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How do different nations approach a girl's first gynecological exam

 
 
CalamityJane
 
  1  
Reply Sat 5 Feb, 2011 09:52 am
@femmes,
Okay femmes, here it goes: from your answer I read your own experiences
and if not, you must have seen a few scary movies too many.

Where do you get from my statement that I will drag my daughter against
her wishes to a gynecologist and have him rape her? My daughter is 15 years old now, very aware of her body and how to take care of it. She is very well educated about yearly check-ups and preventative measures. Education is the key here.

From your post I gather you're in the UK and that women start at age 25 with pelvic exams if ever and you see nothing wrong with women never ever receiving one. You and I are clearly worlds apart in our way of thinking.
Most women are sexually active with 25 (and long before) and I do consider it as gross negligence if they forgo gynecological examinations as well as yearly cervical cancer testings.

Where I come from, having a yearly gyn exam and pap smear is just as a routine exam as going to the dentist - but you probably won't go there either
on a regular basis.

Cancer doesn't only befall older women, unfortunately I've had friends succumb to cervical cancer which could have been prevented had they only gotten regular check-ups.

Luckily, nowadays, very few women think like you, femmes. It's almost
an insult that you call yourself a femmes.
Eliz52
 
  2  
Reply Sun 6 Feb, 2011 08:33 pm
I'm a 52 year old Australian woman and I've never had a routine bimanual pelvic exam, it's never been suggested and I'd refuse it anyway.
They're completely unnecessary in a symptom-free woman and expose you to risk - false positives leading to more potentially harmful exams even surgery. Some poor American girls lose healthy ovaries after a Dr "thinks" she felt something.
The clinical evidence is clear - poor value in asymptomatic women.
The American practice is not evidence based and causes enormous harm to your women - you have the highest hysterectomy rates in the world - 1 in 3 will have one by age 60 and huge numbers of unnecessary cervical and breast biopsies.
Your 16 year old daughter does not need routine gyn exams - if she has symptoms, then that's different, but to suggest a healthy, young girl needs this exam is plain wrong. I believe the American well-woman exam is about profits for doctors and has little to do with health - they should be called sick-woman exams.
Cancer screening is optional, you're lucky that in the UK your daughter is somewhat protected from inappropriate screening which causes enormous harm for no benefit - even 25 is too early for pap tests.
Screening women under 25 is unethical - the evidence is clear - huge numbers of false positives for NO benefit. The very rare case of cc still occurs and is usually missed by the unreliable pap test.
If women want them, look at your risk profile and consider a program that will protect you from false positives and harmful over-treatment. Finland offers 5 to 7 tests in total - 5 yearly from age 30 - they have the lowest rates of cc in the world and send the fewest women for biopsies (35%-55% lifetime risk - a lot better than 95% of American women)
As a low risk woman, my risk of cc is near zero and our program carries a 77% lifetime risk of colposcopy/biopsies - I made an informed decision not to screen more than 25 years ago and recently declined mammograms due to concerns about false positives, over-diagnosis and the risks of testing with radiation exposure and the compression of delicate breast tissue.
Cervical cancer is rare, always was and was in decline before testing started - 0.65% is the lifetime risk of cc here, but 77% will be referred after an abnormal smear (almost all are false positives) that's very high over-detection for a tiny risk. 0.20% get false negatives and only 0.45% benefit...
I'm not surprised your anxious - American women have been brainwashed for generations to accept these degrading and harmful exams - it's starting to unravel and more women are refusing this undignified annual ordeal - doctors must be very worried about losing their lifetime income-generating patients - it's disgusting this has been permitted to go on for so long - the harm these exams do is just awful...few American women have an intact cervix at my age. Young women - 1 in 3 pap tests will be abnormal, not because of cancer, but false positives caused by changes in the maturing cervix or by harmless and transient HPV infections.
If you love your daughter, you'll at least do your reading before subjecting her to this unnecessary and harmful ordeal. The facts are easy to find...ask the doctors that (thank goodness!) refused to put your daughter through this exam, for some medical references. Heather Dixon has a great essay on line that talks about the clinical value of the pelvic exam - poor.
There are many others - see: Dr Joel Sherman's medical privacy forum under women's privacy issues - also, the Violet to Blue site.
Protect your daughter from harm and if she needs to see a Dr FOR SYMPTOMS, give her the option of a female doctor - that makes these invasive exams easier for some women.
CalamityJane
 
  1  
Reply Sun 6 Feb, 2011 08:37 pm
@Eliz52,
Aha!
0 Replies
 
Ceili
 
  1  
Reply Sun 6 Feb, 2011 09:08 pm
@Eliz52,
Wrong. Wrong. Wrong.
For someone who's never had an internal you sure talk a lot of crap.
I can't tell you how many times I've been with a group of women who've had pre-cancerous cells or loop incisions. I have also had women I know, friends die of cervical cancer.
The thing about cervical cancer is... It rarely shows any side effects till it's too late. If you are sexually active, you should get the exam bi-annually. Period.
Doctors don't just feel, they also take swabs. Are you saying labs are complicit in making doctors rich? Or are you saying modern medicine is made up of charlatans?
HPV is rampant and studies have now shown men should also be inoculated against it. HPV covers hundreds of viruses, some may be harmless, but unless you're a researcher, I doubt you could tell the difference from your desk. Yet another good reason for condoms as well.
Are you a proponent of not giving kids inoculations too?
I'm not sure how preventative medicine can be considered harmful, degrading or akin to rape, but twisted minds can turn anything into a perversion I guess.
One woman dying of a preventable disease is too many.
By the by, the cervix is not the ovaries. Ovarian cancer is quite common, especially in older women. How many women do you know with Endometritis? or that can't conceive?
How about Breast Cancer. Most women don't know how to do a proper breast exam and by the time they do feel the lump it's touch and go.

CalamityJane
 
  2  
Reply Sun 6 Feb, 2011 10:02 pm
@Ceili,
Ceili, isn't it funny that both - Eliz52 and femmes just registered to tell us how wrong pelvic exams are. I sure hope that both will reconsider and get at least a yearly check up and pap smear.
0 Replies
 
Eliz52
 
  0  
Reply Sun 6 Feb, 2011 10:28 pm
It's entirely up to you whether you want to have these exams, but the clinical evidence is clear - they are unnecessary and risk your health.
I'd urge every woman to do her own reading, look at her risk profile and make informed decisions.
If Australian and English doctors do not recommend routine well-woman/pelvic exams in asymptomatic women - why do you think that is? The States have MORE cancer and you all have far more procedures and biopsies and a whopping 600,000 hysterectomies are performed every year - if these exams are so great, why don't the statistics show something other than harmful outcomes? 95% of you will have colposcopy (and usually some sort of biopsy) to cover a risk of less than 1%! (See: Richard DeMay, "Should we abandon pap smear testing" on line - American pathologist)
If woman want pap tests - the Finnish and Dutch program provides you with some protection from the high risk of false positives and over-treatment. Any woman considering a mammogram might like to look at the Nordic Cochrane Institute website and "The risks and benefits of mammograms" - produced by the NCI because they were so concerned at the lack of risk information being provided to women.
I can assure you I won't be having well-woman exams in the future, I value my health - our doctors do not recommend them for sound clinical reasons. I've also made an INFORMED decision not to have pap tests or mammograms after considering my risk profile and the risks and benefits of the test.
CalamityJane
 
  1  
Reply Sun 6 Feb, 2011 11:03 pm
@Eliz52,
Quote:
I've also made an INFORMED decision not to have pap tests or mammograms after considering my risk profile and the risks and benefits of the test.


That's baloney! Wherever you get your information from, must be the bush drums. You are so wrong on so many levels, it's mind boggling.
0 Replies
 
aidan
 
  2  
Reply Mon 7 Feb, 2011 12:45 am
@Eliz52,
Eliz- I agree that family history and risk profile play a part in ascertaining whether or not a woman should DEFINITELY have the yearly check-ups or may be able to have check-ups on a less rigorous schedule.

In my own situation - I have three sisters and a mother and two biological grandmothers - and none of those women have ever had breast cancer, a hysterectomy, or any other problem with their reproductive organs. So I've assessed my own risk and have determined that it's probably fairly low.

That's why I adhere to the schedule of check-ups that the NHS or medical establishment over here in England has determined is best followed, as opposed to following the schedule of pap smears and mammograms that I used to follow in the US.
If I did have a family history of any of those problems, I would continue with yearly check-ups and pay for them myself.

My point is that I DO NOT KNOW MY DAUGHTER'S FAMILY HISTORY because I adopted her. I DO NOT KNOW WHAT HER RISK PROFILE IS!
Neither do any of her doctors.
Why is it so difficult to access a simple check-up to put my AND HER mind at ease? She was NOT asymptomatic. She had abdominal pain which was radiating into her left pelvis. I was not a hysterical and overreacting mother.
I just wanted to get a baseline and put both of us at ease.

I just wish there was a happy medium.
0 Replies
 
al09
 
  0  
Reply Mon 7 Feb, 2011 08:43 pm
‘Wrong Wrong Wrong’ & ‘Balony’??

Your reactions really don’t inspire confidence in your strong convictions to screen for a rare cancer… Have you bothered to RESEARCH the links @femmes and Eliz52 have provided to get an accurate idea on the benefits on cervical cancer screening? I have and it’s evidenced based research, Angela Raffle’s research has been cited in numerous medical papers and ethical speculations on the need to screen for a rare disease.

You don’t have to be a doctor to question the validity of a medical procedure, any one with the ability to read can do their own research and come up with the same conclusion, (without cherry picking) pap smears are unnecessary in asymptomatic women.
For the women who think they’ve been saved from cervical cancer through medical intervention ask to see their pathology report, most abnormal cells are NOT cancer nor is it very likely they will become cancer. The dangers to a woman’s health from over screening far out way the risk of actually getting cervical cancer.

“Luckily, nowadays, very few women think like you, femmes. It's almost
an insult that you call yourself a femmes. “

Thankfully there are a growing number of women questing routine gynaecological exams and informed consent.
http://blogcritics.org/culture/article/unnecessary-pap-smears/comments-page-76/#comments
Ceili
 
  2  
Reply Mon 7 Feb, 2011 08:59 pm
@al09,
Why don't you stick with same name. It does nothing to prove your point to create an army of anti-pap advocates. Baloney aptly describes your latest post.
Perhaps you'll enlighten us with the terrible damages and dangers these tests cause. Aside from the ridiculous claims of rape, that is...
I'm glad you're questioning things, unfortunately it doesn't matter how many people you try to be, I'm not buying your pseudo science.
I hope you never suffer from any internal diseases, but for the love of god, don't push these beliefs on other women. It could kill them.
ossobuco
 
  1  
Reply Mon 7 Feb, 2011 09:01 pm
Thinking.. death with purity.
0 Replies
 
CalamityJane
 
  1  
Reply Mon 7 Feb, 2011 09:25 pm
Yeah, unbelievable how narrow-minded some people are. Registering under different names to make her point is just as stupid as the point itself.
0 Replies
 
al09
 
  1  
Reply Mon 7 Feb, 2011 10:25 pm
@Ceili,
Ahh... you can check with the administrator, I have NOT posted under any other name. There are actually more than a few informed women out there!
0 Replies
 
Ceili
 
  1  
Reply Mon 7 Feb, 2011 10:34 pm
And.... you still haven't posted about the terrible dangers of preventative testing.
If you can blindly ignore the facts and that I know several women who have died then all the power to you. I hope you live a long virginal life... lol
0 Replies
 
Jane5
 
  1  
Reply Tue 8 Feb, 2011 12:08 am
If the US had the highest life expectancy in the world then maybe I would agree that your country is doing things right. Australia doesn't do yearly pelvic exams either and we have a longer life expectancy than the US. In fact billions of women all around the world don't do them. Can you explain how we all manage to survive? We don't have higher cancer rate than you. We don't have 1 in 3 uteri removed by age 60 either which I would have thought all those pelvic exams would have prevented. Hmmm. Do you think it's because your doctors are greedy and it's a great cash cow to have you come in for your yearly well woman exam?
BTW. We are not the same person. It's just that were all talking about you on another forum. We all wonder how American women have become so afraid that their bodies are ticking time bombs. Some of the women who post are American. They're the ones who have done the research and realized they've been taken for a ride.
OP, there are many many women out there who think they had precancer. They didn't. They had a false positive. Doctors in the past didn't know that most abnormal paps clear up on their own. I read in an Australian government report on cervical cancer that 88% of cin 3 clears up on its own. You probably damaged your cervix for a false positive.
Cervical stenosis and incompetent cervix are some of the damage that is caused by these treatments for abnormal cells that would have cleared up on their own.
aidan
 
  1  
Reply Tue 8 Feb, 2011 12:35 am
@Jane5,
Quote:
OP, there are many many women out there who think they had precancer. They didn't. They had a false positive. Doctors in the past didn't know that most abnormal paps clear up on their own. I read in an Australian government report on cervical cancer that 88% of cin 3 clears up on its own. You probably damaged your cervix for a false positive.
Cervical stenosis and incompetent cervix are some of the damage that is caused by these treatments for abnormal cells that would have cleared up on their own.


I didn't only have a positive pap smear. I had a vaginal lesion that looked identical to the lesions that women whose mothers had taken DES during their pregnancies to prevent miscarriage developed.
I was born during the time this drug was being routinely prescribed. I was nineteen years old and living in North Carolina - my mother in New Jersey had to try to access her medical records from the obstetrician she was seeing in San Antonio, Texas twenty years before to make sure she hadn't been given the drug.

She was almost certain she hadn't been given the drug, me being her third pregnancy and her never having had a miscarriage - but as she'd had SIX pregnancies and she'd been given some drugs for other stuff - she was determined to make SURE she hadn't been given that specific drug - which as I said, had been the cause of the cervical cancer and subsequent death of a 17 year old girl in our neighborhood two years before this.

I had absolutely no symptoms. The only way they found this lesion was because I went for a check-up - and internal exam. It had to be excised and biopsied.
It was stitched. I couldn't even feel the internal stitches - much less the lesion that had been growing there that no one would have been aware of if I hadn't had that internal pelvic exam.

So whatever - I wanted my daughter checked to make sure she's all set down there no lesions, no cysts- I just wanted to know that there wasn't an internal cause for her pain and that all was well for her.
She was in so much pain, she wanted to know too.
What business is it of yours?

It's not abuse or rape and I too would like to know what damage it causes.

Go ahead - tell me.
hawkeye10
 
  1  
Reply Tue 8 Feb, 2011 01:06 am
@aidan,
It is interesting that this thread does not die, but since it is still active I was wondering.......did the state pay for the exam or was it out of pocket? My experience with the German system makes me think that they would not pay this, but I don't know how England works.
femmes
 
  0  
Reply Tue 8 Feb, 2011 04:00 am
@CalamityJane,
"From your post I gather you're in the UK and that women start at age 25 with pelvic exams if ever and you see nothing wrong with women never ever receiving one. You and I are clearly worlds apart in our way of thinking."

You are wrong. I'm American, I just know better than to believe there's any medical evidence for pelvic exams in asymptomatic women. You're correct that we are worlds apart in our ways of thinking, though.

You are either not reading what I wrote and/or making a common American mistake of thinking pelvic exams (bimanuals) and pap tests are the same thing. I wrote that women in the UK start pap tests at age 25 and don't routinely get bimanuals. That's not the same thing as saying "women start at age 25 with pelvic exams if ever." Women in the UK are invited for cervical screening starting at age 25 and once every three years after that. Cervical screening (i.e. pap testing) involves taking a swab or cytobrush to get a sample of cervical cells. That's a pap test--not a pelvic exam! A pelvic exam or bimanual is when a clinician uses fingers to (try to) feel the uterus and ovaries. (It is totally normal to not be able to feel ovaries manually on a lot of women--part of the reason why bimanuals are not useful!) This is not routinely done in the UK or Australia as there is absolutely no evidence that it is medically beneficial--that's why I said that women in the UK might go their entire lives without ever having a pelvic exam, or might only have one during pregnancy.

Did you even bother to read my links?

Finally, I use the name femmes because I am a hardcore feminist and I'm passionate about women's rights, particularly our rights to control our own bodies. You had better believe that my science is sound and I know what I am talking about.

sozobe
 
  2  
Reply Tue 8 Feb, 2011 06:55 am
@femmes,
What's the big difference between a bimanual and a pap smear, though?

It's not like there are non-invasive ways to do a pap. Once the speculum is out, it's all pretty much the same to me. (An unpleasant chore to get through.)
chai2
 
  2  
Reply Tue 8 Feb, 2011 08:04 am
@sozobe,
sozobe wrote:

What's the big difference between a bimanual and a pap smear, though?

It's not like there are non-invasive ways to do a pap. Once the speculum is out, it's all pretty much the same to me. (An unpleasant chore to get through.)


apparantly that the doctor puts his/her fingers inside to palpate the ovaries and uterus.

big deal.

THAT is the most, well I won't say pleasant, but most, I don't know the right word....comforting, human, connecting with your body, immediately useful come to mind, part of the exam.

That's the time when my doctor is talking to me, and I to her, and I can totally concentrate on the conversation. There's the back and forth "How does this feel? Been having any pain/unusual discharge? and so forth and so on." It's 2 people interacting. It's my physician examining me. If anything feels wrong, she's going to tell me right then.
I don't feel any different about it than if she had to look around in my mouth, up my nose, or in my ears.

Once that speculum goes in, and I know the next thing is going to be a brisle brush scraping off some cells, I just concentrate on counting backwards from a hundred, and staring at the light fixture on the ceiling.

THAT's the unpleasant part. That's the part that feels invasive.

The use of stirrups was mentioned as a negative thing. I don't get that at all.
It's not a device that is tying you down, or restricting you. It's merely a concave place to place your heels, so you don't have to tense your muscles to keep you legs up and open.
You can easily bring your knees together when the doctor isn't examing you.
Every woman knows this, that if you just had your needs up and spread on the exam table, the doctor couldn't get close enough comfortably to even give you a pap.
It's just a place to put your feet so you can slide down the table far enough so that the area that's going to be examined, or have a pap taken, is closer.

I gotta tell ya, this femmes sure doesn't sound like an American, an advocate for women, or frankly, even a woman.

When I'm at my doctors office, my vagina, ovaries, uterus, cervix etc are on equal standing with any other of my body parts.



 

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