Dr. Tanushree is an activist, surgeon, and an OBGYN from Mumbai, Maharashtra, India who is passionate about accessibility and destigmatization. Additionally, she is Mrs. India 2015. Here, she speaks about her purpose in gynecology, it’s link to women’s rights, and answers frequently asked questions about OBGYN visits and women’s health.

Can you tell us about your journey to becoming an OBGYN, and why you decided to pursue it? 

Dr. Tanushree: It’s a very long story. So, I belong to a family of doctors. My father was a surgeon, and my grandmother and aunt were gynecologists. When I was a teenager, I was trying to figure out what I wanted to do, but there were a multitude of things that interested me. Initially, I took up science because it was more of my mother’s dream than mine. But as I went through medical school, I took up the study more, and I just fell in love with everything regarding women’s health. I stopped education for a bit, and I went on to pursue my career in modeling, and in between, I got married. While taking a sabbatical from medicine, I went on to pursue my career in modeling for 2 years. Then, I came back to gynecology, went through my exams, and did my residency. Then finally, I became a gynecologist who works in all aspects of women’s health. 

What is the difference between obstetrics and gynecology?

Dr. Tanushree: This is a very pertinent question that many people have doubts about. The word “obstetrics” means related to a baby. Whenever a woman is pregnant, she falls under the category of obstetrics. Anything not related to pregnancy is gynecology. Gynecology is related to the uterus, the fallopian tube, the ovaries, the cervix, the vagina, the vulva, the breassts, infertility, PCOS, etc. All of these things fall under the purview of gynecology.

What role do OBGYNs play in making sure the woman has a healthy pregnancy?

Dr. Tanushree: Gynecologists don’t only come in after the woman is pregnant. We actually play a very key role in “prenatal health” or before the person becomes pregnant. When the woman is not pregnant, there are a lot of conditions that can be diagnosed and prevented from complicating the pregnancy. For example, if there is a thyroid issue, we can control that. If there is a blood sugar issue, we can control that too. If there is insulin resistance or PCOS, we can save the woman from a lot of trauma, and mental stress before the pregnancy. So, once she becomes pregnant, she is both mentally and physically healthy to be a mother. This is where I think obstetricians play an important role in prenatal health. 

Should most women see an OBGYN before they get pregnant?

Dr: Tanushree:Absolutely. Women go through a lot of stress, especially since nowadays we are actively pursuing careers. We should get married when we want to and decide when we want to have children without pressure. However, as time goes by, there can be complications, especially after 35. If a woman goes through one miscarriage, sometimes she’ll feel like there’s something wrong with her body, and she won’t feel comfortable going to the doctor. But at the same time, she then never gets diagnosed. And in that case, she may go on to have a second or third miscarriage. At that point, she often goes through the mental stress of trauma, self-blame, and anxiety. So, instead, go and see your doctor before pregnancy. If there is something going on, we can deal with it before the whole process starts. That way,  the woman may not even have to go through medications, hormones, anxiety, or trauma. It’s better to deal with it beforehand so the woman doesn’t have to go through that. 

So, for a woman who has experienced a miscarriage, what should she expect from an OBGYN visit?

Dr. Tanushree:Here’s where a lot of counseling comes into the process. Number one, it’s important to make the woman understand that it’s not her fault. It’s not like you did it on purpose or planned it this way. Number 2, medical science has surely progressed, and we have 95% of cases under control. Most of the time, it is either a hormonal imbalance. Perhaps your endometrium is thin and needs a few medications. Maybe your body needs support or rest. Maybe you need an ultrasound because there’s a small polyp, fibroid, or growth on the uterus. Those are little things that can easily be taken care of. Ultimately, the patient needs to be counseled and calmed down because whatever it is, we are going to sort it out. Maybe it won’t happen this month or the next because we’ll take it slow and steady. We’ll take baby steps, but pregnancy will happen. Most likely, you will be a mother.

For infertility, IVF* is a really popular option now. Is IVF a good option for women who are going through infertility? Is that something that you would immediately recommend for a patient or would you advise them to try and see what else can be done?

*During IVF, mature eggs are collected (retrieved) from ovaries and fertilized by sperm in a lab. Then, the fertilized egg (embryo) or eggs (embryos) are transferred to a uterus. One full cycle of IVF takes about three weeks. Sometimes these steps are split into different parts and the process can take longer (Mayo Clinic).

Dr. Tanushree: I wouldn’t say that IVF is ever an immediate solution, but every patient and every scenario varies. First of all, there are investigations that review the couple trying to conceive (TTC as we would call it). These investigations are very necessary because they allow us to understand how each couple is different. Sometimes, we are focusing on the woman, and one simple test like semen analysis of the male partner is missed. All the while, we have tried everything on the woman, and she’s already gone through an entire self-blame journey. We can never negate the possibility that the male’s semen quality was low, the sperm count was low, or that perhaps there was a semen infection. So, I always tell the patient to go through the steps one by one. Go through the steps, and let your gynecologist explain to you what is needed. However, if she’s in her 40s and has already tried several times, I’d want to retrieve whatever eggs I could, and give her a biological child. So, it truly depends on every patient. 

Outside of fertility and pregnancy, why is it important to see a dermatologist?

*Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) that can cause cancer.

Dr. Tanushree: A simple vaccine called the HPV* is the only vaccine preventative of cancer. All of the other treatment modalities we have control cancer. There are no other vaccines that prevent cancer, but this vaccine is universally available. The best age to administer it is between 9 to 14 years. Moreover, you should see a gynecologist during puberty. So, visits should begin when the girl is 11 or 12 and about to start her period. Also, it’s given to both men and women. After 25 years, each woman is supposed to get her HPV screening or pap smear. This should happen every 3 or 5 years. Every year, you should get a full breast check from a gynecologist. We check the axilla, the brachial plexus, and the clavipectoral. We check the breast tissue for any lumps or nodules. We do a general test to see if the uterus is fine. Doing a basic ultrasound tells us so much about the internal body. So, after 21, the patient should make an appointment every year even if she’s not pregnant and feeling completely fine. 

• In short, an annual examination and screening should be had every year after age 21 .

• One should receive an HPV vaccine during ages 9-14

• Every 5 years, you should get your pap smear even if you’re doing absolutely fine, your periods are fine, and you’re not pregnant. 

If a patient wants to visit the OBGYN for a pap smear, what should they expect?

*The endocervix is the opening of the cervix that leads into the uterus.

** A change of cells to a form that does not normally occur in the tissue (cancer.gov)

*** The presence of abnormal cells within a tissue or organ. Dysplasia is not cancer, but it may sometimes become cancer.

Dr. Tanushree: A pap smear is a very simple office procedure. It doesn’t include any anesthesia, and there’s no pain whatsoever. From start to end, it probably doesn’t take more than 20 seconds. You’ll lie in a comfortable position, and whenever you tell the gynecologist you’re ready, a disposable speculum(a metal or plastic instrument that is used to dilate an orifice or canal in the body)will be inserted which is not painful at all. It’s narrower than two fingers (Oxford Dictionary). 

Then, the cervix is located which barely takes 10 seconds. Then, a small brush is taken, the cells of the endocervix* are taken, and they’re sent for testing. This is a very reliable test that helps us screen for cervical cancer. There are a lot of precancerous stages that you can catch with a pap smear. Before the cancer becomes full-fledged, pap smears help us detect the small cellular changes like metaplasia and dysplasia***. If we detect these cellular changes,  we can catch it at that point, and the treatment is 100% effective. Basically, pap smears allow us to catch small cellular changes at the right time.

Do you feel that pap smears are accessible where you live?

Dr. Tanushree: We are trying to make them so. In India, I think especially women are really deprived here still. I might be an urban, educated woman sitting in a comfortable, office space, but we want to access as many women as we can. But unfortunately, for a woman to walk out of her house to do something for her body is very difficult. So, we try to create awareness through social media and free pap smears. We engage with the government, and there are non-profit organizations helping us out. We are still in the transition, but luckily, more and more education is happening. I would say though that there is still a long way to go. 

So, if there is a husband in the picture during OBGYN visits, is he sitting there?

Dr. Tanushree: So, sometimes even when the woman wants to be alone during an OBGYN visit. She’s not allowed to be alone. The man or the mother-in-law is sitting there, and the woman cannot really open up about her sexual queries or certain problems that she’s having. So, this is what I do with my patients. The scanning room is accessible only to the patient and the doctor. I won’t allow relatives in. They can sit down in my office, and they can wait, but when the patient comes in for an examination, pap smear, or scan, it’s only her and me. Then, for those minutes, she gets to open her heart out, and generally, tell me whatever she has to.

How do you think educating women about their bodies plays an important role in mental health?

Dr. Tanushree: In this society, there’s still so much stigma, especially when it comes to a woman’s body. For example, I grew up in a small town, and I had vitiligo. I still do, and for the longest time, my identity surrounded that. 

I was “the girl with vitiligo,” and that’s how I was known in school. My academics and talents were all surpassed by the reputation of having vitiligo. At that time, there was a big stigma in India against vitiligo because we are so conscious about our color, looks, appearance, and our skin, etc. Initially, I wasn’t even confident enough to talk about it because it was such a taboo. I was scared that my friends wouldn’t talk to me or eat from my lunch box. I used to wear socks because it was on my legs, and I would never tell anybody. If somebody asked, I’d be like “Oh, I got burned…”

It was only when I educated myself, became a doctor, and became an OBGYN that I met like-minded people who made me realize that vitiligo doesn’t decide the person I am. It doesn’t harm me. Vitiligo doesn’t harm my family, It doesn’t hurt me, and it doesn’t cause any problems. Upon this realization, I knew that empowerment, education, and awareness were such important spheres of the same being. Consequently, if I want to empower the women around me, I need to create education, and I need to create education through cultural awareness. Even if it’s through my small patient group, Instagram, YouTube, or interviews, I strive to create awareness. It’s all about awareness. 

It’s important for women to know that we are more than just our bodies. 

No matter the form, we are more than our bodies.

Can you tell me what PCOS is?

Dr. Tanushree: PCOS is becoming so common today. Every second, a woman faces some aspect of it. Before, it was called PCOD, which is Polycystic Ovarian Disease. However, the term “disease” is not really encompassing because it isn’t really a disease. It’s just a syndrome which means that it’s transitional and symptomatic. So, once you have it, you can never 100% control it, but it can be totally and completely controlled. This is what happens with PCOS. Every egg that should rupture (burst) once a month does not. Likewise, ovulation doesn’t happen, and lots of eggs get accumulated in the ovaries. So, the “cysts'' are not actually real cysts, and they don’t need an operation. It’s an accumulation of unruptured follicles that eventually leads to hormonal surges like testosterone, progesterone, and estrogen. Then, you start getting acne and facial hair which is known as hirsutism. You start having mood swings, food cravings, and you start gaining weight. And then, the syndrome leads to anxiety which can create a circle of self-blame and depression. So, even though it’s not a serious syndrome, it deeply impacts women. Given that, I think the sooner we catch it, control it, and treat it - the better. 

Are there any other syndromes or conditions that can affect a woman’s mental health?

Dr. Tanushree: So, even something as beautiful as pregnancy can wreak havoc on a woman’s body. Because she’s going to be a mother soon, she may feel happy and loved by family members when she’s pregnant.  And suddenly, when the baby is born, it’s like the mother is forgotten sometimes. The woman may start dealing with postpartum depression and the stress of being a new mother. 

In fact, it’s medically proven that the post-partum period is one of toughest moments in a woman’s life. So, even though she’s gone through pregnancy, delivered, and everything has gone fine, OBGYN visits are still so important. The symptoms of postpartum are so strong that we women can end up resenting our own children. Severe postpartum can make breastfeeding or even seeing the child feel like an unpleasant obligation. This is an extreme hormonal low, and this is a profound physical change that hampers the woman’s mind even if she doesn’t realize it.

Where you live, is there a lot of awareness about postpartum?

*An episiotomy is an incision made in the perineum — the tissue between the vaginal opening and the anus — during childbirth

Dr. Tanushree: No. Unfortunately, no. I have had patients who have never come back after pregnancy because they already have small children, and sometimes they forget about themselves. But, if they do come back maybe a year later, you can see that they are in clinical depression. But, nobody really paid attention to their mental health. So, we’ve started making it where the patient is bound to follow up. Whether it’s a suture removal for a C-section or an episiotomy*, we’ve asked for the patent to follow up after two weeks. Perhaps we’ll ask to check in on her and the baby just to see how she’s doing. We're trying to get women in India the care that they deserve, and I think we’ll eventually get there. 

So, for a patient with postpartum, should the first instinct be an OBGYN or a mental health professional?

Dr. Tanushree: Always OBGYN. There are so many medications that an OBGYN will be able to better advise on. For example, we’ll be able to explain what is safe during lactating and breastfeeding. So, always go to your OBGYN, and let them diagnose it. And if they think therapy or counseling is required, she will refer you. 

Do you have an ultimate goal for making women’s health more accessible?

Dr. Tanushree: I want anyone who defines themselves as a woman to feel safe from judgement. Every woman is beautiful, and when a woman comes to talk about her health, she should never feel judged. This means trans women too. Even if a woman has a vagina and breast now from surgery, they should see a gynecologist. A dermatologist can counsel about what to do, what not to do, and about estrogen. 

The patient’s identity should always be important to physicians. For example, some OBGYN patients don't identify as women. So, they are not women, but they might still need a gynecologist because they have a uterus, and likewise, they may face problems that an OBGYN can help with. So, I'm trying to create a platform where anybody who needs support from a gynecologist can find it. I'm available, and my team is available to create a safe environment where no one is judged. We provide full proof knowledge, medical, scientific and evidence-based knowledge given that there's so much information on the internet that is misconstrued or simply not true. Teenagers and young adults can easily be led to the wrong thing. 

That’s why I try to reach as many people as possible. I don’t want them to endure what we went through as teenagers. We are out here fighting for education and human rights. We are on the planet to be exactly who we want to be. Everyone should have the opportunity to thrive, and we are all waiting for this type of India - this type of world. Everyday is evolving, and it’s very hopeful to be in a country that’s ready for change.

Are OBGYNs a part of the transfeminine bottom surgery process?

Dr. Tanushree: So, that is done by a whole different team of surgeons that are urologists and general surgeons. I follow up with overall care after the surgery.

In your professional opinion, does educating and opening conversations with women about the experiences they've had with their health progress women's rights? Could it combat internalized sexism as well?

 

Dr. Tanushree: Of course. When women come to me, especially women who are dealing with PCOS, they are so low in self-esteem sometimes. On top of that, when a woman has been restricted by society, it is much harder to have boundaries. When the self-esteem is crushed, the identity can be crushed. So, I always say take baby steps. Celebrate the little victories. Celebrate the one thing you did for your health, the one day you took care of your mental health, the one day you had discipline, and the one day that you stood up for yourself. Say, “Although I’m struggling with some things now, I am tackling and dealing with them. If I am truly trying my best, no one has the right to tell me that I should be doing better. I am trying my best.”

@gynae_guru