigne [00:21:22] Yeah, that's a great point, Jessica. One of my first OBGYN experience in contrast to yours. I mean, I did, you know, march myself in at 18 to my mother's doctor, I can't say that that was fully thought through or, you know, researched or whatever, but this particular physician had this lovely way of interacting with new patients, which was that you met her in her office with your clothes on and she got to know you. And then she presented the idea like, Are we going to do an exam today? Are you ready to undress? And I always thought that carried such, do you know, I mean, such a respect for the patient and her experience? And then, I mean, as a small side note, you know, and you know this about me and my husband, your cousin. So we started dating in high school. And so she didn't know me from Adam at that first visit. But when I talked about dating my high school boyfriend, she could have let that mean so many things based on her experience and bias. But she didn't. She didn't couch that in tone that dismissed it. She allowed it to be like my story in real for me, both at 18 and later in my life when I married him. And she, in fact, also heard me say at 18 that I was going to college and that I was pre-med. And every year after that, when I went back to her during college for my birth control pill refill, she said, You know, how are the pre-med studies going? Have you refined where you're going to go to med school? She advocated for that part of my growth, too. So she was a real positive impact on me about what it's like to be kind of seen by that person and not marginalized by that person.

Jessica Honegger [00:23:08] So powerful. And I think after even hearing you today, I hope this gives hope that there are people out there like you who are called to this profession. I do want to end since I've been an advocate of midwifery. Yes, midwives do paps too. So is it possible to have all of your care under the care of a midwife?

Dr. Andrea Campaigne [00:23:33] 100 percent it is. We are happy as OB GYNs to serve as sort of consultants to midwives and to patients who only think that they might need us in sort of higher level circumstances, both around birthing and around sort of the general practice of women's health, including like contraception and STDs. And yeah, even some like screening labs and things like that. So I love you also know about me, I love midwives. I advocate for midwives. I have received care from midwives in my own life. If that is the access point for women, that makes them feel more comfortable, that is a fantastic access point.

Jessica Honegger [00:24:14] Wow. This was really healing for me.

Dr. Andrea Campaigne [00:24:18] Good. I mean, I tell you this,

Jessica Honegger [00:24:21] I'm going to pretend like we just had an appointment together, and I got to rewrite some of those bad experiences.

Dr. Andrea Campaigne [00:24:28] Good. Thank you for saying that, Jessica. It's not, you know, that is not easy. I know that. [00:24:33]I would also say on a regular basis, I invite women into my space and have to help them overcome some kind of traumatic experience, either traumatic experience on their body or a traumatic experience with regard to health care or communication. But there are a lot of people that are called to help women and who are aware of that, and so every individual's healing is at their own pace. Right. And I don't expect them just to sort of get comfortable because of the physical surroundings or the pay or the doctor's reputation. But I would love for more women to believe that a step forward is possible. [40.2s]

Jessica Honegger [00:25:14] That's brilliant and beautiful, and I hope you're left with hope for our own healing and that we will steward our beautiful, profoundly made worth it bodies. Well, that was a Going Scared first for me. You know, I went scared and asked about labia and shared with you all some of my traumatic stories with OBGYNs. I'm sure I'm not alone in that, and I hope that some of you that have some of those stories that make you feel less than safe and comfortable in your doctor's presence can now feel empowered to create a new and different story going forward. I do believe it is possible, and I'm glad that Dr. Andrea Campaigne cast that vision for us. If you live in Austin and you're looking for a job, well, you should go find Dr. Andrea Campaigne. Because let me tell you, she does have that special mojo of the midwife and doctor. Well, thank you so much for joining me on this vulnerable episode where I took you inside a hospital and to an OB-GYN appointment and talked about all sorts of things that we've never talked about on the podcast. The music from today's show is by Ellie Holcomb, and I'm Jessica Honegger. Until next time. Let's take each other by the hand and keep going scared.