More than most other medical fields, reproductive health care, if not done well, can feel like an invasion – of body as well as privacy. Which means the relationship between a woman and her gynecologist is often more – or less – than the relationship with, say, the average GP.

In our first analysis based on our survey with 1,100 women regarding their reproductive health care, we reported that 25% of women feel dissatisfied with their gynecological care. But is that dissatisfaction related to the doctor-patient relationship?

We asked women three questions to find out:

• Are you able to talk to your gynecologist about sex openly and without fear of judgment?
• Do you feel the information you share with your gynecologist is safe and confidential from family and friends?
• Have you ever lied to your gynecologist? If so, about what?

Overwhelmingly, most women are honest with their gynecologists: 83% said they’ve never lied to their gynac, whereas 11% said they had lied outright or purposefully withheld information.

Perhaps not surprisingly, women who report not lying to their gynecologist are more satisfied (75%) with their care. Women who lie or withhold information are more torn – closer to 50-50 in their reported (dis)satisfaction.

77% of women who report having lied to their gynecologist and 85% of women who report withholding information, say they feel they cannot speak with their doctor about sex openly and without fear of judgment.

Interestingly, honesty appears to be more about choice than comfort. Judgment from doctors seems to be common: Only half of all women felt they could have an open, non-judgmental conversation about sex with their gynac. And 42% of women who report full honesty their gynac also don’t feel they can have an open conversation about sex without judgment from their doctor. Roughly the same proportion of women who responded ‘Not yet’ to whether they’d lied to their gynac felt similarly.

But one key factor that might make some women more comfortable with honesty, even in the face of judgment, is the fact that overwhelmingly (91%) women who report full honesty with their gynacs also say they feel the information they share is confidential. Women who report having lied to their gynac are less certain of confidentiality – only 69% felt their information was safe from family and friends. Women who say they haven’t lied, but simply omitted truths were even less certain – 57% said they felt the information they shared with their doctor was confidential.

Women under 25 and women 46-55 were the least likely to feel their medical information would remain confidential, with only 68% and 60% respectively feeling their confidences would not make it back to family and friends. Relatedly, these two age groups were also the most likely to lie or purposefully withhold information from their gynacs.

Most women who reported having lied to their gynac said it was to avoid judgment, shaming or pressure to have children. Some simply felt too shy to share. Most women reported lying to conceal one of two things:

• A past abortion
• Sexual activity (type or amount)

When only half of all women report feeling they can discuss sex confidentially, openly, and without judgment with their gynacs, it means 1 in 2 women who responded have to navigate their reproductive health care in the dark. Take this respondent, who lied about “being sexually active, since they never asked. Assumed that I didn’t need a Pap smear since I wasn’t married.” Any woman who is sexually active needs regular Pap smears.

And lack of openness and confidentiality can facilitate worst-case scenarios: “I did not know how to tell her about my sexual activities as she wasn’t approachable,” wrote one respondent, “and thus ended up not being diagnosed correctly.”

Which means that when it comes to good gynecological health, many women have to be an advocate not only for themselves, but for new norms, just to get the care they deserve. Take this woman — while she doesn’t feel her information is confidential, she doesn’t feel she can discuss sex without judgment from her gynac, and she’s generally dissatisfied with her gynecological service, she still makes sure she gets the care she needs; when asked if she’s ever lied to her gynac, she responded, “No. I do not care if my sexual health makes them uncomfortable. I care about the fact that they are supposed to be the experts and help me.”