An hour, and what it's for.
Longer than most medical appointments, on purpose. Pelvic pain is complicated enough that a short visit cannot reach the bottom of it.
Endometriosis, adenomyosis, fibroids and the other causes of pelvic pain are genuinely complicated. They involve several organ systems and produce a long list of symptoms, and most people arrive carrying years of history that has to be untangled and put in context before any of it means anything. That is what the hour is for.
Before you arrive
We send a detailed symptom and history questionnaire to fill in beforehand. It exists so that the appointment is not spent re-asking questions you have already answered, which is the single fastest way to waste an hour.
There is one thing the questionnaire cannot capture, and it is the most important information you can give us: what all of this is doing to your life. Not the symptoms, but the effect of them. What it stops you doing, what it has already cost you, and what you want back.
That is what tells us what actually needs fixing. More than any individual symptom, we need to know how you want to be able to live and what you need from us to get there.
Our starting position
We usually read your questionnaire before we walk into the room, and quite often we already have a fair idea what the diagnosis is. That is not clairvoyance. It is that we have heard the same story hundreds of times, and watched a great many people suffer in the same ways.
So the starting position is to believe your symptoms, your pain and your experience. The job from there is to work out what is causing them. It is a puzzle, and it is a real challenge. Sometimes, honestly, it is not much of a challenge at all, because you are the third person we have spoken to that day with the same set of problems.
Checking that it isn't something else
Endometriosis produces so many symptoms across so many organ systems that doing this work means knowing a good deal of medicine outside gynecology. Bowel, bladder and nerves, and the conditions that often travel alongside it, like POTS, Ehlers-Danlos syndrome and MCAS.
That breadth has a second use. Knowing what those conditions look like is also how we check that what you are describing is not something else entirely, belonging to a different part of medicine.
If it is, the job changes but it does not stop. We help you get to the person who can actually treat it, and we keep helping until you are better, whoever ends up doing it.
Your history, put in order
Then you tell us what you have been through to get here. We put that alongside the symptoms and work through it together.
Something useful often happens at this point. Seeing the symptoms laid out against the history explains why the last few years went the way they did. People frequently understand their own story better by the end of this part than they did at the start, which is a reasonable thing to want from a medical appointment and not something most of them have been offered.
The diagnosis
With the history and the symptoms together, we can bring things up to the present day and give you a diagnosis. A careful history usually reaches it without a diagnostic operation.
The options, honestly
Then we set out the options, with a straightforward assessment of each. Sometimes there are things worth trying that are likely to work well. Sometimes the available options are not as good as anyone would like, and we say so plainly rather than letting you find out later.
There is usually a range of choices rather than a single obvious one, and helping you navigate that range is a large part of the job. You should leave understanding what is available and what you can reasonably expect from each of them.
The plan
Then we fill in the detail. Treatments, or sometimes no treatment. Any labs or imaging that would genuinely help. Then the next step, and the step after that, and the step after that, until you are in a good place.
What you should end up with is a real long-term road map: short term, medium term and long term, built around what you need for your life rather than around a protocol.
What to bring
Anything you have. Records from previous doctors, operative reports, imaging, labs, and less formal things too, like symptom diaries or notes you have kept yourself.
Some people arrive with a great deal of this and some with almost none. It is useful when you have it, but it is our job to take a history and ask the right questions to get to the bottom of things, and we will work it out either way. Not having your records is not a reason to delay booking.
What you leave with
Most of the time, a diagnosis and a clear plan.
Often you also leave with options and the time to think about them, knowing there is someone to help and to support whatever you decide. Some people want to start a medication that day. Some want to go ahead with surgery. Some want to wait and see how things go and decide later, and waiting is a real option rather than a failure to decide.
If we need imaging or labs
Occasionally there are details we cannot get from the visit or from your previous records, and we order imaging or blood work. It is not often, but when it is needed it matters, and we fit it around the timeline you are working to rather than the other way round.
When we do, there is a follow-up visit, which can usually be by video. We go through the results with you and normally show you the actual images, so you can see what we are seeing rather than being told about it. That is the same principle asgoing through the operative photographs afterwards: being shown is different from being told.
In person or by video
Many consults can be done by video, and a good number of ours are. It is the same appointment and the same price either way.
One rule trips people up, and it is worth knowing before you book: you have to be physically inside Massachusetts at the time of the visit, wherever you happen to live. That is how medical licensing works rather than a policy we chose, and it isset out in full on the traveling page.
Some things need hands. If you need an examination, for instance to check for rectovaginal nodules, to assess the size of the uterus, or to take a biopsy before a hysterectomy, that has to happen in person. It usually does not have to be the first visit, so starting by video is still reasonable for most people, and if you are traveling we will fit any examination into a trip you are already making rather than adding one.
What it costs
The complete consult is $450. Virtual or in person, same price. History, imaging, diagnosis, plan. It is the same price whether you come in person or see us by video.Full fee detail →