Tuesday, August 24, 2010

How embarrassment

The Age is reporting today that only one out of two Australian women in their 20s is having a regular pap smear test for cervical cancer.

Why? Apparently, it's because it's 'embarrassing'.

So here's what I want to know. Are these the same young women who wouldn't be seen dead sporting pubic hair?

And if they are, why is it more embarrassing to have a clinical examination done by a doctor (you can always go to a female doctor if that makes you feel less embarrassed) than it is to have your short-and-curlies ripped out by some total stranger whose training, if any, you know nothing about, and at whose hands you could end up with the most godawful rashes and infections?

If you get cervical cancer (and don't forget what aspiring Prime Minister Anthony John Rabbit thinks about Gardasil, the vaccine that could prevent it), things will be done to you by doctors that will be infinitely more invasive, painful, time-consuming and, yes, embarrassing than any pap smear. They will be done to you in an attempt -- an attempt that may well not be successful -- to save your life.

I love Gen Y. But sometimes I don't understand them at all.


Frances said...

50%. Seems quite a high number to me. In my day it would have been 0%.
One out of two feel endangered, and have tests. Poor kids.

lauredhel said...

I would suggest that firstly, they're probably not the same women. Young women aren't a monolith any more than we oldies are, and plenty of young women have been abused, raped, and body-shamed into not stripping down for doctors _or_ beauticians.

Secondly, if some women do choose to strip down and spreadeagle for beauticians and not for doctors, my hypothesis number one would be that beauticians are, often, a damn sight more respectful of women's bodies than many doctors are. That's certainly been my (general, non-Brazilian-related) experience.

Kerryn Goldsworthy said...

Frances, I'm not quite sure what you're getting at. You seem to be suggesting that the young women who do have the tests are the ones with the problem -- endangered'? 'poor kids'? -- which I can't relate to at all. I had a good friend who died of metastasised cervical cancer at 45, leaving children of 13 and 15, and if she'd had regular pap smears she'd probably still be with us, as she was the first to point out at the time.

Lauredhel, that's a good point about beauticians v doctors -- I've encountered good and bad in both professions (also general, non-Brazilian-related!), regarding respect for women's bodies, in about equal proportions.

Link said...

Yes my thoughts too. Although I'm not quite sure how many women do actually go in for the pre-pubescent 'look'. I'm way overdue for a pap-smear, but I figured having been celibate for the past million years I might just get away with it for a few more. I'm not keen to present my twat to anyone at close quarters especially not to some poor young (or old) 'beautician' for hair removal. I suspect there's less women getting Brazillians than we are led to believe and they're probably be the same ones who also aren't getting pap smears.

M-H said...

Apparently, according to the news story, young women also don't feel they have time to get these tests done. I'd assume that most of them are seeing a doctor for the pill, so I wonder why the doctor doesn't strongly suggest they have a smear test while they're getting their contraceptive script. I have to see a doctor at least once a year to get my asthma meds signed off, and she always does the basic health checks then, and puts the hard word on me about my smear (if it's due) while I'm there. And of course I always submit as gracefully as it's possible to do so.

I just don't think that 'lack of time' is a reasonable excuse.

JahTeh said...

Since I have now attained my 'born again virgin' status, it hasn't been something I've thought of much as the memory of the last one is still fresh in my mind. An unfamiliar doctor and remarks about the fat in that region making it difficult for him.

I have scientist friends who are working to perfect a test that will detect one single cancer cell instead of waiting until it grows into a mass.

Kerryn Goldsworthy said...

Yes, the fat hate rate among male doctors (usually directed at women) is really quite remarkable, as is their open rudeness. I know women who haven't been to any doctor for years, for fear of being humiliated -- not just 'embarrassed' by the situation, but openly insulted by the doctor.

Mitzi G Burger said...

I think some of those ludicrously embarrassed girls would get the test if it was called a Brazilian smear. It's all in the marketing.

Anonymous said...

There's this metal thing being inserted into the vagina and slowly widened or whatever happens. I'm not too sure cause even though I have them regularly I kind of try not to thing about it too much.

That could be a reason.

Waxing is a bit different in that regard.

Anonymous said...

Mitzi, that's a bit dismissive. My point was that pap smears penetrate the vagina, as does a manual examination.

How do you know when you have a manual examination - how do you know if you are being sexually abused?

I mean really - how is it different? Speaking as someone who was abused i can't tell the motivation from the manual action of the hand.

Far out.

People are wiping out a generation here cause they think they are being airheads.

I mean which one of you looks forward to a good pap smear?

or having a finger inserted up your vagina?

Of course some young women will avoid it.

Don't be so scornful.

As for the brazilian waxing - Female Chauvinist Pigs - good book.

Anonymous said...

As a Gen Y I can share my experience: I had one and and I am never going back. It has nothing to do with being embarrassed but with PAIN. My God! They said it would be uncomfortable but that was the understatement of the year.

Mary Bennet said...

I haven't had once since my OB/GYN insisted when I was pregnant a few years ago now and it was about four years before that that I'd persuaded a medical clinic GP I should have one.

And an acquaintance eventually died of what started as cervical cancer in her mid thirties so I do know and understand the risks.

But there is a problem with how the system operates.

I am embarrassed and it is uncomfortable and expensive if your doctor doesn't bulk bill pathology and annoying to have to find time for two appointments but over the years I've had at least three GPs act as if it was embarrassing for them as well.

I'm annoyed that the onus is on me to tell my doctor it's due (why doesn't the national registry notify the doctor as well as the patient in case of changes of address?) and ask for one. At least one doctor (a woman) advised that I should have made a special appointment for a test when I showed up.

I see my (male) GP fairly regularly. The time before last I mentioned I hadn't had one for a while and he changed the subject and neither of us raised it on the next visit.

So I'm not surprised at all that younger women than me would avoid having tests. At least they have the option of the vaccine now.

Marshall-Stacks said...

Having survived a Positive Pap test I can assure you that everything beyond that point is so vile, you may, as I do, prefer the disease to take me than endure the treatment.

The new vaccine should be tipping everyone to realise that cervical cancer is an STD brought to the woman, by the man - who has statistically had many many partners. Having sex at an early age is a contributing factor.

re above negative opinions on GPs: the standard consult is 8 minutes and unless a specific extended consult has been arranged, it is impossible to undress and redress in minutes.
For Melbourne bloggers, the Womens Clinic at Richmond has the right vibe.

Mitzi is going in the right direction - Combined Pap & Brazilian clinics are the answer.

Frances said...

Kerryn: I was contrasting the carefree outlook of my age group when young, (ill-advised though it may have been), with the attitude of those GenYs. The old-wives lore at the time said that "bad women", ie prostitutes, got cervical cancer, and elderly nuns got breast cancer. Obviously, this can't have been factual: but the prospect of disease and mortality didn't cross our minds.

I wonder if the incidence has changed over the years? I recall, for instance, that pest controllers, until the mid 70s, used to spray houses with a chemical that had been banned in the USA as carcinogenic some years before: one incident among several.
Your friend's death, and the thought that it was avoidable, is of course tragic.

Kerryn Goldsworthy said...

Anon, I think you're being more defensive than is warranted. Nobody is 'wiping out' a whole generation. Certainly not me. What will literally 'wipe out' more of your generation than necessary is cervical cancer, if you don't have tests.

Ms Marshall-Stacks is quite right about the STD: human papilloma virus, to be precise, also known as genital warts. Self-protection by diligent condom use would go some way towards offsetting the risks of not being tested.

Yes, it can hurt, though that tends to depend on the doctor. But I gather that Brazilians hurt more. And for longer.

Mary Bennet, that is a shocking story about GPs being embarrassed by that (or indeed any other) examination. I seem to have been much luckier in my GPs over the years than I thought. If they don't have a detached scientific approach to the human body then they should never have become doctors in the first place.

lucytartan said...

An elderly family member who at the time lived in a small country town has reported that her GP, the only one in the town, would not do Pap smears, or any other procedure involving examining women's reproductive organs, as it was against his religious principles.

Beggars belief, doesn't it - but she wouldn't lie about it. She doesn't live there anymore.

In my twenties I had no regular GP for a while; instead I naively went along to the university's clinic and saw whatever doctor was on duty. I told a GP that I was overdue for a smear test and wanted to have it done while I was there, and he told me to make another appointment to see a woman doctor. I did, of course. As a younger woman I moved suburbs a lot, and wasn't sick much - I didn't see any one doctor enough to develop a trusting relationship with her or him until I was nearly thirty. And so it's not surprising that my recollection of early Pap smears is that they were painful. Now that I'm having some sort of medical adventure involving a speculum about once a week, I understand that being relaxed makes a huge difference to the level of discomfort involved.

That said, when you're young you think you'll never die - you take all sorts of risks. I think it's really an urgent duty of the medical profession to get young women having regular smears. If the doctors want to have control of women's sexual health, then they need to take that responsibility, and do whatever they have to do to make it happen.

Kate H said...

Interesting comments on this post...

I've recently had treatment for a pre-cancerous cervical abnormality and frankly it's a snack compared to what I imagine having chemo/cancer must be like, so I don't really get the comment about the treatment being "vile". Sure, it wasn't fun, but otherwise I'd probably have cancer in a few years. And I'm only 31, so it happens young, and I had the pap smear not because I felt endangered but because I thought it was the sensible thing to do.

I've also had nothing but good experiences with the doctors including my male gynecological oncologist. Respectful, kind, caring and gentle. My male gyno has a female nurse in the room with him at all times.

As for the pain of waxing vs pap smear - even a "bikini" waxing hurts more for longer, or at least that's been my finding. I don't go in for brazilians so I can't comment on that, but I can't imagine it would be less painful than just a bikini wax.

Anonymous said...

I have an extremely gentle and sensitive female GP, but I have found pap smears rather painful in recent years. Not sure why. Those who are reluctant to have the test because it is uncomfortable or embarrassing should really get over it and grow up. If the problem is the doctor, find a better one. We are lucky that there is a reliable screening test for this type of cancer. It saves lives. End of story.

Kerryn Goldsworthy said...

Anon, well, they are scraping bits of tissue off your inner parts for the pathology. Dunno how old you are but everything thins out eventually.

And yes, I'm a bit concerned by the tone of 'Oh but it hurts so I'm not gonna do it.' Mammograms are no picnic either; I wonder how many people aren't having them 'because it hurts'. That said, I used to be quite stoic about medical procedures and am appalled to find I'm more of a wuss about them as I get older, so it's not like I don't get it.

But I've never, ever understood some people's attitudes to their own bodies, as though they were not responsible for them or in charge of them. Am currently boggling at the awful stories in the press about former water polo player Keli (sp?) Lane -- if she didn't want to get pregnant, as she obviously did not, why did she do so over and over again? To have one unwanted pregnancy may be regarded as a misfortune; to have five or six looks like carelessness.

Helen said...

Hi everyone,

I work at PapScreen, so am responsible for the ads running in Victoria at the moment, and the coverage in the news recently.

So it's interesting to hear all your thoughts about Pap tests.

For those who haven't really found a doctor they're happy with, just thought I'd let you know that in Victoria, we have over 400 specially trained nurses who can take Pap tests, and we would highly recommend visiting one of them if you're after a better experience - they attend regular training with us and really do everything possible to make the experience as comfortable as possible.

If you live in Victoria, you can find your nearest Pap test nurse using the advanced search function at www.papscreen.org.au.

Kerryn Goldsworthy said...

Helen, that's great. Can I put your comment up as a separate post so a few more people will see it?

librarygirl said...

Thank you for posting this PC.
It shamed me into making doctor's appt for next week ( one year overdue).

meli said...

yep you've shamed me into getting onto it too. i've only ever had one - about five years ago. it was fine. i never actually got the results because there was a confusion with my address and they'd promised to send it to me... i'd booked one earlier this year in australia but i ended up unexpectedly needing all sorts of much more distressing and invasive procedures done, and i just couldn't face one more. but i'm seeing my doctor next week so i'll mention it to her.

i'm bad at getting them done not because i'm bothered about the procedure, but that i'm chronically disoraganized.

but there's a girl at work about a year younger than me (30) who had surgery last week to investigate a positive smear test. she won't get the results for another three weeks. luckily she's much better at living in a strange country and arranging what she needs despite that than i am...

Kerryn Goldsworthy said...

I didn't mean to shame people, really I didn't, though good on you and incidentally it really is time I went for a mammogram ... it's not as if I'm a paragon about this sort of thing myself. But you've only got one life. Ms Tartan is right about the way you think, when you're in your 20s, that you'll never die; in my experience one tends to sober up about these things in one's mid-30s or so. But I've now seen two friends of my exact age (which always hits home) die of cancer and in both cases it would have been preventable.

librarygirl said...

shamed in a good way! it just seems to be something we endlessly put on the back burner (wrongly) because we're "too busy"...
And no it's not fun but I've had a kidney biopsy and that was about 50times worse.

Anonymous said...

I congratulate you for posting on this issue. I no longer have Pap smears because I've had a hysterectomy for severe endometriosis. I must say that going to gynaecologists for investigations and then having surgery really does cure you of any squeamishness! After a while, you really don't care anymore whether it's a male or female doctor doing the work, as long as they find the problem and treat you properly. And if you're doctor is embarrassed or doesn't listen to you about how much the Pap smear procedure hurts (it really shouldn't be that painful; uncomfortable yes; unless, of course you have a retroverted uterus, which is another matter) or is less than what you expect your doctor to be then you should find a better doctor. I have had yearly mammograms since I was 40 because my mother and aunt have both had breast cancer. I don't like them, but I recognise that they are useful in detecting cancer, and might just save my life. A few moments of discomfort are worth it!

Helen Marsden said...

Kerryn - sorry for delay getting back to you! Yes of course you can post my comment re Pap tests as a separate post ... share away.