Goo
This is a good resource. And from here:
They do say that the virus is not present in all women with cervical cancer. My understanding is that the association is quite strong. I’ll do some more looking.
There is one other thing that a pelvic detects: low-level yeast or bacterial infections that the patient may not even be aware of. I had a doctor discover one of these (bacterial) when I was about 20, still a virgin. I was just used to a sort of vauge discomfort, and it never occured to me that something was wrong and could be treated.
Going at least once when you are 18 just to make sure that everything is more or less “normal” is also a good idea, I would think, whether you are sexually active or not.
You know better than this. Keep this shit out of my forum.
Thank you.
Canada uses different preventive health care standards for Pap tests and physical exams than the United States. Both countries have access to and examine the same data. It is all about risks, whether early detection makes a difference, cost of tests and how harmful the test is.
The ultimate point is that no one needs to have any screening test as long as they undestand the risks and benefits of not having it done. It is unethical to do a screening test which can cause harm or discomfort without expalining the drawbacks. This is commonly done for HIV but not for Paps or mammography.
The best book explaining preventive health care decisions in both United States and Canada is probably Mosby’s Family Practice Sourcebook:Evidenced-Based Approach by Dr. Ken Marshall. He presents both sides of any argument well.
I am a 24-year-old woman who has been having yearly gynecological exams since age 18. Maybe I have just been lucky with my choice of gyn, but I’ve never experienced any pain or anxiety during an exam, and I’ve always had a Pap smear done. Okay, I was nervous the very first time, but this was because I’m always nervous abut doing things I’ve never done before. I’ve never experienced discomfort, either. Sure, it’s not a pleasant sensation, but it’s not unpleasant, either. It just IS, if you follow. Which brings me to my question- what sort of experiences (other than the psychological scare tactics) have others had with their gyns? I have no real basis for comparison, so I’m really curious- what is it about the gyn that upsets so many women? Do I just have an abnormally high pain tolerance? But I also embarass easily- and somehow, nothing a doctor ever does has ever embarassed me. I suspect most doctors just look at patients like inspectors at an assembly line- and I sorta prefer it that way. They’re just doing their job, IMO, so I don’t get worried or offended by it. But I realize other people feel differently- so can anybody share why they dislike the gyn?
Okay, here’s my story. Overdramatics time.
I’m away at college and come down with a yeast infection. I call the student malpractice providers and try ot get some Diflucan. The doctor says they’d have to do some sort of vaginal swab procedure and send the culture off to get tested before they can write me any prescriptions. I figure okay, what the hell.
At no point did anyone ever tell me that stirrups and a speculum would be involved. I’d never had a gyno exam before, and I figured they were just going to take a q-tip and swab up some of the yeasty stuff from my underwear or something like that. The doctor I’d gone to up until now was the laid-back sort who gave out free samples of things like Diflucan after hearing your story about how you’d spent a lot of money on over-the-counter creams and you still had a yeast infection. This was also my first encounter with the student health center (Motto: The Patient Is Always Lying Because They Want Prescription Drugs.)
It ends with me on the table, scared and embarrassed as hell. The doctor uses the plastic speculum with the spring hinges on it, and snaps the thing all the way open right away. It’s some of the worst physical pain I’ve ever felt in that region. I immediately start whimpering about how much it hurts, and the nurse just sqeezes my hand and tells me to be tough, it’ll all be over soon. The doctor then starts poking me in the cervix for some unknown reason and asking me “does it hurt if I press right here?” If this was a pap smear, I never got any results back, and no one ever told me what this test was or what it was for. (At no point do either the doctor or nurse say “Now this is a such-and-such, and this is why I’m using it.” I wasn’t expecting the speculum to open, either. I don’t even know what it’s called until that night, but I’m getting ahead of myself.)
I get dressed, go use the bathroom, and notice right away that I’m bleeding. I go find the doctor and tell him that. He says “Oh, a little blood is normal,” and hands me a maxi pad.
I go fill the prescription and go home, cursing the student health center all the way.
At about 8 at night (keep in mind that the appointment was at noon) I go to use the bathroom again, and realize that I’m still bleeding. At this point, I freak out. I call security and tell them to take me to the hospital.
The hospital is one of those hideously understaffed rural county hospitals, and there’s also been a massive car accident that night and three ambulances have just showed up. I sit in the waiting room for about three hours, still sore and trying not to move too much.
Once I do get to see a doctor, they dismiss me with “Oh, a little blood is normal,” and tell me to call back in the morning if it hasn’t stopped. The bleeding does stop during the night, but I still swear that the edge of the speculum must have cut me somewhere. Everyone else I’ve told this story to has said things like “OMG OMG he must have cut your hymen!” but I’m an aggressive bike rider and tampon user, and can’t see why it would yield that much blood.
Bastards. shakes fist at the campus malpractice providers
Ok, that was a very bad experience. thy are not all like that. If there is ever another one like that, remember that you have to complete and total right to stop whenever you want to. YOu can just get up and walk out. And tell them things: don’t be brave. They are assuming that you are the verriest wimp, and that if anything really hurt you’d be screaming your head off. One big big thing to tell them is that you are a virgin. My second pap went something like this:
Me: Ouch!
Doctor: Are you a virgin?
Me: Yes
Doctor: Maybe we should use a smaller size.
Me: Maybe we should!
I was like 19 at the time, hardly old enough for viginity to be bizarre. Gynos are used to everyone being wither pregnant or trying not to get pregnant, I think. Biased sample in their office.
However, If you are young, it is a good idea to have a doctor actually look at you before you treating a yeast infection. If you don’t know, you normally have both yeast and bacteria growing together in your “area”. The key there is balance: an infection is when either one gets out of control. So if the problem is htat you have too much baterica and not enough yeast, and then you kill off what’s left of the yeast, the bacteria get even worse.
Last, I think you’d be doing some other young girls a favor if you would forward that last post just as it is to the campus office. They might should see how they look to others. (But take out the malpractice line. If you leave thta in, they will see a threat to sue, and that turns off the compassion centers of the breain and turns on the defensive system).
"It is all about risks, whether early detection makes a difference, cost of tests and how harmful the test is. "
I don’t agree that it is ONLY all about risks, etc. It is also about values. That is why different individuals and even different countries, completely cognizant of the straight dope, can make different decisions. Some people have money and don’t mind so much the discomfort and potential danger of the unecessary diagnostic work up and and possible treatment that at false positive might lead to and are so afraid of cancer they need the assurance a negative test can give them (even if it a very limited assurance). Such people want every screening test there is. Other people hate doctors, hospitals, etc. and would rather take a tiny chance of dying prematurely from a disease caught too late to be cured than face regular visits to the doctor and uncomfortable tests, etc. These people, if they are truly well informed, will make equally sensible decisions but they will decide to forego many of the available screening tests. We have examples of both kinds of people on this board.
"It is all about risks, whether early detection makes a difference, cost of tests and how harmful the test is. "
I don’t agree that it is ONLY all about risks, etc. It is also about values. That is why different individuals and even different countries, completely cognizant of the straight dope, can make different decisions. Some people have money and don’t mind so much the discomfort and potential danger of the unecessary diagnostic work up and and possible treatment that at false positive might lead to and are so afraid of cancer they need the assurance a negative test can give them (even if it a very limited assurance). Such people want every screening test there is. Other people hate doctors, hospitals, etc. and would rather take a tiny chance of dying prematurely from a disease caught too late to be cured than face regular visits to the doctor and uncomfortable tests, etc. These people, if they are truly well informed, will make equally sensible decisions but they will decide to forego many of the available screening tests. We have examples of both kinds of people on this board.
Just out of curiosity, what is a D&C?
(I’m female.)
D & C usually stands for dialate and curettage, a procedure used in some gyn surgeries. Basically they dialate the cervix and take scrapings of the uterine lining. It can also refer to abortions.
I see. Thank you.
Dao- there have been studies that show that lesbians are more likely to develop certain kinds of “down there bits” cancer.
The cancer rate is about one in three as is.
On bad experiences: I have not really had any really bad experiences, but I changed my last doctor because I had made an appointment and specifically asked for extra time to talk about some things, thinking after the exam, I would dress and go into his office and we could talk, just like I used to do every time with my (now retired) old GYN. But no, after the exam, me still on the table and without a chaperone, with no clothes on and that sheet over me, him with his hand on the doorknob, I was given the opportunity to talk about some issues. I did not like that at all.
On that note, your GYN should always have a chaperone in the room. If he does anything vaguely sexual or uncomfortable to you, report him! Unfortunately, there are some (very few, but they’re out there) docs with mental problems who like to use their position of authority for their own little tittilations.
I concede that values play an important role too. But many of the rich people who want all the tests don’t realize how imperfect the tests are, particularly tests like the PSA. Studies show women overestimate the value of mammography by over six times. Many tests, deaspite frequent use, have never shown any benefit in reducing overall mortality from the conditions they were supposed to screen for. Doctors who profit from these tests do not always tell the wealthy patient this. Advocacy organizations like the American Cancer Society generally recommend far more testing than would be supported by the literature.
IIRC, there is no good proof mammography is a better test than breast exam by a physician (studies used both, no study used mammography alone). Looking at the nine biggest breast cancer studies, probably about 10,000 tests have to be performed to save one life. This number is much lower for both occult blood screening or colonoscopy for colon cancer (1:1000-1500 if done annually for ten years) or Pap tests (roughly 1:600 with proven decline in mortality). The data on PSA is far from clear.
andy -
Crap. >_<
Oh, wait, I meant that as “oh crap” not as “that’s crap.”
<—dumb
“But many of the rich people who want all the tests don’t realize how imperfect the tests are”
You mean like Liz Taylor who used to check herself in to Scripps Clinic in La Jolla, California for a week every year for “a complete physical”? (Maybe she still does.) I remember reading about her megaphysicals in the late 1970s, around the time the Canadian Task Force on the Periodic Health Examination came out with their recommendations which were, at least by Scripps Clinic standards, what you might call minimalist.
The article describes the recent widespread availability of low cost, whole body CAT scanning to the private-paying, health care consumer. Consumers are flocking to their local McRadiology to get their scans. Most of the clients have no medical indication for this exam; they have a low pre-test probability, making it likely that findings detected in this scan are false positives. Some of the clients, on further investigation, do have a malignancy or some other correctable serious medical condition. For these individuals, the scan is life saving: for example a case where an asymptomatic kidney cancer is detected at a surgically resectable stage. In many others, however, the identified lesions prove to be benign, creating a needless medical work-up with its inherent costs and risks.
Anyway, please take the time to read this article. It’s well written and highlights the potential for adverse effects from false positive screening tests, especially in the setting of screening a low risk population.