*Siphumele Sidzamba, 25, has never been to a gynaecologist and is one of many South African women without a specialist doctor.
“I tried to go when I was 18, to a public clinic, but they sent me away because I was not sexually active at that time," she said.
"Now that I’m older, I don’t see the need to go and see one, because it’s expensive when you don’t have medical aid and sitting in the queue at the public hospital is not worth it.
“Plus, it does get a little awkward talking about things down there.”
Many women worldwide don’t visit a gynaecologist for reasons such as exorbitant consultation fees and limited access to the service in public hospitals.
Yet, seeing a gynaecologist will help detect potentially cancerous cells and sexually transmitted diseases (STDs).
That’s why International Gynaecological Awareness Day (10 September) is so important.
But many South African obstetricians are abandoning the profession because of high medical insurance premiums, which makes it difficult for many of them to practise and make a profit. Many doctors specialise in both obstetrics and gynaecology.
Apart from checking women’s gynaecological health, they conduct ultrasounds and amniocentesis to detect abnormalities in unborn babies, monitor pregnancies and deliver babies.
Dr Steyn Smit, 44, based in Worcester, said he had practised as an obstetrician and gynaecologist for almost two decades.
He recalled the first baby he delivered: “It was in the middle of the night, towards the end of the year. The family welcomed a beautiful baby girl, it was instant gratification.
"I couldn’t sleep because of the excitement I had and adrenaline was just amazing. It’s a feeling I was looking forward to having for the rest of my career."
He quit obstetrics to focus solely on gynaecology because of the expense of indemnity cover for obstetricians.
A large number of South Africa obstetricians are abandoning the profession for the same reason.
In 2017, the Medical Protection Society’s insurance for obstetricians and gynaecologists cost around R800 000 a year - an increase of 925% from 2009.
The premiums are high because a doctor can be sued if a baby was harmed at birth and could possibly have to pay for the child’s expenses for life.
“For almost two years, I was doing obstetrics at a loss. I tried to make it work by taking funds from gynaecology but it didn’t work. My funds were depleted," Smit said.
“Because I live in a small town, I get to see the people I’ve turned away either in the shopping mall or at church and it breaks my heart that I couldn’t be of help to them."
Health Minister Aaron Motsoaledi said the high insurance costs caused by medical litigation were contributing to the mass exodus from the profession.
“The sad thing about all of this is the high premiums, making it almost impossible for these specialists to keep their doors open," Motsoaledi said.
"The premiums are not based on a projection of the future or the present, but based on what they might discover you did in the past years, which they can’t even remember or dispute."
He said those who were indirectly paying for these increased premiums were women, because gynaecologists put up their fees to try to keep their obstetric businesses profitable.
In 2018, health watchdogs have predicted obstetric premiums will pass R1 million.
Is the government doing anything to avoid the exodus of much-needed specialists?
Motsoaledi said it has a three-plan to address the issue. The first will be to focus on the medical solutions to ensure that mistakes are reduced and to ensure that doctors work hand in hand with nurses for risk-avoidance purposes.
The second step will be to improve hospital administration, so that “come litigations, there are documents to back the doctors”.
The government was also in discussion around litigation laws to protect the state, doctors and patients.