How to Do a Pelvic Exam
Posted by Rachel on June 28, 2007
New England Journal of Medicine has just added a video on pelvic examination* to its instructional series, “Video in Clinical Medicine” – unfortunately, it’s behind their subscription wall, but I wish you could see it. It’s not often that women get to see a pelvic exam from the other side of the thin paper drape, so if you have access to a NEJM electronic subscription through your library, I recommend checking it out. However, I’m going to try to describe some of the information presented (blogging as I watch), so you have a better idea of what exactly is going on during an exam.
Section 2, Indications, states that women should have a pelvic examination when they have:
-Vulvar or vaginal complaints, such as pain, discharge, abnormal bleeding, itching, and/or a mass;
-When pregnancy is suspected or proven;
-In women who have been exposed to sexually transmitted infections.
It also highlights the American Cancer Society’s recommendations for pap screening, listed here (scroll down to section on cervical cancer). The ACS guidelines mention that women who are older than 30 and have had 3 normal paps in a row can switch to every-three-year screening unless they have risk factors such as HIV infection; the NEJM video adds new sexual partners as another risk factor for screening more frequently.
Section 2: Preparation
Regarding patient history, viewers are instructed to ask women about their total number of sexual partners and sexual orientation. I have never, ever been asked by a physician about my sexual orientation, and am curious as to whether any of you have.**
I was pleased to see the instruction to ask women about prior discomfort during a pelvic exam, although I don’t think I’ve ever been asked that, either.
The preparation section also includes an equipment list – they forgot the instruction about “find the coldest piece of metal known to humankind.” 
Section 3, Procedure:
Did you know that one reason you should urinate prior to the exam is that “a full bladder may compress the vaginal canal and obstruct the view of the cervix?”
This section also provides the instruction to make sure the patient has been offered the opportunity to have a chaperone in the room during the examination. Are you generally offered this option? Do you want this option? I’ve had “chaperones” in the room without being asked, which I find disturbing.
On patient positioning – “You should be able to easily visualize her vulva, but still keep her knees covered.” Sweethearts, when you’re feeling up my boobs and poking around my vagina, the privacy of my knees is the least of my worries.
One qualm with this – the model patient is completely shaved. I’m sure that’s for video purposes, so it’s easier to see the woman’s anatomy while learning about the procedure. However, in the real world, this is not what many women are going to look like. How does that change how well the woman can be “visualized” on exam? How does presenting models in this manner shape those learning to perform the exams?
So, what are they looking at down there? According to the video, it’s the “entire vulva, perianal area, vaginal canal, and Bartholin glands.” I thought this was interesting, because I don’t think I’ve ever, ever heard the words “Bartholin glands” in an exam. [See the vulvar anatomy] Among the things they’re looking for are rashes, lesions, swelling, and trauma, as well as areas of irritation, discomfort, or pain.
The video then informs us that some of the more common findings include:
-Lichen sclerosus
-Vulvar dermatitis
-Vulvar ulceration
-Condyloma
-Vaginal varicosities (none of you mommy bloggers told me about this!)
[See list and description of "benign vulvar lesions," "vulvar problems," and "self-help tips for vulvar skin care."]
Hey! Wait! They just said to warm the speculum with warm water! C’mon, people, follow the instructions! Speculum goes in to a “depth of 4-5 centimeters,” in case you were wondering. Sure seems like more.
Oh! I wish you could see what the pap part of the exam looks like! There’s the cervix! Okay, so if you get one kind of pap test, it’s a wide brush that looks like a push broom that they sweep over the cervix. If you get the other kind, it’s a “spatula” (seriously, they call it that), followed by a small brush that looks more like something you would clean out an instrument with.
“A healthy adult vaginal pH is 4.”
“Trichomonads will appear to vibrate on the slide.”
“Let the patient know she may have a small amount of bleeding after pap smear sampling.” – Nope, don’t think I’ve ever been told that, either.
Next, the part where one hand goes in the vagina and the other goes on your belly – “The abdominal hand should be used to sweep the pelvic organs downward, while the vaginal hand is simultaneously elevating them.” This is for size, shape, and symmetry, mobility(!), position, and consistency(!!) of the uterus, and checking for appropriately sized, mobile ovaries. (Is “mobile ovaries” taken as a band name?) They’re also looking for “adnexal masses” (that would be a mass on the ovary).
Reasons for rectovaginal examination: assess retroverted uterus; screen for colorectal cancer; evaluate for pelvic pathology. The animation (used for the internal bits) for this is priceless, especially given the purple disembodied hands.
Section 4 is called “Troubleshooting.” What is there to troubleshoot about a pelvic exam? According to the video, “In obese patients, the cervix can be difficult to visualize, due to excess vaginal tissue.” The solution? Cut off the thumb tip of an exam glove, and slide it over the speculum like a sleeve. This gives the speculum two extra “sides” to hold the tissue out of the way.
Yep, apparently that’s the only troubleshooting that is needed. Hmm.
Section 5: Contraindications
Apparently, there are “relatively few,” including physical or mental disability, abnormal anatomy, or physical immaturity. Consider examination under anesthesia in the case of physical immaturity with an intact hymen. Delay if liquid-based pap is not available and the patient is “menstruating heavily.”
And that’s a wrap!
[Also, the Feminist Women's Health Center sells a self-exam kit for looking at your own cervix and vagina, with instructions.]
*Obviously you shouldn’t go running around performing pelvics on strangers just based on this blog post.
**None of my observations apply to my current pelvic exam provider, who is awesome.
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Heather said
When I lived in MN and was having severe problems with my endometiosis, I was sent to four doctors in one day. The fourth and final doctor’s questionnaire was extremely detailed and included sexual orientation and a huge checklist for any activities I may or may not have been involved in. Even though I was in a lot of pain that day I wondered if any of the younger or shy patients would fully disclose the information expected on paper rather than in an interview. I understand they probably assumed it to be time-saving, but even as an adult I found the list somewhat embarrassing to read, much less fill out.
Rachel said
I think it depends on the person. Many people would probably rather do a paper checklist, then only have to talk about the things that raise a red flag, rather than having to answer sensitive questions face-to-face. One thing I dislike is going to the doctor and getting a paper form in the waiting room for whether I’m in pain or anyone has hurt me. That feels like something I want to talk about rather than check off.
conniebonnie said
In one midwifery class i was looking at (i think i’d be rushing things a bit if i just started taking midwifery enrichment classes while only a doula) there is a class on well-woman exams and in the last class you pair off and perform them on each other…
Rachel said
Connie – sounds interesting! I wonder if you get to pick your partner?
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missedconceptions said
Wow, when you are hemorrhaging and walk into an ER and explain, between muffled screams, that you are miscarrying, they cut out all of the small talk when they do your pelvic.
I think “Dr. Big-hands,” my ER doc that evening, had just refreshed his pelvic-exam giving skills with this video. At least it felt like it. I don’t think he had done a pelvic exam in a long, long, long time.
I have always had a chaperon, even with my regular female OB doctor. They make it less obvious, however, by informing me a nurse is coming in to “assist.”
Rachel said
MC, what do you think about that “assist” language, when the nurse is standing in a corner the whole time? I suppose they don’t want to say, “Nurse here is going to make sure I don’t do anything inappropriate with your woman parts.” “Assist” sounds much more pleasant.
missedconceptions said
Well, if the nurse is just going to be in the room, they give her stuff to do so the “assistant” title is warranted. I guess when you are wrist deep inside someone, it can be a little awkward to have to reach for your own utensils and swab your own pap-smear slide.
My favorite, though, is when they TALK to said “assistant” as if you are not there with your knees splayed open. “So, how was you weekend? Do anything fun? Hey, can you pass me some more towels, she is REALLY bleeding? And did you like camping?”
Maggie Cannons said
As far as the “option to have a chaperone” goes, I fully welcome having the “option.” The part I object to is when I have brought my chaperone with me and he is sent from the room so that some complete stranger can chaperone. The first OB/GYN I ever went to did this. He asked some nurse to come in a watch. I asked him what was wrong with my chaperone and he said “he’s male.” I said “yeah, but she’s your nurse and he’s my husband, so who do you think I’m gonna trust more? Forget it, exam over.” I left. Funny thing is, the hospital with which this doctor is affiliated called the next day to ask about my experience. He doesn’t work there anymore.
Rachel said
Good for you, Maggie.
JUANITA SALINAS said
Thank the lawyers for the chaperone. It is done to protect the examiner, not the examinee. Believe it or not, some women come with a male accomplice with the covert intention of suing the examiner for “improper touching”, whatever that is. A chaperone is not necessary in a relationship of mutual trust. Besides, most doctors have done it a thousand times and are not thrilled at the sight of female genitalia. There is always the exception, though.
Rachel said
Juanita,
Thanks for your comment.
Rebecca said
Surprisingly, most women I do paps on now are shaved. And hair doesn’t obscure anything, so I wouldn’t worry. I’ve been asked my sexual orientation or the gender of my partners. If they don’t know, how would they know how to assess my risk for STI’s and need for contraception. Most male providers will have a chaperone for their own sake. As a woman, I ask my patients if they would like one.
Rachel said
Rebecca, thanks for your comment!
yngve haug said
My wife was born in China and always ask me to join her when she is having her yearly exam and the doctors have had no problem wit me being there when she is being examined. Last Saturday when we went to a new doctor since the old one moved, my wife advised the doctor that she wanted me to be there while she had her exam. The doctor told her that this was against her policy. My wife then told her that I always accompany her and that she feels much more at ease since her English is not that good and she is very uneasy being there alone. However, I did leave the office as the doctor requested. Shortly afterwards the nurse came and told me to come back. My wife was not able to answer all the questions and refused to go on with the exam. Te doctor asked me why she was there and when I explained that she was there for an HPV test. which she had about 4 months ago and that we were told to get a new one in 4 months. The doctor responded that once you had a positive HPV test, it will always be positive and that it takes about 25-30 years before it possibly would develop into cancer and by that time my wife would be 75!. I told my wife to get dressed and we immediately left the office… My question to you is how do you find a really good doctor who has no objection to the husband being there as a chaperone as well as making my wife feel at ease since she is refusing to be examined without me being there?
Thank you.
Rachel said
It’s hard to know in advance which doctors will be a good fit for you. However, you could certainly call the doctors’ offices (whoever she might want to see, your insurance covers, etc.) and explain the situation, and see who is agreeable to your being there, and make an appointment with them. Also, I wonder if your old doctor meant for your wife to have a pap test after 4 months because of the HPV result, and the new doctor just didn’t understand that?
Rachel said
Also, I don’t think it’s correct that someone with a positive HPV test will always test positive.
ricky said
I’ve never had a rectal exam as part of the pelvic exam, although in your posting about Farrah Fawcet, one of the links recommends men over 50 have an annual rectal exam, adding this recommendation does not apply to women because they get the rectal as part of their pelvic.
I’ve had three children and five pregnancies and now have grandchildren. I’ve NEVER had a rectal as part of a pelvic. I’ve had a rectal three times in my life, and a colonoscopy twice. The second colonoscopy was at my INSISTENCE, where polyps and a diverticulitis were found.
It seems to me it’s the medical profession needs to pull up its socks here, not the consumer.
Rachel said
Ricky, you know, I’ve only had it once or twice with the pelvic. My mom’s doc does it every time. My current provider never does it. I wonder why that is?
a women's health NP said
Rachel and Ricky-
A rectal exam is not necessary in an asymptomatic healthy young woman under the age of 50. Some providers will do it if a woman is retoverted – her uterus points to the back instead of the front – making it more difficult to palpate. As a health care provider to mostly young healthy woman, I do not do a rectal even on retoverted women because it does not really give me any vital information and women generally hate it. I know I did when I was on the receiving end. I think older providers were trained to do it regardless, so they are more likely to do it. Screening for colon cancer begins at 50 and that includes a rectal with the pelvic exam along with other tests.
Other issues-
As for shaved pubic hair…it is in fashion now and I see a lot of it, so that shaved model is actually an accurate reflection on what’s out there.
As for chaperones…more complicated than you think. Male providers have to have them for their protection, women providers don’t, which is a little silly if you think about it because women providers are just as vulnerable to false accusations as male providers. As a female provider I generally let patients bring whoever they want into the exam. But I’m leery of moms coming in with their daughters (daughter unlikely to be honest about sexual history)and male partners that seem just a little too possesive (potential abusive relationship). In those cases I like to take the health history alone and size things up, then they can come into the exam for moral support if truly desired.
Asking about sexual orientation…there is a place to check that on the intake form. It is best to not make a big deal over it. Sad but true, it can freak out the young heterosexual women to even be thinking about it let alone asking about it and they are the majority. Most of my lesbian and bisexual clients don’t need to talk about it and frankly it doesn’t change anything but need for birth control. Anyone can get an STI. If I happen to miss it on the intake form and I ask a lesbian about what she uses for birth control, she sets me straight (so to speak) and we just laugh at my mistake, it doesn’t seem awkward.
As for HPV lasting forever…old thinking. Now we know that HPV is very common, most women get it and it clears from their body fairly quickly. Even if it causes problems like abnormal PAP smears or genital warts, even though the abnormal cells on the cervix or the warts will need to be treated, the HPV virus will eventually clear…it doesn’t stay in the body forever. Unfortunately there are some people out there who are spouting the old information.
-a women’s health care nurse practitioner
Rachel said
Women’s health NP, thanks for your insights, and for verification on the HPV issue. I think you’re probably right that older providers may have been trained to do the rectal regardless, because the only time I’ve had one do it, it was an older gentleman. I think you’re right about the chaperone issue, on both counts – I never understood why female providers wouldn’t have one as well, and think people are probably more honest when they don’t have a parent/spouse hanging over them. Thanks again!
Sarah Summer said
Vaginal ph is very important–interesting post.
cara said
1. My nurse asked me about my sexual orientation when I went in for a check up. Nothing overt, just if I was sexually active, and was it with men or women.
2. A recto-vaginal exam is also used to test for ovarian cancer, when patients present with symptoms (see: 2007 Consensus Statement on Ovarian Cancer). That, a Transvaginal Ultrasound and a CA-125 blood test are used to detect ovarian cancer.
3. I’m also about 95% positive (I can check) that HPV does not stick around forever – even the kinds that can cause cancer.
Lisa said
Despite popular belief, HPV does not cause cervical cancer–this has never been concluded. Some strains (like type 16) are almost always associated with 98% of cervical cancers, but do not CAUSE cancer. Furthermore, the CDC statistics show that nearly 100% of all sexually active adults will be develop HPV infections at some point in their life. If HPV were the CAUSE of cervical cancer, there would be far more greater incidence and deaths due to cervical cancer. Persistant HPV infection of the cervix may increase susceptibility to cervical cancer, but in-and-of-itself, HPV DOES NOT CAUSE CANCER. http://www.FDA.Gov–look up HPV–you will not a find a single document that states a cause and effect, only an association, big difference.
The HPV hoax is designed to scare women into the stirrups every year, utlimately to provide an easy customer base for pharmaceutical companies to sell vaccines and unnecessary surgery, like colposcopy, cryo, leep and hysterectomy, the single most over-used surgery.
Rachel said
Lisa, I’d refer you to http://www.cancer.gov/cancertopics/factsheet/Risk/HPV
Amy Jo said
Interesting posts and I’ll look forward to seeing this video. Sounds like some sensitive approaches. I am currently directing a film called “At Your Cervix” about the most ethical and empowering way that medical providers learn to perform pelvic exams–on Gynecological Teaching Associates. I’ve taught exams using my own body for the last 7 years, and some of the GTAs have done so for nearly 30! (www.atyourcervixmovie.com)
We teach rectal exams and they are NOT a throw away unnecessary part of exams. Providers typically do not offer them because they are squeamish about giving them or think their patients won’t want them. A rectal exam is the only way to check the underside of the uterus–which is very significant in retroverted uteri, but important no matter what. Lots of stuff can go on there and go undetected without routine rectal exams. There are also rectal structures which are checked and palpated during an exam. Recently, I was discussing these teaching methods with a rectal specialist who asked, “Why aren’t providers doing rectal exams? Women come to me with advanced cancers because no one is examining them and finding it.” Rectals are important and you can ask your provider to do one for you. Sadly, I once asked a provider and she did a horrible rectal that could not possibly have given her any useful information.
About sexual orientation. There is no need to ask what people’s orientation is–how they identify themselves in not what a provider needs to know. They need to know what BEHAVIORS a person engages in. So “Are you sexually active with men, women or both?” followed by other specific behavioral questions, would be a better approach to determine risks. I could call myself “heterosexual” and be engaging in other activity I don’t want to tell you about, especially since I’ve just identified myself heterosexual.
Thanks for all the posts.
Rachel said
Amy Jo, thanks for your comment. I’d love to see the film when it’s available.
Peter( like weight loss) said
Rachel, Unless you have the bare necessity for it, the doctor may not do the check up. If it is required then they will not ignore it. Else if you feel that taking one such checkup will be good, you can suggest to your physician and she will explain in detail or perhaps may do the check up.
Charles said
The 4-5 cm insertion of the speculum is simply not true! Why have a speculum with 4 inch blades if you only insert 2 inches?
MH said
I see the midwife I used during pregnancy for all of my exams because I liked her so much. She’s a nurse practitioner so my insurance will cover it.
The main reason I go to her is because the first time I saw her and got an exam from her during my pregnancy, she asked me if I had ever been uncomfortable during a pelvic exam, or had anyone hurt me during a pelvic exam, and I said yes. She pointed out certain muscles for me to relax using a breathing exercise and the exam was not painful at all which was a first for me. Also, they use real sheets in the office instead of those disgusting paper things, and I was sold.
Also, I had seen four different gynecologists before her and not one of them had bothered to mention to me that my uterus tilted, and that my cervix is mis located. Thanks, docs.
Joe said
Concerning the author’s comment about the average patient not being completely shaven, this is definitely not true. As an OB/GYN resident, I do pelvic exams everyday. The majority of women now are at the very least “groomed”, with a high percentage shaven. Yes, we do notice, but not in a creepy way.
Rachel said
Joe, I’m glad it’s not “in a creepy way.”
I just think it’s worth pointing out that women come in all kinds of shapes and sizes and preferences, pubic hair included.
Nicola said
Great post. Informative and amusing.
Once had a GP who was also a gyno and would give your pelvic area the once over even if you went in for a chest infection and was so expert he didn’t need to use a speculum. At the end of one consultation he told me to pop back in a week to pick up the results of my smear which surprised me as I hadn’t even noticed he’d done one. When I told my husband I’d been unaware he remarked, He’d make a good pick pocket.
Jo said
Several posts misunderstand the purpose of the doctor having a “nurse” or other “chaperone” present during a pelvic (or other exam). The 2nd person is there to PROTECT THE DOCTOR from false accusations of impropriety and other styles of legal (or illegal) shakedowns. An assistant is not really needed, and many medical practitioners don’t bother with one.
OLHamada said
Rachel,
Re your comment that I was making this up – please see Comment #26 above from Lisa. I see that you directed her to cancer.gov. Thanks. A redaction from your post on Aunt B’s blog would be a kind gesture.
OLHamada said
Rachel,
My apologies, it was Aunt B that suggested I was making this up (it’s been a long day). Sorry.
Rachel said
Thank you for your apology. I did note that *I* never said such a thing [other readers, this is a bit of inside baseball] – commenters being distinctly separate from me, and different from what you had suggested. As you note, the next comment after Lisa’s is me, referring her and others to a National Cancer Institute fact sheet. I don’t like to let factually wrong comments stand, but in this case I thought it better to respond with an educational resource for my readers.
susan said
I’ve never had a issue with a pelvic exam….but I recently had one done..they told me I was postive for hpv….and that was the end of the phone call…like I got scared cause I thought I had hiv…..or something…they were so impersonal and I had no idea what it was and she would not evan explain it to me…
Kim said
Last week I went to a gyno trying to get off Prometrium. He was ok up until right before he left. I had had a pap smear in April and this new gyno that I went to didn’t examine me at all. Right before he got up to leave he said something like “unless you feel the need to get naked”. I was completely floored. I have had several physical exams in my life and have never had a gyno say that to me. I was close to tears on my way home. I had a friend help me write him a letter. I will never go back to this disrespectful, out-of-line so called doctor.
Sarah Summer said
With respect to the issue of chaperones for pelvic exams… I personally prefer not to have an extra person in the room. Most of the doctors I have seen have used chaperones, and they have never asked me whether I wanted one. In a couple of instances, I had nurses stationed below my waist while my feet were in the stirrups… which put them in full view of everything I didn’t really care to show them.
Many people think it’s important to offer patients chaperones, with which I fully agree. On the other hand, no one seems to be advocating an option not to have one. Any advice on how to get some privacy?
Elisabeth said
I’m afraid I don’t have any advice for you, but I think I’ve written eerily similar comments on other websites. Seconding motion to be able to opt out of chaperones.
Actually, the first time I saw a doctor who used a chaperone was particularly bad. I was a young and shy 20 yrs old. This doctor asked me whether I would like my mother to move to the head of the table so she couldn’t see, to which I answered yes. The doctor then put my feet in the stirrups and told me the nurse was coming. The stirrups (and therefore my private parts) were facing and placed close to the door. There was a little curtain in front of the door–it might have been 3 or 4 ft wide and actually stopped short of my left foot. When the nurse opened the door, I wasn’t sure whether or not I would have been visible to people in the hallway. The nurse then walked the width of the little room, walked back more towards the center, (where she would have had a bird’s eye view) and tilted her head! I was mortified. What was going through this doctor’s head?
“Hm… she doesn’t want the woman who gave birth to her and changed her diapers sitting down there, but I’m sure a complete stranger will be fine.”
While a chaperone who stays at the side or head of the table is better, I still find their presence quite intrusive.
All the nurses I encountered at this large ob/gyn practice had another not-so-private habit of asking why I was there while still in the corridor.
I know people who work in these fields are unphased at the mention and sight of such things. However, that does not excuse such oblivious insensitivity.
Susanna said
Kim, maybe the gyn was just trying to be funny. But I agree, it’s not very funny. He probably didn’t realize how sensitive and uncomfortable the whole procedure is for a woman.
Sarah Summer, just tell the nurse to back off. Or tell her to stand by your head.
Eric said
I’m still confused why women even bother with the pelvic exam. I agree with a previous poster, the whole hoax that brainwashes women into thinking that if they don’t strip down and go spread eagle in stirrups they’ll get cervical cancer. The funny thing is, women are more prone to have a heart attack than breast or cervical cancer…yet I’ve never heard of any type of yearly to regulate heart health.
It’s also quite funny how doctors hold BC hostage pretty much “requiring” you to get a pap in order to receive the prescription. I put requiring in quotations because it’s actually not required. BC’s effectiveness and side effects have absolutely nothing to do HPV. I’m in medical school and one of my Dr.’s referred to it being “about as harmful as aspirin”. Men can get viagra without a prostate exam, yet women are duped into showing a doctor their goods to get BC.
And don’t get me started on the whole inaccuracy of pap smears in the first place…plagued with false negatives and such. Funny how doctors still insist on having women spread ‘em when there’s the CSA blood test which is 50% more accurate and absolutely non invasive.
You wonder why a lot of women aren’t on BC and there are tons of teenage pregnancies? It’s because younger women who haven’t been totally brainwashed are absolutely horrified of having some stranger stare at their vaginas, stick objects in there, then basically figure them as the coup de grace. Then, when they state they’re against a yearly, they’re told to “grow up” and “see counseling”. Back in the old days, gynecologists said a stressed woman was suffering from hysteria and that he had to stimulate her clitoris (basically make her orgasm) to cure the disease. Thus, the vibrator was born. I bet women in those days were told to “grow up” too, huh?
Honestly, you women need to stop believing everything a man in a lab coat tells you. Do some research yourself.
Sandra said
Eric, let me know when you get your MD. You can give me a BC prescription without molestation! Also, who the hell offers that CSA test? I googled it, and of course it said “Did you mean PSA test?”
Susanna said
Eric, I for one have not seen a gyn for years. Because of the reasons you stated (I had figured out as much on my own) but initially because I reasoned that since I usually try to avoid the company of uncouth people, why pay dearly for somebody to be hostile and condescending towards me (my experience with gynos)?
You are dead right about teenage concerns. But condoms have been invented, they are a great invention, and perfectly sufficient. Never met a man who wouldn’t rather wear a condom than not have sex. I seriously wish I had never ever gone on The Pill. It only gave me some extra weight I never managed to shake and permanently disrupted my until then perfectly regular cycle. But I believed all the brainwashing. There you go!
beebe said
If you are stupid enough to be examined by a male physician you deserve to be sexually assaulted.
Rachel said
Beebe, nobody deserves to be sexually assaulted, no matter the circumstances.
Susanna said
My mother and grandmother recommended I choose a male gyn as they “were not mean like female gyns”. But I recoil at the thought so I’ve decided to forgo the examinations altogether. At least until I get some symptoms of any kind.
Homer said
Women who agree with how gynecology is today and think it’s ok to be examined by a MALE doctor in the way they still do it, is because these women do not have respect for themselves, that’s why.
Michaela said
Eric, can I shake your hand?
I totally agree…
I’m a lawyer and I don’t just accept the need for invasive or any exam or test – I ask questions and if I’m not happy with the answers, my answer is NO….
I declined pap smears 30 years ago – there was no risk information available, just a hysterical scare campaign.
Over the years I’ve been bullied, hassled and insulted by doctors, but I stood firm…
It saddens me that risk information is withheld from women…IMO part of the “doctor knows best, don’t worry your pretty head” attitude…
How can you give informed consent when you’re “required” to have the exam or test? – are given no risk information or submit after being bullied and frightened….
The facts shocked me…
Cervical cancer is an uncommon cancer – only 1.58% of Australian women would get this cancer in an unscreened population.
The pap smear is an unreliable test throwing up lots of false positives and negatives….77% of women having 2 yearly testing will have a colposcopy and biopsies, yet only a tiny number will have malignancy. Most women find a colposcopy a distressing experience and some end up with permanent damage to the cervix.
Angela Raffles has produced some amazing research (she’s a cancer screening expert) – 1000 women need to be tested regularly for 35 years to save ONE woman from cervical cancer….
Puts it into perspective…doesn’t it?
IMO the smear test has helped a few and harmed thousands….
I do not have routine pelvic or rectal exams – my research found they were unnecessary in asymptomatic women.(and can be harmful)
I refused breast exams when I was young – it’s a rare cancer in women under 40….
When I turned 45…I decided that given breast cancer is fairly common in older women, to have an annual breast exam from a female breast cancer physician.
I have declined mammograms after reading Professor Baum’s articles (a top UK breast cancer surgeon) – same problems – false positives and harmful follow-up incl surgery. New research also suggests they may increase your chances of getting breast cancer – they suspect because of the squeezing and bruising of the breast tissue. There is also a problem with the discovery of slow growing ductal carcinoma in situ – a cancer that will rarely bother a woman, but once biopsied, it can become invasive – also, once diagnosed, the breast is usually removed….(legal reasons, they can’t take the chance it might become invasive) Many older women have DCIS…
I also agree with you Eric – the only exam required to get the Pill is a blood pressure check. I decided not to use the Pill – I didn’t want to be tied to doctors and was concerned about side effects.
I understand some doctors are now supplying the Pill on-line – they object to the invasive obstacles that are placed before women wanting access to the Pill – good for them!
The CSA Test is indeed almost 100% reliable – I’ve heard this simple blood test will not be welcomed by doctors currently making a fortune from pap smears and follow-up…
Women who want access, need to demand access asap…there are too many vested interests that will try and block this advance.
Question the need for testing and invasive exams – do not allow yourself to be bullied and frightened.
Knowledge is power – I don’t live in fear…I feel like I’m in control of my body.
Also, do not agree to a male doctor if you’d prefer a female doctor – it’s your right.
Sadly, there is a long history of disrespect and abuse of women by male doctors (and other males in the medical world)…and it still happens today….
Good luck everyone!
Kelly said
I’m concerned at Homer’s remark that Women who agree with how gynecology is today and think it’s ok to be examined by a MALE doctor in the way they still do it, because these women do not have respect for themselves.
I’m not sure I’d call it lack of self respect the way I think he meant it. It’s more like I’d say they’ve just given up which I might call “forced lack of self respect”. And believe me, Homer the loss wasn’t without a significant amount of horror. To me the desire to have your body left alone is inborn. Moreover, as children, females are taught to keep their legs together, not to scratch in public and not to have premarital sex. Yet when it comes to doctors and intimate exams suddenly we are expected to be ok with strangers touching us and seeing us naked. My problems started when my own Mother took me to a male doctor at age 5 for repeated bladder infections. I remember asking to go to a woman but was told either there weren’t any or it was too much of a problem to switch doctors. The excuse was always whatever my Mother could think of to get me to comply. That was in the late 60’s and a short time later I did get a woman Dr. Unfortunately it was after a lot of humiliation. Studies have shown children learn modesty at around age 3.
When your choices about your body are taken away especially at a young age or when you are subject to intimate exams from Drs of the opposite sex at any age it’s easy to lose a part of yourself. In order to endure them you numb yourself and try to trivialize it so the trauma isn’t as great. This can cause sexual promiscuity. It did for me. “I’ve already been exposed. What do I have left that’s sacred. My body doesn’t belong to me. I’m not supposed to say no to men” Honestly, I was so traumatized that’s how I felt. My parents didn’t protect me. It doesn’t matter if it’s a doctor or not. The fact that you had no choice and you feel like no one is protecting you is what makes you feel lost. As parents we need to empower our children (both daughters and sons) to know they always have a choice. If there’s no other way because of a true medical problem we must guard our children’s modesty and mental well being as if they are adults and then some. I could go more in depth but this is already long enough.
I have never gone to a male physician as an adult. I just can’t do it. I live in fear of ending up in the emergency room someday with a male ready to do his thing, be it a pelvic exam, urinary catheterization or anything else. My only consolation is that maybe I’ll be in so much pain I won’t care. I’m not suggesting medical professionals, male or female all have prurient interests. I know to most of them it’s commonplace and that after seeing so many bodies they don’t see them sexually anymore. I’m just saying that for the person laying there who doesn’t do it 20 times a day it isn’t commonplace and it’s still an embarrassing and very sexual exam. They are looking at the parts of your body you don’t show everyone, parts you save for intimacy. It can’t be anything but a violating sexual experience for the patient. I don’t know about you all but I don’t want to have sex with my Dr.
Additionally, It’s even traumatic to say no when they’re standing there ready, expecting you to comply. Recently that I refused to have a male take my medical history at my female urologist’s office. I just couldn’t talk about my problem with a man. I remember a female nurse standing there looking at me like I was out of my mind. She didn’t even tell me a male would be coming in. I ended up in tears which is also embarrassing and demeaning. I am offended that my urologist even put me in the position of having to say no to a male. That should be something they ask before you even come in. “Do you mind if a male/female does ___”. As a person I felt bad for the guy they were trying to train because I’m sure he was embarrassed to be asked to leave for being born male but I blame that on them too for allowing the situation to occur without my consent.
I just want my female issues dealt with totally by females. I’m tired of being embarrassed. It’s private and I want to keep it that way. I feel like I’ve already been violated so much it’s been very hard to believe I can have my privacy again. I wonder how many women have had to work through similar feelings.
It wasn’t that many years ago Doctor’s were considered “Gods” who you didn’t argue with. Thank goodness this is changing but still the fear of dying of cancer is a huge catalyst in convincing women to go every year for the exam. We need more education on subject matter like Michaela’s above. We need Dr’s backing it up too. If it doesn’t get out there no one will know. I’ve read that the US does more examining and negative biopsies than in Europe or any other country. Now, I don’t consider Europe to be a third world country and they are as advanced as us medically so it sounds like we need an attitude adjustment.
Weight Loss said
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Jon said
My God Kelly, I love you and your attitude. Being a 40 year old male, I have been bullied into thinking it’s ok for some strange man to be doing anything he wants to the love of my life. “Oh, he’s just a doctor… he doesn’t care… he does this all the time.” All the excuses we’ve heard for years, and have been duped into believing. I just shut up and let them do whatever they want to her, “because it’s for her own good.” This year is just about to kill me. She’s been seeing the “same doctor” for years now and during her routine examination, “cervical dysplasia” was discovered. Of course I freaked, scared to death what that means, what it might do to her, et al… So I read up on it. Ok, more inside work being done. I ask if she wants me to go with her to the biopsy for support and was told that I don’t need to. “They probably won’t let you in the room. It’s going to be ok- 8 out of 10 women get it.” It’s not going to be ok- if it was, a follow-up wouldn’t be necessary, right? So, I asked if the same doctor that did the initial exam was going to do the follow up. I learned that a female PA did the first test, and that “this new male doctor there” was going to do the follow up colposcopy. “I thought you’ve been going to the same doctor for years and didn’t want to change doctors? If nothing ‘weird’ is going on, why can’t I be in the room?” It’s all a bunch of BS in my opinion. I don’t get q-tips inserted into my penis every time I go to the doctor. Of course now depending on the follow-up results, she may be going for this “simple painless proceedure” every three months for the next year, maybe more. Yeah, that’s why they tell you to take pain relieving drugs before going, and the cramps can last through to the next day as well… painless…
My *main* concern is still that I don’t know yet what can become of the dysplasia. This is the love of my life, and I don’t want anything to happen to her, but I’ve done a ton of reading since, and sometimes it sounds more like a scam than not.
Liz said
Rachel,
Great article! Interesting comments.
I’m also a medical student, like Eric, but unlike him I don’t think pelvic exams are a hoax. I hope someone sets him straight before graduation. It’s sad for me to see that so many people jumped on his bandwagon of supposed facts.
I’ve got some facts for those of you who are willing to listen to large, well-funded research organizations, like the CDC (Center for Disease Control) and NCI (National Cancer Institute). If you’d rather stick with conspiracy theories, there’s nothing I can do to stop you, but I hope you’re lucky enough not to get cervical cancer because you won’t know it until it’s spread very far if you never let yourself be examined.
PAP SMEAR TEST
As for the accuracy of the pap smear. The traditional method where the doctor actually smears cells on a slide is being replaced with the “ThinPrep” test– what Rachel described in her article. A spatula (yep, we call it that, but who cares if it gets the job done?!) and brush are used to collect skin cells from the cervix, and these instruments are then swirled in liquid to get as many of the cells off as possible without distorting them, as they would be if smeared on a glass slide. So if your provider is giving you the standard of care, he/she will use this test, which has decreased the false negatives (saying you don’t have cancer when you really do) from 5.6% to 2.2%. And really, if you consider most tests, the old test– with almost 95% true positive tests (accurately diagnosing cancer)– wasn’t a bad test. Now at about 98% accurate, it’s almost as good as an HIV test, which is almost 100% accurate.
-Linder J, Zahniser D. “ThinPrep Papanicolaou testing to reduce false-negative cervical cytology.” Archives of pathology and laboratory medicine: 1998 Feb;122(2):139-44.
-http://www.cdc.gov/hiv/pubs/rt-counseling.htm
HUMAN PAPILLOMA VIRUS (HPV)
HPV is a very common virus. “Approximately 20 million Americans are currently infected with HPV, and another 6.2 million people become newly infected each year. At least 50% of sexually active men and women acquire genital HPV infection at some point in their lives.”
-http://www.cdc.gov/STD/HPV/STDFact-HPV.htm#common
HPV is passed from contact with an individual who carries the virus. HPV infects by living in the skin cells of the affected tissue. And sometimes it causes changes in the cells that make them more likely to transform into malignant cells– cervical cancer if the affected tissue is the cervix, which is the usual case for women. Sometimes the body can fight off the infection on its own, but if you can tolerate the mild, temporary discomfort of a pelvic exam, it’s the best way to catch cancer early or even prevent it altogether by removing pre-malignant cells.
CERVICAL CANCER IN THE U.S.
The CDC estimated that 11,070 women would be diagnosed with cervical cancer in 2008 (statistics take a while to be final).
-http://www.cdc.gov/STD/HPV/STDFact-HPV.htm#common
But apparently 11 thousand women getting cancer just isn’t enough reason to worry, according to those who’d rather opt out of the exam. As for myself, I think it’s a great deal to be able to avoid cancer, even if it means about 5 minutes or less of awkward discomfort a year.
Maybe I feel that way because I’ve seen women with invasive cancer who have to have massive surgeries to remove anything that can be removed to try to catch the cancer that’s already spread throughout their genitals & abdomen. After these horrible surgeries, they still have a 40-70% chance they will succumb to the cancer in the next 5 years because it’s already spread & all of it can’t be found to be eliminated. And this is a cancer that can develop at any age and any length of time after exposure to HPV.
-Friedlander, M and M Grogan. “Guidelines for the Treatment of Recurrent and Metastatic Cervical Cancer.” The Oncologist: Vol. 7, No. 4, 342–347, August 2002.
******
So please, for your own sake, take my word that a pelvic is by far the better choice if it helps you avoid invasive cancer (meaning it’s spread already by the time you catch it).
******
MORE HPV FACTS!
For those who are still not convinced about HPV, here are some facts about HPV and the link to cervical and other cancers from the National Cancer Institute (an organization that helps link cancer researchers to each other to share & improve cancer research– quite possibly the most important organization for cancer research).
1) Human papillomaviruses (HPVs) are a group of more than 100 related viruses.
2) Genital HPV infections are very common and are sexually transmitted. Most HPV infections occur without any symptoms and go away without any treatment over the course of a few years.
3) However, HPV infection sometimes persists for many years. Such infections are the primary cause of cervical cancer. HPVs may also play a role in cancers of the anus, vulva, vagina, penis, as well as oropharyngeal cancer .
4) In 2006, the U.S. Food and Drug Administration approved Gardasil®, a vaccine that is highly effective in preventing infection with two high-risk HPVs that cause most cervical cancers and genital warts.
-http://www.cancer.gov/cancertopics/factsheet/Risk/HPV
AND TO DRIVE THE POINT HOME…
“It is important to get tested for cervical cancer because 6 of 10 cervical cancers occur in women who have never received a Pap test or have not been tested in the past five years.”
-http://www.cancer.gov/cancertopics/factsheet/Risk/HPV
I’m not surprised many people misconstrue the link between cervical cancer and HPV. In a recent study, the authors (from the National Cancer Institutes) said,
“Awareness about HPV among U.S. women is low. Having heard about HPV did not ensure accurate knowledge. Strategies for communicating accurate information about HPV transmission, prevention, and detection as well as risk and treatment of cervical cancer are needed.”
-Tiro JA, Meissner HI, Kobrin S, Chollette V. “What do women in the U.S. know about human papillomavirus and cervical cancer?” Cancer Epidemiology, Biomarkers, & Prevention: 2007 Feb;16(2):288-94. Epub 2007 Jan 30.
EDUCATION, TRAINING, & PRACTICE
So, Rachel and all others who’ve tried to set the facts straight, keep up the good work. It’s obviously needed if even medical students can be so misinformed & then spread those “facts” onto others. And from the stories of women who have had bad experiences with their providers, it is obvious that even on such a basic procedure, training differs, as does what a student takes away from that training.
I’ve performed at least 30 pelvic exams in my short clinical tenure thus far, and I’d like to say that what the other providers have said is absolutely correct. We try our best to make the patient comfortable & informed. And unfortunately because of our litigation-happy society, we need protection from some patients. It is very important though that the patient have someone there to support them or not have anyone there who makes them uncomfortable.
******
SPEAK UP FOR YOURSELF! THERE’S NO GUARANTEE ANYONE ELSE WILL!
The most important thing for patients to keep in mind though is that most providers really do have your best interest in mind but may make mistakes– we’re only human– so if there’s something you feel he/she should/should not have done, you should speak up. Then at least we have the chance to make things right for you & learn from our mistakes. Everyone I consider a role model in my training would not hesitate to hear a patient’s opinion on something that’s a make or break issue to them. So consider sharing your thoughts before you get too upset or give up on your provider. Even if you feel he/she doesn’t deserve a second chance with you, think of that person’s other patients & give him/her a chance to improve from what they learned from you so no one else will suffer as you did.
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Thanks again for the article, Rachel! Sorry this is so long. I couldn’t in good conscience let those statements go on as they were. Take care.
Rachel said
Liz, thank you for your comment!
558354 said
No one has addressed the fact that with the estimated numbers of childhood sexual abuse, many of your patients are survivors. Pelvic exams are horrible enough for women who were not abused as children. For survivors, they are torture. Also, they may not feel comfortable enough to disclose their past abuse. It appears that no one is teaching medical students that resistance to invasive procedures may be an indication of past abuse. This needs to change. Finally, the reality for some survivors is just this: death is better than the vile degradation known as “medical care.”
Alison said
Obviously, to have pelvic exams or not is a personal choice. However, be aware that despite the unlikelihood of gynecologic cancers, they do happen. And sometimes a really good gynecologist can catch a cancer early and save a life. I would much rather lose my uterus, my ovaries, have chemotherapy, have pelvic exams every six months AND reduce the risks of something inside me not getting caught early. So we make our choices. And being 20 or 40 does not make one immune to near silent cancers. I am still alive.
Andrea said
I am surprised by the number of women on this thread who experience (and the number of men who view) pelvic exams as a kind of assault. Naturally this is a valid viewpoint and women’s wishes and feelings about it should be respected. By the same token I think people who don’t experience pelvic exams that way should also be respected and not accused of having low self-esteem or being brainwashed, scared, or ignorant, or somehow just not understanding that they are being victimized, all of which appear above. The majority of pelvic exams I’ve had were done by pleasant and competent women and men and, although physically somewhat painful, they are not emotionally distressing for me. I never had any issues with shame or modesty regarding a doctor looking at my vagina, nor have I experienced erotic or victimizing undertones in a pelvic or breast exam. To me and many other doctors and patients it’s just another examination of another body part. So before going off about how stupid women are who get pap smears, etc. you may want to consider the fact that there is a huge variety of experiences regarding pelvic exams and many women may know the facts about frequency of cervical cancer and everything else and STILL find yearly pelvic exams a reasonable trade-off.
Angeline said
558354 summed it up for me when he/she said “the reality for some survivors is just this: death is better than the vile degradation known as medical care.” Too true, and for 30 years I’ve been fending off doctors who think their nasty little yearly test is something I should submit to willingly and without issue.
They use condescending attitudes, throw out medical statistics and other verbal scare tactics, and then resort to trying to convince you the exam is no big deal. It’s what they’re taught in med school from the sound of things, but it IS a big deal to a lot of women. Doctors feel they are doing the “right” thing by constantly bullying women who are resistant to having these invasive tests done, but they are only fooling themselves. What they are actually doing with their pushy attitudes is ensuring that women like me will NEVER submit. I can’t help it, but the more someone tries to push me into letting them do something to my genitals that I don’t want done, the more I think of them as people who are NOT working in my best interest.
If they were honestly worried about their patients’ care, they would offer an alternative the minute they realized that their patient was truly upset and not wanting to be physically violated. They could offer the CSA test, or let the patient do a self-pap (yes, they do exist). I’m sure the glorified medical community would jump to argue that neither would be as accurate as letting them do the deed, BUT if they really cared about the patient wouldn’t it be better than nothing? The bottom line is, most doctors have been trained to believe that everything should be done their way, and the patient should just spread her legs and get over it.
Joanna said
Liz, I read your post with interest.
Just one question….
If pelvic exams are so important to your health…
Why is it that the vast majority of the world’s doctors do NOT recommed routine pelvic exams in asymptomatic women?
In fact, my doctor believes they can be harmful, as they often lead to further unnecessary and possibly harmful testing.
These exams are for many women, an absolute ordeal and should only be carried out when absolutely necessary.
The States and Germany are the only countries who recommend annual gyn exams (pelvic & rectal exams)
It therefore seems the value of the routine pelvic exam is debatable/dubious to say the least…
I understand more and more American doctors are even questioning the value of these exams.
I’ve never even been offered one. (I’m 38)
Jon, the reason 8 out of 10 US women face cervical biopsies is because they’re OVER-SCREENED.
Over-screening for cervical cancer increases the likelihood of false positives and cervical biopsies.
Biopsies are not to be taken lightly…they can be painful and women can be left with damage that can cause infertility, problems during pregnancy and psychological/psychosexual problems.
Finland has the lowest rates of cervical cancer in the world and sends far fewer women for biopsies.
They offer screening from age 30 and then 5 yearly until 50, 55 or 60 (depending on past results and risk profile)
5-7 tests in total…
55% of their women will have a colposcopy in their lifetime, with only a very small number having any malignancy.
In the States, your women have 50+ smears over their lifetime and a whopping 95% will have a colposcopy/biopsies…(and you have MORE cancer!)
There is an interesting article by RMDeMay, “Should we abandon pap smear testing” American Jnl of Cl. Pathology, 2000 (includes the 95% figure)
Testing young women (under 25 or 30) is IMO, unethical, as it leads to biopsies in a high number of cases.
Cancer in this age group is very rare.
American doctors are under pressure to stop screening young women and are considering a start age of 21, which is still too young IMO. (see article)
http://www.medicinenet.com/script/main/art.asp?articlekey=104176
The UK recently refused to lower the screening age from 25 to 20, having regard to the harm v benefit ratio.
The States is the only country in the world that screens virgins…a highly unethical practice.
One in three US women have had a hysterectomy – a VERY high figure.
We do not have breast exams until we’re about 40…as cancer is rare in young women and breast exams of young breast tissue often leads to biopsies.
The States recommend mammograms from age 40…be careful with this one.
There is quite a bit of research to show that there are high risks associated with screening women in their 40’s. (I’ll post the article)
We’re offered mammograms from age 50…but there is lots of worrying research now.
False positives, biopsies, unnecessary surgery and treatment, the dilemma of ductal carcinoma in situ (DCIS) – a slow moving cancer that usually doesn’t bother a woman, but once biopsied, it can become aggressive and once diagnosed, the breast usually comes off.
There is also research that suggests mammograms may increase the risk of breast cancer…why?
They suspect the compression of delicate breast tissue and/or the radiation exposure.
I think more than ever before we need to do our own reading and make our own health decisions.
Following US recommendations is likely to LEAD to health problems.
I really believe US women are over-examined, over-screened and over-treated to their detriment.
Womanhood is not a disease.
The practice of denying women birth control UNTIL they agree to full gyn exams is highly unethical and only happens in the States.
Cancer screening is unrelated to the safe use of the Pill…this requirement denies you the right to choose and IMO, amounts to coercion.
I have some American friends who all use the HOPE program at Planned Parenthood…they get the Pills with no exams or test.
My American friends are now screened according to their risk profiles…some are screened 3 or 5 yearly and some very low risk women have declined screening altogether.
It seems clear the risk of a false positive and biopsies is FAR greater than the risk of this cancer.
Every women will feel differently about the amount and type of risk she carries in her life.
Couples who were virgins and are in a lifetime mutually monogamous relationship are a special group often overlooked.
Our doctors advice these women of the risks of testing and the very low chance of benefiting from screening.
Cervical cancer is caused by HPV, which is a sexually transmitted disease – you can’t catch HPV from a virgin.
Virgin means no intercourse or genital to genital contact.
Good luck everyone….look after yourselves!
Your lives don’t need to be dominated by unpleasant exams and tests…in fact, you’re protecting your health by doing your reading, understanding your risk profile and acting accordingly…
Joanna said
Jon, The commonness of dysplasia is mentioned in this article by Angela Raffles, a UK cervical screening and public health expert. She calls it the “dysplasia swamp”…
“But the findings did little to halt the screening juggernaut. “For the past 20 years, regular screening has been a medical article of faith,” says Dr Angela Raffle, consultant in public health medicine in Bristol, consultant to the National Screening Programmes and author of the recent BMJ report on the outcomes of cervical screening. “Anyone who got up at a conference and asked for greater honesty about the harms as well as the benefits was shouted down as a heretic.”
The fundamental problem with cancer screening is what Raffle calls the dysplasia swamp, dysplasia being the medical term for abnormal cells. “If a pathologist looks at enough bits of you, he’ll find precancerous tissue somewhere. It is so common that it must be part of the normal process of tissue damage and repair. What we don’t know is which ones are going to spread and which can be safely left. That’s why we have to over-treat in order to help the small number who’d otherwise end up with something serious.”
Raffle is also involved in Bristol’s breast-screening programme which covers a million people. “Every year we detect 130 cases of breast cancer through screening,” she says. “Most of these women are very grateful and feel they owe their lives to the programme. But, extrapolating from the recent Office for National Statistics figures, the annual number of deaths prevented in our screened population is six. So, even in most of the women whose cancer [we] detect, screening has made no difference. Either they have a type of tumour that would have been curable even if left until symptoms developed, or they have a progressive form of the disease that will kill them anyway, despite being picked up on screening. There is only a small window of opportunity when a cancer is at the stage where screening can make that all-important difference.”
This sort of analysis suggests that the decision to offer mass screening is as much social and political as scientific and medical. “The fervour with which it has been promoted,” says Raffle, “means that in the past there was little proper scientific scrutiny of screening, but there is a serious discussion to be had. If you have £10m to spend, should you run a screening programme – or should you spend the money on other things, like better diagnosis and treatment, and on some of the things that the NHS doesn’t do well, like home care or prevention or palliative care?”
The debate over prostate screening is even more polarised.”
Anyone interested in prostate screening should also read this article in full.
There are serious concerns about the reliability of that screening which leads to biopsies.
The risk of harm is higher because the prostate is deep in the body…men can be left with long term problems.
The whole article can be found at http://www.guardian.co.uk/society/2003/nov/15/medicineandhealth.publichealth
Deborah said
It is important to understand your risk.
My Dr told me that exposure to HPV is needed to get cervical cancer BUT that most women who are exposed, DO NOT go on to cancer.
They now think its exposure to HPV AND another factor that pushes a small number of women to cancer.
My Dr favours HPV and smoking…or HPV and a compromised immune system.
There are lots of theories, but you must have HPV in your system to be at risk of this cancer.
My husband and I were virgins when we married…
A couple of doctors tried to pressure me to have smears.
I’d heard of the link between HPV and this cancer and wanted more information. My Dr was almost offended that I should question the value of the test.
I don’t appreciate that sort of attitude…this is my body, after all.
Sadly, our doctors are paid to reach high screening targets…they get a large cheque from the Govt when they hit 85% of their patients.
This has led to some unethical conduct and doctors tend to exaggerate the risk of the cancer and avoid mentioning the risks and the limitations of the test to get you into screening.
Unfortunately, it’s more about money and less about our health.
I spoke to four doctors before I found a Dutch doctor working in Australia, who went over my very low risk and the fairly high risks of testing.
She said if I wanted to have 5 yearly testing, I had to accept there was still a 50% chance I’d produce at least one false positive that might lead to a biopsy. She warned we away from the 2 yearly screening program. She also gave me a chart that showed the likelihood of a false positive with the different screening intervals and some information on cancer rates.
This is an uncommon cancer that was in decline before screening was introduced.
She also said the reduction in the death rate was not all down to screening…there were other factors including the fact many more women have had hysterectomies these days.
The reduction is not all down to screening.
She also said some women in my position choose not to have smears at all.
It was a matter for me….accept a tiny risk of cancer or have the testing and accept a 50% chance of a false positive.
I really appreciated her open and honest advice.
It helped me make my decision.
It does pay to be cautious…mass recommendations don’t take account of the individual.
Low and high risk may need to be individually assessed…in fact, all of us need to be told the truth, so we go into testing with our eyes open and aware of the possible consequences.
I don’t agree with the way screening is almost demanded of women with little information.
My husband recently saw the Dr and asked about prostate screening.
His Dr does not recommend it, as it produces lots of false positives.
My husband came home with a few photocopied articles about the pros and cons of testing. Two of his friends have also been warned about the risks of prostate screening.
Why aren’t women treated the same respectful way?
The usual thing is a doctor telling a woman she SHOULD or MUST have a test with no or very little information.
Also, many doctors do try to scare women into testing.
Doctors are not paid to get men into screening either…
I really disapprove of this conduct.
We’re all adults and like men, we’re quite capable of making our own decisions.
I now demand to be treated that way…sadly, my Dutch Dr has returned to her country…so I’m on the hunt for someone similar.
Wish me luck…
Deborah said
There is a great discussion of the risks of cancer screening on the blogcritics site with lots of great links.
It makes me angrier and angrier the more I read about this testing….breast and cervical.
Why is it acceptable to mislead and frighten women into testing and we end up paying a high price with our mental and physical health?
I have lost trust and faith in the medical profession.
It’s shameful that any professional, ethical and moral doctor would take part in these programs – at least the way they are currently promoted to women.
Even if you feel OBLIGED to offer a screening test…you should also feel obliged to point out the risks and leave the decision up to the woman…but instead we see women being pressured, misled, unethical practices and even women forced to have testing to get contraception. (this latter practice does not happen in Australia, but it happens in America)
All of these doctors should be held responsible for the harm done to healthy women.
http://blogcritics.org/culture/article/unnecessary-pap-smears/