By: Jean Johnson for Uterus1“I remember back during my early Pap smear days when I had to endure the procedure in order to get birth control pills. It was all pretty weird; especially the time this one male physician was finishing up. He removed the speculum, did his manual vaginal feeling around bit, and then without warning jammed his finger up my bum,” said fifty-something Suzanne Greer of Los Angeles. “Once was quite enough of that, thank you very much. Since then no matter who I’ve seen, I’ve been quite clear that that I do not permit rectals to be done on me during pelvic exams.”
| Take Action |
Protect yourself from cervical cancer:
The National Women’s Health Information Center (www.4woman.gov) suggests the following in protecting against cervical cancer:
Get regular pap tests
Don’t smoke
Maintain a strong immune system by loading up on diets high in a variety of vegetables and fruits and nuts
Be monogamous
Use a condom every time you have vaginal, anal or oral sex
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Sigh. War stories from the pelvic exam table. It’s enough to make females give up. While physicians like to refer to the pelvic exam as a routine procedure, women across the board shudder at the thought of stirrups. Still they troop in for the annual affair, and there’s good reason why. In particular, the Papanicolaou or Pap test allows physicians to check the cervix for human papillomavirus (HPV). The HPV virus includes over a hundred types, some of which can lead to cervical cancer over time. That is why with women over 30 – in order to determine whether or not commonly occurring HPV viruses are the types that place a woman at risk – physicians often do an HPV DNA test along with the Pap test.
As far as the nuts and bolts go, the first part of a pelvic involves visual inspection of the genitalia. Then by inserting a speculum into the vagina, physicians examine the cervix and vaginal walls, and with a spatula collect cells from the cervix for the laboratory analysis. Once the Pap specimen is collected and the speculum removed, physicians proceed to a manual exam by placing an index and middle finger into the vagina to palpate the uterus and ovaries for abnormalities. The last part of the exam – at least for women that haven’t followed Greer’s lead – is the rectovaginal inspection. Clinicians insert their middle digit into the patient’s anus and explore the rectum for any polyps or lesions that might indicate possible colon cancer.
“I always take the little cards home and provide the requisite stool specimens to they can at least have some assessment,” said Greer. “But I’m quite firm on not mixing things up. I’m there for female business, not colon cancer. And after going through all that a pelvic entails, getting goosed by my doctor is not my idea of fun.”
The ‘little cards’ Greer speaks of are guiac or fecal occult blood tests whereby laboratory analysis of stool samples can provide some indication of intestinal bleeding that might indicate cancer. But this sampling doesn’t take the place of rectal screening according to Robert Phillips M.D. of Desert West OB/GYN in Phoenix. “The rectal exam is part of the pap smear. At the age of 40 we start doing rectal exams and guiac testing to screen for colon cancer. It’s not the best way, but it is the most opportune time to start that process. Occasionally you will even feel a tumor,” said Phillips.
In response to whether physicians routinely inform patients ahead of time or if they learn by surprise the way Greer did, Phillips said, “We usually say, ‘we got your smear pap, and now since you’ve reached that wonderful pinnacle of 40, you need to have a rectal exam too.’ I do think some warning’s nice and a little discussion about why a rectal exam is necessary makes a lot of sense.”
Greer agrees. Still, she’s looking forward to 65, that golden age after which those that have had normal Pap tests and are not at risk for cervical cancer may be able to abandon the procedure altogether.
Phillips, though, cautions that even older women who might not need Pap tests still require annual pelvic exams if they want to maintain good medical care profiles. Only with close inspection, says Phillips, can physicians monitor one’s nether regions for a host of problems associated with the female organs – and the large intestine.
