Sunday, June 22, 2008

Fertile Crescent

Write about the "Dark Continent" and you're sure to get a reaction. Actually, I had to quell and then ignore all my own reactions before I hit "publish" on yesterday's Bench.

Women who have been tending to their health as prescribed by their gyn doc or nurse practitioner understand the absurdity of what we put ourselves through every year. We have to go sit in the stirrups--and I don't mean at the horse ranch--annually if we don't want to chance being a statistic: Cervical cancer used to be the number one cause of cancer deaths in women. Key phrase: used to be. Deaths and incidence of cervical cancer have declined as the number of women getting annual exams has increased.

Great. Fabulous. So why do I need to write publicly about the details of that very private practice? Well...ultimately, how private is a practice that half of the population submits itself to every single year? How solo is the experience when, as reported again and again, it ranges somewhere between mortification, degredation and personal empowerment, depending on what kind of woman you're feeling like that day?

I bounced the Bench post back and forth in my head before publishing it, alternating between loud laughs and not-so-subtle cringes. One voice in there said: Ah, what the hell. It's "Sex and the City." Every woman experiences it. Another voice said: Oh my God, you're going to describe yourself in that position? We know what doctors do in that room. Another voice said: Men reading this post will faint on the spot. To which another voice answered: Men have as many words for their members as Eskimos have for snow, and their turn-your-head-and-cough moments are hardly hidden from popular talk.

Meanwhile, my experience of that annual excursion to the ranch--let's just let go and call it the ranch, shall we?--my observation of that time-of-the-year is that it's absurd. The whole picture. After all, that physical place each woman and all society holds precious and dear, that bodily Bethlehem that women carry as their source of being, power, identity, passage, rites of their own and of the children they bear, THAT one vortex of humanity gets exposed in the most demeaning and embarrassing and silly of ways, every year--usually under a dusty, unattractive ceiling, and always within these degrading acute triangles of steel that force demureness off today's set list right quick. If we can't look at it and laugh, we get buried in a lot of undue shame. And additional shame is one less thing we could stand to carry around in our body's Bethlehem, can-I-getta-witness.

1 comment:

  1. Well, you neglected to mention "Physician Assistant" (and a few other licensed primary care providers available for annual screenings, but I will try not to take it personally!)

    Regarding the ol' exam? Well, I am sorry that you had an unpleasant experience (in lieu of another term), but I really hope this will not deter you (or your readers) from having an annual health evaluation.

    Regarding cancer: the most common cause of cancer related deaths in women is lung cancer (approximately 71,000 deaths/year with about 100,000 new diagnoses every year in women alone in the U.S. (breast cancer is second with approximately 40,000 deaths per year and about 182,000 new cases in women per year). In terms of gynecologic-related cancers, including uterine cervix, uterine corpus, vulva, ovary and vaginal cancers? In total, there are approximately 28,000 deaths per year and about 78,000 new cases per year. (Cervical cancers represent about 3800 deaths and 11,000 new cases per year). [Amer. CA Society, "Cancer Facts & Figures, 2008"]

    So what's my point? The annual exam is (or SHOULD be) more than just a "cervical cancer screening." What's important to differentiate is between an actual pelvic examination with bi-manual and rectal examination versus a, "screening test." There are other screening tests available that may include obtaining endocervical and/or vaginal swabs.

    What I think is important to note is that one's healthcare provider should perform the appropriate exams and obtain the appropriate samples for screening and diagnosis after obtaining a detailed and thorough health history (including family history). Each patient is different and has different circumstances and criteria. For this, I defer to several organizations such as the Centers for Disease Control, The American Cancer Society, The American Obstetrics and Gynecology and many other organizations that can assist with one's healthcare maintenance and screening schedule.

    As a healthcare provider, I am saddened to hear of yet another provider that failed to provide a comfortable and safe experience. I do not want to assume, but it sounds like patient education was omitted as well as an opportunity for and equal dialogue exchange of information? (were you even allowed to ask any questions?) Please tell me a clinical breast exam was performed at least!

    There are many excellent providers out there, unfortunately, this requires, "shopping around," just like anything else. The other thing I highly recommend is letting your current provider know that your experience was more than sub-par...

    My two cents...--m

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