‘Barbie’ movie’s ending is an important reminder for women’s health

By Madeline Holcombe, CNN

(CNN) — SPOILER Alert: Do not read past this line if you haven’t seen “Barbie.”

After all of Barbie’s glories and misadventures on the path to becoming human, moviegoers leave her at a pivotal moment at the close of the new film.

That moment isn’t starting an extraordinary astronaut job or winning a Nobel Prize or even realizing authentic human beauty: It’s a gynecologist appointment.

In the film, the character Ruth Handler (who in real life invented the doll) explains that “Barbie” doesn’t have an ending. Instead, the movie closes with Barbie beginning the full human experience.

Why is something as ordinary as a doctor’s appointment important enough for the final scene of the film? What makes this regular inconvenience a unifying entry into womanhood?

To help us with these questions, I spoke with CNN Medical Analyst Dr. Leana Wen, who is an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She previously served as Baltimore’s health commissioner.

CNN: Do we give enough attention to women’s reproductive health?

Dr. Leana Wen: Reproductive health care is still not regarded as part of total health and well-being. This applies not only to people in their reproductive years but also those who are undergoing menopause and need care during and post menopause.

Much more needs to be done around reproductive health, including investment in research and medical care.

CNN: Why might it be important that “Barbie” culminated in a gynecologist appointment?

Wen: Having everyone see Barbie go to the gynecologist normalizes the experience. It solidifies the understanding that reproductive health is an integral part of overall health.

I hope that will be one of the main takeaways from the scene, which is that every girl, every woman, every person who has female reproductive organs should seek regular preventive care to address their reproductive health.

CNN: What’s the age that teens should have their first appointment with a gynecologist?

Wen: Teens should begin their first reproductive health visit between the ages of 13 and 15 years old, according to the American College of Obstetricians and Gynecologists. This is a general preventive health visit in which the health care provider begins to establish a relationship of trust with the patient in a one-on-one, confidential setting.

There will be opportunity to discuss specific concerns, if there are any, and the provider will document the patient’s medical  history and perform a physical exam. Generally, an internal pelvic exam is not done unless there are specific symptoms, such as pelvic pain. If the patient has not yet had their vaccines against human papillomavirus (or HPV), a leading cause of cervical cancer, this will be offered, too.

It’s important to note that while, during this discussion, we use the terminology of “girls” and “women,” the reproductive health visit I’m referring to applies to anyone with female reproductive organs. Anyone with a cervix can have cervical cancer, regardless of whether they identify as female, male or nonbinary, and all of these individuals should heed the recommendation to begin reproductive health visits during adolescence.

CNN: How often should women and people with female reproductive health organs see a gynecologist?

Wen: Visits are recommended annually for preventive care and screenings. There can be more frequent visits when specific concerns arise. For instance, women with heavy, irregular menstrual bleeding may need additional testing to find out the cause.

CNN: What occurs during these visits?

Wen: It depends on the patient’s age and whether they are seeing other health care providers. Many women only see a gynecologist for their health care, and if that’s the case, there may need to be additional attention paid to screen for medical issues such as diabetes, anxiety and hypertension. Others have a primary care doctor and visit a gynecologist solely for reproductive health concerns; if that’s the case, the visit can be more limited to sexual and reproductive issues.

The gynecology visit generally begins with getting basic measurements: Your height and weight are taken and blood pressure and heart rate checked. The physician (or nurse practitioner or physician’s assistant) will discuss your medical history, your family history of certain illnesses, and your sexual and reproductive health history.

Some questions you may be asked include: At what age did you begin menstrual periods, and how often do they occur? Do you have symptoms like pelvic pain, discharge and such? What is your gender identity and sexual orientation? Are you sexually active with men, women or both? Are you monogamous, or do you have multiple sexual partners? Have you been pregnant before? Are you looking to become pregnant, and if not, what kind of birth control do you use?

There will be a general physical exam, but whether there is an internal exam depends on your age and symptoms you report. If you have no symptoms, there is generally no internal exam until the Pap test looking for cervical cancer is due.

The recommendation for Pap tests is that they begin at age 21, followed by Pap testing every three years until age 29. From age 30, cervical cancer screenings continue in the same manner or could be done using HPV testing or an HPV/Pap combined test every five years.

Of course, these recommendations would be different in individuals with elevated risk. Also, depending on what other symptoms you report, the provider may recommend additional testing — for example, blood tests looking for anemia in someone reporting heavy menstrual bleeding, or screening for sexually transmitted infections.

CNN:  Why are regular appointments important?

Wen: Everyone should have a health care provider that they see on a regular basis. That’s the person they can ask any and all health questions of, no matter how uncomfortable or embarrassing.

For many women, that person is their gynecologist. Regular appointments, at least once a year, are important for preventive purposes and to establish an ongoing relationship. Going annually gives an opportunity to detect new issues, like rising blood pressure or depression. It allows your provider to keep track of screenings you may need, including for breast and cervical cancer. And the ongoing relationship gives you someone you can contact if new issues arise between visits.

I want to add a personal note about the importance of regular screenings. I was diagnosed with cervical cancer in my late 20s, during a routine Pap test. It was early stage, and surgery cured the cancer. I have not had a recurrence, and I have been fortunate to have two children after that. Cancer screenings save lives, and having a provider who ensures you follow the latest recommendations on frequency of screenings is essential.

CNN: What if it’s hard to make an appointment with a gynecologist? Can patients see another health care provider?

Wen: Yes, though it must be a provider who is comfortable with addressing all aspects of your reproductive health care.

Personally, I see an internal medicine physician who is well-versed with reproductive health care and comfortable with my cervical cancer history. Many family physicians and primary care providers will be well-positioned to take care of your reproductive health needs, but some may not perform Pap exams themselves or have experience with certain aspects of care (for example, inserting intrauterine devices for birth control). Ask ahead, and if they are the only option for you, you could also ask them for specialist recommendations if and when specific care is needed.

CNN: What questions and topic areas should women ask about during their visits?

Wen: This will depend, again, on whether the gynecologist visit is your only source of medical care. If so, you should ask all your medical questions during this visit. If not, you can focus your questions on issues centering on reproductive care. Do you have any new or concerning symptoms, including issues like vaginal itching or pain during sex? Is your birth control working for you, or do you want to discuss other options? Remember that there is no question that you should feel too scared or uncomfortable asking. This is the reason your doctor is there, to help you stay healthy and well.

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