17
   

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

 
 
femmes
 
  1  
Reply Tue 8 Feb, 2011 05:24 pm
@sozobe,
The big difference is that there's no medical benefit to bimanuals, so they shouldn't be done. If they don't bother you, fine, but there's still no point in having them.
0 Replies
 
femmes
 
  1  
Reply Tue 8 Feb, 2011 05:32 pm
@chai2,
"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."

Of course they can. Like I said, stirrups are not used for pap testing in the UK--that means that millions of people there get pap tests without them. You bend your knees and put your feet flat.

Here's a link that describes what happens at a smear test in the UK:
http://www.bbc.co.uk/radio1/advice/factfile_az/smear_tests

Not only do they not use stirrups, they don't use hospital gowns either. You could just wear a long skirt and remove your underwear:
"You'll need to take off your knickers and lie on your back with your legs bent and apart while the doctor or nurse uses a speculum (a small metal instrument) to look at your cervix."

More evidence here:
http://www.health.am/gyneco/more/necessary-for-pelvic-exams/

"While critics have argued that Pap smears aren’t as accurate when women are not in the stirrups position, Seehusen notes that the feet-on-the-table approach is standard in the UK and Australia, where Pap smear accuracy is no more of a problem than it is in this country.

Seehusen launched his study after a colleague told him she never had her patients use the stirrups for a pelvic exam. To evaluate the approach, they had 197 women undergo Pap smears with or without stirrups. The women rated their physical discomfort, sense of vulnerability and sense of control during the exam.

Women who had the exam without stirrups felt significantly less vulnerable and uncomfortable than the women who used the stirrups, although there was no difference in their sense of control. "
0 Replies
 
chai2
 
  2  
Reply Tue 8 Feb, 2011 06:39 pm
oh that's bull.

you're really scraping the bottem of the barrel now, complaining about stirrups.

next you'll be saying stirrups = rape

oh no, and the dreaded hospital gown. Laughing

My physician is very thorough and palpates lungs (the entire back), checks out my rectum for polyps (plus in the past I have suffered, and I mean SUFFERED, from hemarrhoids, examines my breasts for lumps/discharge, any other changes and feels all nodes in my armpits, groin, behind the knees and examines my feet. In general she goes over all my skin area, and examines anything internal she has access to.

The thought of wearing street clothes throughout this exam is ridiculous.

If you like, when you go to YOUR doctor, tell him/her you don't want to have your feet in stirrups if it bothers you that much. You seem to be able to open your mouth enough here.

For a pap test, you obviously need to remove clothes. What? Do you think the woman should leave just shove her pants and underwear down to the middle of her thighs and tell the doctor to just deal with it? Maybe she should wear a dress/skirt (I don't even own either) and tell the doctor to just move the panties covering her perineum off to the side, and work around it?

This is idiotic. We're not in Victorian England, or in Iraq.
Talk about making a person feel uncomfortable about their body. If I were raised with that rigamarole, I'd be thinking I must have dirty parts I have to hide as much as possible. Instead, in my health care providers exam room, I am free to discuss any part of my body, and have my doctor/nurse practitioner examine anything.

That's not a restriction or my submission, that is my Right.
femmes
 
  0  
Reply Tue 8 Feb, 2011 07:48 pm
@chai2,
Quote:
That's not a restriction or my submission, that is my Right.


Sure, it's your right to do whatever the heck you want with your own body, just as it is my right to make my own decisions about mine. The problem is that you are not coming from a position of informed consent (since you didn't know that the exam has no proven benefit and you assume that American norms are followed everywhere). If you still want to go ahead with it even knowing it's uselessness, that is your right, but that doesn't make it ok to force someone else (your 16-year old daughter) to do the same thing. It's not. It's her choice. If you are forcing her then you bet I believe it's rape.
sozobe
 
  1  
Reply Tue 8 Feb, 2011 07:49 pm
@femmes,
But what is "forcing," in your definition?

Since you're talking about age of informed consent, you seem to be saying that a 16 year old can't give consent. That if she goes, she is automatically being forced.
femmes
 
  1  
Reply Tue 8 Feb, 2011 08:01 pm
@sozobe,
Quote:
Since you're talking about age of informed consent, you seem to be saying that a 16 year old can't give consent. That if she goes, she is automatically being forced.


No, absolutely not. I believe that 16-year-olds can give (and therefore refuse!) consent. The comment was that CalamityJane would just automatically make a pelvic exam appointment for her 16-year-old daughter for no other reason than she thinks it's the standard thing to do, though. No input from the teenager--the mother makes it sound like she's going to choose the doctor, make the appointment, drive the teen there, etc. The teenager isn't really given an opportunity for meaningful consent or refusal in such a scenario, and that is very, very wrong. Not to mention, as I keep saying, there's no medical justification for it.
Ceili
 
  1  
Reply Tue 8 Feb, 2011 08:54 pm
One has to wonder if these "women" have ever had a baby.
CalamityJane
 
  1  
Reply Tue 8 Feb, 2011 09:55 pm
@femmes,
How do you know all these things, femmes? How do you know what my daughter thinks and if she will give consent or not, or if I just plainly drag her to the butcher. You assume a lot and as I said before, you've read too many horror stories in your life, if not experienced it yourself.

Point is, never assume what's in your head, is also in everyone else. I do not
hear your voices, I do not carry your paranoia and I am sure as hell don't
share your utter ignorance.
CalamityJane
 
  1  
Reply Tue 8 Feb, 2011 09:57 pm
@Ceili,
Oh Ceili, don't even get down that road. I shutter to hear what they have
to say about child birth Wink
femmes
 
  1  
Reply Wed 9 Feb, 2011 12:16 am
@CalamityJane,
Because that's what you wrote? You said
Quote:
once my daughter is 16, I'll take her to my (female) gynecologist too (in the U.S.)


No regard for her consent at all. What will you do if she refuses?
0 Replies
 
roger
 
  1  
Reply Wed 9 Feb, 2011 12:21 am
@CalamityJane,
Like immunizations. Clear case of Assault and Battery if I ever heard one.
0 Replies
 
aidan
 
  1  
Reply Wed 9 Feb, 2011 12:58 am
@hawkeye10,
Hawkeye - I had to pay for it, which I was happy to do. To tell you the truth, I always feel a little guilty NOT paying for medical treatment here - though we pay outrageous taxes and have no access to public funds (it's written on our visas) - as we're not actual citizens - just residents.
Honestly, I don't know how the UK does what it does for people.

And some of it goes from the sublime to the ridiculous. I was reading a story in the paper yesterday about a family of 14 - 42 year old father, 39 year old mother and 12 kids being given a million dollar home in London as their council house and 70,000 pounds a year in benefits!
I asked my co-worker Adrian - WHY?! Why does the council pay for these people to sit in this house, produce children and not require them to work when they could!!

He couldn't figure it out either - especially as they'd told the interviewer they'd rather have a big caravan to travel around in than a mansion in London.
Oh well - maybe it's the American in me coming out.

I think I'm starting to get the picture you're painting Femme. You remind me of my friend Dana who was pathologically opposed to and actually afraid of penetration of any sort.
She was 27 years old and had been living with a man for a year and she asked me if I had any issue with being penetrated. I said, 'No - why?' and she went on this long screed about it being rape and assault and abusive and etc., etc.
She had slept in the bed with this guy for over a year and wouldn't let him penetrate her.
Not to be mean, but I think that's a pathology or phobia. I don't have it - neither does my daughter.
An internal is not intrusive and damaging - if you're a woman and want to ascertain your internal reproductive organs are normal and healthy, in good working order- it's a fact of life.
I'd rather have a pelvic than go to the dentist - any day of the week.

And all I can say is it's a good thing I was living in America when I was or I wouldn't have my son - bottom line - simple as that. I was part of that one percent that was helped by that internal exam as part of my check-up when I was totally asymptomatic.
femmes
 
  1  
Reply Wed 9 Feb, 2011 01:40 am
@aidan,
No, the problem is with lack of consent, not penetration.

Quote:
if you're a woman and want to ascertain your internal reproductive organs are normal and healthy, in good working order- it's a fact of life.


Not in the UK, obviously. There's no "baseline" when you're talking about pelvic exams. Your daughter's doctor obviously didn't think they had value!

How about PubMed? Will you accept that as a source?
http://www.ncbi.nlm.nih.gov/pubmed/17475104

"Reliance on the accuracy of the pelvic examination is upheld in many medical textbooks, but review of the literature does not support the accuracy or reproducibility of this examination. That this "test" is useful for ruling out serious disease will be exposed for the myth that it is."

More:
http://www.racgp.org.au/afp/200806/200806stewart.pdf

"Well woman checks are commonplace in general practice
and may include pelvic examination, usually in conjunction with
a Pap test. These checks are performed with the assumption that
they can detect pelvic pathology, including signs of ovarian
cancer. An earlier review of the literature recommended against
the use of pelvic examination as a screening test in asymptomatic
women.1 Of note, The Royal Australian College of General
Practitioners (RACGP) and the Royal Australian and New Zealand
College of Obstetricians and Gynaecologists (RANZCOG) do not
include pelvic examinations in their guidelines as a screening
activity, either alone or in association with Pap tests."

aidan
 
  1  
Reply Wed 9 Feb, 2011 02:07 am
@femmes,
Okay - you're asking me to accept your guidelines which would have compromised my health and fertility over the guidelines in the country I grew up in, which saved my fertility and maybe my life?

Do you not understand what I'm saying?

If I had lived in Australia or England - my lesion and dysplasia would not have been found.
My dysplasia could have progressed to full-blown cancer and I could have lost my reproductive organs or could have DIED!
At the very least, the fact that my cervix was compromised would not have been found and I would not have been able to carry my first and only pregnancy to term - and I'd have lost my son - a baby I PASSIONATELY wanted!
I wouldn't have been able to look at a miscarriage or the loss of a child as some do, 'Oh well - I'll just try again.' I would have been devastated.

The fact that in the US pelvic exams and pap smears are seen as necessary, routine, and not as invasive or unnecessary torture of young women
saved me from a lot of pain and heartache - since from the time I was five years old, my biggest dream in terms of being a woman was having a baby and being a mother.

Okay - maybe other people see it differently. But that's the way I see it.
That's why it was important for me when it came to my daughter.
And I don't understand why, if someone wants a check-up, there is such huge reluctance to let someone have it.

She was consenting. They still said, 'No - we don't think it's necessary'.
That's quite a chance they're taking, especially when I'm standing there telling them I don't know her genetic family history. Maybe her mother and grandmother died of ovarian or cervical cancer.

I'm not talking about what is right for everyone. I'm talking about what is right for my daughter.
It felt like someone telling me I couldn't feed her what I believe is healthy for her because they don't believe it's healthy for her and they want me to feed her what they think is healthy for her.
femmes
 
  1  
Reply Wed 9 Feb, 2011 02:59 am
@aidan,
I don't know the details of your cervix being compromised, so I can't comment on that, but I can comment on this:

<i>If I had lived in Australia or England - my lesion and dysplasia would not have been found.</i>

There's no evidence you had a precancerous lesion, though. You wrote that you had a vaginal lesion when you were 19, not a cervical one. Vaginal cancer is exceedingly rare, even rarer than cervical cancer. It accounts for only about 3% of all reproductive cancers in women. Only about 760 people die of vaginal cancer annually in the US (that's a tiny number when you consider the population), and the vast majority of them are over 60. (Source: http://www.wcn.org/articles/types_of_cancer/vaginal/risk/index.html) It's exceedingly unlikely that whatever you had as a teenager was precancerous or would ever have developed into anything. You don't actually say that it was biopsied and was malignant, just that you had it removed. You're more likely to be struck by lightening or win the lottery than have vaginal cancer at 19. You live in the UK now--you see that teenage girls are not dropping dead willy-nilly!

Pregnancy loss is devastating for most women and I don't blame you one bit for worrying that it could have happened to you. However, the fact of it is that overscreening for cervical cancer, specifically treating too soon with LEEP proceedures and cone biopsies, can increase the risk of incompetent cervix and miscarriages:

http://cervicalcancer.about.com/od/cervicaldysplasia/a/leep_pregnancy.htm

http://women.webmd.com/news/20040504/cervix-treatment-may-endanger-pregnancy-later

"One expert offered his opinion on cervical dysplasia treatments: "If it was my wife or daughter I would encourage her not to have anything done. Many studies show that 75% of these precancerous cells go away on their own," says Ira Horowitz, MD, vice chairman and director of gynecologic oncology at Emory University's Winship Cancer Institute in Atlanta. "

aidan
 
  1  
Reply Wed 9 Feb, 2011 03:22 am
@femmes,
Honestly femmes -
I don't remember what the results of the biopsy, etc. were.
My mother and my sister were both nurses and they were there through the whole thing with me and they were in agreement with everything that was happening and I trusted them, so I felt that they were making sure I was in the best and most caring hands.

And I do remember my mother being very sad-looking but comforting and her telling me not to be afraid and then I said, 'I don't think I could die, could I? But I'm afraid I won't be able to have children,' and she just said, 'Well, you can always adopt', - in other words she was afraid I might not be able to have children either- so there must have been something going on that made them all think that what was happening was the best course of treatment.

The whole cervix thing had to do with that DES stuff too- although my mother didn't take it and in the end they could find no concrete reason for my symptoms.
But I remember the doctor explaining it to me that the cervix has to be muscular and elastic to hold up to the demands of gravity and a seven pound baby placed on it - if it wasn't it would open prematurely.

He said that some women had cervixes which were a softer consistency - like butter - and that this was congenital and that cerclages didn't tend to work for them as the thread just cut through them, like butter- and didn't hold.

He said I was lucky because mine had some musculature or firmness to it - although not as much as normal - so I WOULD need a cerclage, should I ever get pregnant, but that my cervix could hold it.
And the only reason they found this out is because I went for that exam - NINE YEARS before I got pregnant. So I was aware of what my problem would be and I could inform the doctor from the beginning and I could take CONTROL of my health and happiness because I KNEW what was happening in my own body - and all because I'd believed in check-ups.

And you still don't address the issue of refusing to give someone what they ask for. As far as I'm concerned that's paternalistic and condescending.
aidan
 
  1  
Reply Wed 9 Feb, 2011 03:30 am
@femmes,
Quote:
"One expert offered his opinion on cervical dysplasia treatments: "If it was my wife or daughter I would encourage her not to have anything done. Many studies show that 75% of these precancerous cells go away on their own," says Ira Horowitz, MD, vice chairman and director of gynecologic oncology at Emory University's Winship Cancer Institute in Atlanta. "


And what about the other 25%? Oh well....
femmes
 
  1  
Reply Wed 9 Feb, 2011 03:44 am
@aidan,
Quote:
And you still don't address the issue of refusing to give someone what they ask for. As far as I'm concerned that's paternalistic and condescending.


I completely agree with you, as far as that goes. Hawkeye10 wrote that
Quote:
I am thinking that this has to do with the fact that this is your daughter. If you wanted an unnecessary invasive procedure that you were willing to pay for then they would take your money and do it, but because you were trying to subject you daughter to what they see as in invasive unnecessary procedure money does not fix the morality problem of them doing it to someone who has not had a say in it.

and that is my feeling as well. I get that you keep saying your daughter consented, but that wasn't apparent from your original question (and, if you want to get nitpicky, we have only your word for it). If your daughter had posted on this board saying "I want a pelvic exam to evaluate my symptoms," I would have thought it would be unlikely to help her but that she had every right to it, especially paying out of pocket. But she didn't post it, you did.
femmes
 
  1  
Reply Wed 9 Feb, 2011 03:51 am
@aidan,
Quote:
And what about the other 25%? Oh well....


No, of course not, and if you had actually read the link it explains that.
0 Replies
 
aidan
 
  1  
Reply Wed 9 Feb, 2011 03:54 am
@femmes,
Well, I promise you I'm not lying.

But as I asked - what about the other 25% of dysplasic cells that progress to full-blown cancer?
I did read the link. It doesn't offer anything different than what I read in 'Our Bodies Ourselves' 20 years ago.
That doctor doesn't talk about what will happen to the women who a) don't find the dysplasic cells and b) don't do anything about them.

That doctor's full of ****. If he were my father - I'd tell him to get over himself and I'd have my dysplasic cells dealt with. Yeah - I'm gonna spend the next ten years waiting to see if I were one of the lucky ones who had the more common 75% type of dysplasia or one of the unlucky ones who had the less common 25% of dysplasia.

And that's only if I knew I had the dysplasic cells in the first place. Which I could only know if I had had a preventative check up.

Once again, all I can say is I'm happy I grew up where I did.
 

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