17
   

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

 
 
sozobe
 
  2  
Reply Wed 16 Feb, 2011 06:11 am
@femmes,
That's interesting.

Speaking for myself, femmes, I'm interested in the topic of how important an exam really is. My objection to your posts here is that you've made it very personal, and you've been accusatory in a way not borne out by the posts you're responding to.

Just for example:

WSJ wrote:
"If a woman is asymptomatic and feeling fine, "


Aidan made it very clear that her daughter was NOT feeling fine and DID have symptoms.

This post -- simply bringing our attention to a pertinent article -- doesn't bother me nearly as much.

Just wanted to separate those two things.
0 Replies
 
CalamityJane
 
  1  
Reply Wed 16 Feb, 2011 09:51 am
The mother of my daughter's friend died last week of ovarian cancer. She wasn't even 40 years old yet.
Femmes can go through life without any gynecological exams whatsoever,
it's her prerogative, just don't suggest the same to others.
femmes
 
  3  
Reply Wed 16 Feb, 2011 08:59 pm
@CalamityJane,
The sad thing is, though, that I would bet that the mother of your daughter's friend HAD been getting regular pelvic exams (and if she hadn't, it would have made no difference). The fact is, pelvic exams don't detect ovarian cancer. There is no screening test for ovarian cancer. From the article I posted above:

Quote:
But Dr. Westhoff and her co-authors point out that bimanual exams don't lead to earlier diagnoses of ovarian cancer and aren't recommended for that purpose by ACOG, the American Cancer Society or the U.S. Preventative Service Task Force. They are seldom performed in the United Kingdom, where the proportion of women diagnosed with Stage 1 ovarian cancers is the same as in the U.S.


Also:

from http://en.wikipedia.org/wiki/Ovarian_cancer

Quote:
Routine screening of the general population is not recommended by any professional society. This includes the U.S. Preventive Services Task Force, the American Cancer Society, the American College of Obstetricians and Gynecologists, and the National Comprehensive Cancer Network.[36]

No trial has shown improved survival for women undergoing screening.[36]


The main factor that prevents ovarian cancer is oral contraceptive use: women who use oral contraceptives for 10 years have about a 60% reduction in risk of ovarian cancer. So making it easier for women to get and use the pill (say, by not requiring pelvic exams to get it!) could substantially decrease the number of women who die from ovarian cancer.
ossobuco
 
  2  
Reply Wed 16 Feb, 2011 09:18 pm
@femmes,
So, didn't you read the last half of what you linked?
Ceili
 
  2  
Reply Wed 16 Feb, 2011 09:26 pm
@ossobuco,
Some people have an uncanny knack for only reading what they want to see. Sad ain't it, that she insists on sounding like an expert when she's really no more than a dangerous fanatic.
hawkeye10
 
  3  
Reply Wed 16 Feb, 2011 09:31 pm
@femmes,
Quote:
The fact is, pelvic exams don't detect ovarian cancer. There is no screening test for ovarian cancer. From the article I posted above:

Americans are not big in dealing with facts...we are having the same problem with frequent breast exams, breast tissue extractions, prostate cancer testing , and to a large degree with colonoscopies as well...they all prove to be useless or nearly statistically useless, but we want them anyways.

We see it with HPV vaccine as well, where it cost over 500 per person for the treatment that is far from totally effective to deal with less than 25K cases of HPV caused cancer per year. If we do girls only it is $1 billion per year, if we do boys it is $2 billion.

Quote:
The median age at diagnosis (the age at which half of cancer patients were older and half were younger), is—

•47 years for HPV-associated cervical cancer.
•70 for HPV-associated vulvar cancer.
•69 for HPV-associated vaginal cancer.
•68 for HPV-associated penile cancer.
•62 among women and 57 among men for HPV-associated anal cancer.
•64 among women and 58 among men for HPV-associated head and neck cancers.*
So how many days of life are lost to HPV caused cancer?? IDK, but certainly not a lot and thus I have serious reservations about spending $ 2 billion a year to cut that number down some.
ossobuco
 
  2  
Reply Wed 16 Feb, 2011 09:39 pm
@hawkeye10,
You are a ******* putz.
All fudge.
hawkeye10
 
  3  
Reply Wed 16 Feb, 2011 09:56 pm
@ossobuco,
Quote:
You are a ******* putz.
All fudge.
in other words you find the truth to be unappealing. How unusual *sarcasm*

the missing link for my stats
http://www.cdc.gov/cancer/hpv/statistics/age.htm
0 Replies
 
aidan
 
  0  
Reply Wed 16 Feb, 2011 10:55 pm
@femmes,
Quote:
aidan,

Article published today in the Wall Street Journal:

Questioning the Need for Routine Pelvic Exam
Commentary Argues It Deters Regular Gynecological Care

Of all the indignities that women endure in their lives, one of the most dreaded is the routine pelvic exam.

Many women find it embarrassing, invasive and even painful. And being instructed to "relax" frequently has the opposite effect.

Now, a commentary in the January Journal of Women's Health has raised a provocative argument: For healthy women with no symptoms of disease, a routine pelvic exam serves little purpose—and may be so disliked that it dissuades some women from getting regular gynecological care.

"If a woman is asymptomatic and feeling fine, getting naked on a table with stirrups and a speculum is not adding extra value," says lead author Carolyn Westhoff, a professor of Obstetrics and Gynecology at Columbia University Medical Center and of epidemiology at the Mailman School of Public Health. "We should be talking about diet and exercise and immunizations—and having time to listen to what she's worried about. We can let go of something that is uncomfortable and embarrassing and not that useful."

In fact, the American College of Obstetricians and Gynecologists (ACOG) is re-evaluating its recommendations on the subject. "We are looking at this very closely," says Cheryl Iglesia, chair of ACOG's Committee on Gynecologic Practice.

Traditionally, a key reason for doing a pelvic exam has been to take a Pap smear—a sample of cells on the cervix to check for signs of cervical cancer—long recommended annually. But in late 2009, ACOG revised its recommendations for Pap smears to every two years for women ages 21 and 30 with no symptoms or other risk factors, and every three years from 30 and older.

Given that change, ACOG is rethinking other elements of the annual exam as well, says Dr. Iglesia. "There may be times when [a pelvic exam] is not necessary and your 15 minutes of managed-care time may be better spent talking."
What's in a Pelvic Exam?

Some of the checks done in routine visits may be done by other means.

Cervical cancer. Annual pap smears that sample cervix for abnormal cells have helped reduce cervical cancer significantly; ACOG now recommends them every two years from ages 21 to 30; every three years after that for women with no health issues.

Ovarian cancer. Odds of survival are much greater when diagnosed early, but studies show that the bimanual check is not effective in finding Stage 1 cancers.

Fibroids, cysts, endometriosis. Many of these can be felt with a bimanual exam before they cause symptoms, and early intervention can stave off fertility problems and pain. But sonograms provide more detailed information and many such abnormalities resolve on their own.

Sexually transmitted diseases. Can be detected via urine or blood tests or self-administered swabs, but some are asymptomatic so women may not know to be tested outside of a routine pelvic exam.

Contraception. Pelvic exam is needed to insert an IUD or fit a diaphragm but isn't necessary for prescribing pills or patches.

Visual exam of vagina, uterus, external organs. Can provide information on injuries, hormone levels, cancers and other issues not available otherwise.

Source: Journal of Women's Health, January 2011; WSJ reporting

In addition to the Pap smear, an ob-gyn also traditionally uses a pelvic exam to check the ovaries and uterus for signs of cancer. The ob-gyn uses two fingers to palpitate the organs inside while pressing on the patient's abdomen from the outside, the so-called bimanual exam.

But Dr. Westhoff and her co-authors point out that bimanual exams don't lead to earlier diagnoses of ovarian cancer and aren't recommended for that purpose by ACOG, the American Cancer Society or the U.S. Preventative Service Task Force. They are seldom performed in the United Kingdom, where the proportion of women diagnosed with Stage 1 ovarian cancers is the same as in the U.S.

Bimanual exams do sometimes lead to additional tests and procedures, such as having ovarian cysts or fibroids removed that may have resolved on their own, says Dr. Westhoff, who notes that one reason ACOG moved away from annual Pap smears was that abnormalities seen there sometimes led to laser excisions or biopsies that could harm a patient's fertility unnecessarily. When women do have symptoms, such as abdominal pain, backache or irregular bleeding, ultrasounds can reveal more information than palpitation can, she adds.

Pelvic exams are also commonly used to screen for sexually transmitted diseases and before prescribing contraceptives. But the authors note that chlamydia and gonorrhea can be detected just as well via blood or urine tests or with swabs that women can administer themselves. And while a pelvic exam is needed to fit a diaphragm or insert an intrauterine device for birth control, there's no need for one before prescribing the pill or a patch.

"I don't want a young woman to be afraid to come in for contraception because she's afraid she'll get a pelvic exam," says Dr. Westhoff. "The pelvic exam is irrelevant to starting the pill. But a substantial portion of doctors still require one. I think a lot of them have just been taught that that's the thorough way to take care of patients, and nobody has stopped to ask, 'What are you looking for?' "

Some other ob/gyns say a pelvic exam can provide numerous clues to a patient's condition. "There's a treasure trove of information you can glean from a pelvic exam," says Laurie Green, a San Francisco ob/gyn.

For one thing, Dr. Green says she can gauge roughly how close a woman is to menopause from the color of her vaginal walls, and says she has occasionally spotted malignant melanomas. She has also spotted cancers during the rectal portion of the exam, and cervical polyps that can make intercourse painful.

Bimanual exams can sometimes detect early stages of endometriosis, an overgrowth of uterine lining outside the uterus, and fibroids that may be asymptomatic now but can pose problems later. "I've had patients who get pregnant and they come in with massive fibroids, and if the fibroids had been removed earlier, they would have a much lower risk for preterm labor," says Dr. Green. "You would lose all of that if you didn't do a pelvic exam."

And while many women detest the pelvic exam, some consider it a crucial part of the visit. Mary Jane Minkin, a professor of ob/gyn at Yale University School of Medicine, says that with the older women she sees in her private practice, "I'm discussing their general health, health habits, weight, exercise regimens, smoking, sexual issues—all of it important—but what sanctifies the visit is the pelvic exam."

Without it, she wonders, "Would they really come in regularly for the health counseling and would insurance reimburse for it?"

Another issue is litigation, Dr. Minkin says. "If something could have been picked up on a pelvic exam and a pelvic wasn't done, do we get sued?"


Yeah - so as far as I can read and comprehend, this article just further muddies the water in terms of whether a pelvic exam is useful or not.
The first half seems to imply that it isn't particularly useful and the second half of the article directly contradicts the first half.

My issue is NOT particularly with the lack of funding for regular screenings.

My issue is more with the prevailing attitude that seems dictatorial and patronizing and dismissive of a woman's individual concerns- but now in the other direction.
When someone is trying to take care of their own health, and has determined that there is something that they would like to have done - a check-up or screening that they have determined would be useful to them for whatever reason they may have - WHY is it alright or acceptable for someone to tell them - 'No - I don't think you need that, so I'm making my decision override yours in terms of your own health'?

And we're not talking here about people who are trying to self-mutilate or self-medicate in a way that would be harmful. We're talking about a routine, two-minute exam which will leave no lasting or lifetime scars and would only serve to put someone's mind at ease.

So now, are you in agreement that if they discontinue the routine screenings, that those women who would derive comfort and peace of mind from a check-up that included an internal because that has always been their custom should just accept that someone else knows better and they will not be able to access one come hell or high water?

Again - I am NOT talking about routine screening for all women of childbearing age.


femmes
 
  0  
Reply Wed 16 Feb, 2011 11:02 pm
@Ceili,
It's not me you're having a problem with--it's the US Preventative Services Task Force, the World Health Organization, and the WSJ. I would add ACOG to the list, but they haven't changed their recommendation yet. The American Cancer Society states that pelvic exams are unlikely to detect ovarian cancer at an early state and they don't recommend pap testing until age 21.

I don't know about you, but I think of The Wall Street Journal as a pretty conservative source.
0 Replies
 
femmes
 
  0  
Reply Wed 16 Feb, 2011 11:03 pm
@ossobuco,
Yes, did you?
femmes
 
  1  
Reply Wed 16 Feb, 2011 11:16 pm
@hawkeye10,
Quote:
We see it with HPV vaccine as well, where it cost over 500 per person for the treatment that is far from totally effective to deal with less than 25K cases of HPV caused cancer per year. If we do girls only it is $1 billion per year, if we do boys it is $2 billion.


True, but for women at least the vaccine could well be cost-effective if it prevents a lot of expensive and painful followup tests . The cost of a single colposcopy and biopsy can easily be over $500, or even more if the patient needs anesthesia.

http://www.medscape.com/viewarticle/461570
Quote:
The cost of colposcopic biopsy and interventions for managing the ASCUS or low-grade SIL patient has been estimated at $6 billion annually in the United States.
ossobuco
 
  2  
Reply Wed 16 Feb, 2011 11:22 pm
@femmes,
Yes.
0 Replies
 
hawkeye10
 
  2  
Reply Wed 16 Feb, 2011 11:42 pm
@femmes,
Quote:
True, but for women at least the vaccine could well be cost-effective if it prevents a lot of expensive and painful followup tests
We are talking about spending to do this population wide, so looking at only those who get a possible cancer gives a false picture. The Vaccine is only 70% effective against cancer, and the three shot regiment has only been proven effective for five years, so there are more costs most likely coming with the boosters. Not only that, but because this is only 70 % effective there has been zero reduction in the recommended pap smear schedule (cost) so what are we getting for our $1 + billion a year (factoring in the likely boosters)? And Does the manufacturer of the vaccine really need to collect $120 per dose? Remember, we are starting girls out on this at 12 YO, so there is 70-80 years that the vaccine needs to be kept active in the body...that could mean a lot of boosters, @$120 a shoot plus paying the staff plus paying for the office space. This is likely a very expensive lifetime program to deal with a relatively small problem that we are already paying to address with routine pap smears.
0 Replies
 
femmes
 
  2  
Reply Sat 19 Feb, 2011 03:27 am
@aidan,
Quote:
So now, are you in agreement that if they discontinue the routine screenings, that those women who would derive comfort and peace of mind from a check-up that included an internal because that has always been their custom should just accept that someone else knows better and they will not be able to access one come hell or high water?


How many people would feel that way, though, if they knew how little value pelvic exams have? Would you really say "I know this is worthless, but I'm going to keep on doing it anyway"?

Quote:
We're talking about a routine, two-minute exam which will leave no lasting or lifetime scars and would only serve to put someone's mind at ease.


It shouldn't be routine, and it does leave lifetime scars for a lot of people. The whole point of the article was that the exam is so unpleasant it keeps people from getting needed healthcare such as contraception and STI screening. Half the pregnancies in the US are unplanned, and I would bet that a lot of the reason why is that it is so hard to get hormonal contraception without also submitting to a pelvic exam. That's sick.

If the only purpose is to "put someone's mind at ease," then maybe that's not such a good thing. I've known lots of people who have ignored symptoms because they just a normal pelvic, so they think nothing could be wrong.

All that said, I don't have a real problem with people who want pelvic exams for themselves--my real quarrel is with someone like CalamityJane, who thinks its ok to put her 16-year-old child through it for no reason.
hawkeye10
 
  3  
Reply Sat 19 Feb, 2011 02:52 pm
@femmes,
Quote:
All that said, I don't have a real problem with people who want pelvic exams for themselves--my real quarrel is with someone like CalamityJane, who thinks its ok to put her 16-year-old child through it for no reason.
I would not even go that far, all I am saying is that when a mother appears to be putting their kid through an apparently needless invasive procedure they should not be amazed or pissed if there is some push back from the doctor.
0 Replies
 
CalamityJane
 
  -1  
Reply Sat 19 Feb, 2011 04:26 pm
Now, I don't know anymore who is more nuts - femmes or hawkeye.
Don't you worry about my daughter. Even with being only 15 years old,
she's got more wisdom than the two of you combined.
hawkeye10
 
  1  
Reply Sat 19 Feb, 2011 06:52 pm
@CalamityJane,
Quote:
Even with being only 15 years old,
she's got more wisdom than the two of you combined
Do vague, unsupported assertions of other peoples defects normally work for you??
CalamityJane
 
  0  
Reply Sat 19 Feb, 2011 07:25 pm
@hawkeye10,
hawkeye10 wrote:
Do vague, unsupported assertions of other peoples defects normally work for you??


Isn't it funny: that's exactly what you and femmes are doing.
0 Replies
 
steve75752
 
  4  
Reply Fri 11 Mar, 2011 09:16 pm
@femmes,
Rape is a vicious violent crime. The comparison is offensive and insults my sense of decency. The young woman is not asymptomatic. Current guidelines suggest which symptoms present an indication to perform a pelvic exam or other tests. She deserved better care. Clinical experience dictates a higher standard of care than she received. You are welcome to continue to go without adequate care.
0 Replies
 
 

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