So you want to go on oral contraceptives. You go to the doctor telling him/her of your choices but ... you must gave a pelvic and breast exam to do so.
What do you do?
In some instances ... run the other way as fast as you can. In some others, face the music. Hey, it'll only be a matter of time and you'll need a pelvic anyway, right? Might as well do it now.
Doctors are now saying that the pelvic exam may not be necessary and could be preventing many young women from getting protection ... out of fear and general misinformation. A simple blood pressure test and review of medical history could be enough.
i actually wrote a speech about this my sophomore year for a speech contest. or, rather, about the need for a pelvic exam for emergency contraceptives, but it's a related topic. (me and my friend got really mad when planned parenthood told us they wouldn't give us preven w/out a pelvic exam, even though we weren't having sex).
basically, yeah, i think if you're having sex it's probably a good idea to have the exam. but it's a good point - what if you just want protection? what if you're scared? there are tons of girls who are having sex, and who should be doing all the things on the ST checklist and having exams and big bank accounts, but they just don't, for whatever reason. the way i see it, if there is no vital medical reason that these girls should be prevented from getting protection, then they should get the protection!
------------------ if you want to kiss the sky, you better learn how to kneel (on your knees, boy) -U2
If I didn't have to have people I don't know or love poking around my genitals against my every wish I'd be on depo provera or the pill right now. I'm not even having sex, I just want my periods to hurt less and be less than a week in length and it'd be nice if my acne would lighten up...I could stand to gain a pound or two too.
Posts: 155 | From: WA | Registered: Jul 2000
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(psst...momma cat - you should talk to your doc about that! often, if you're going on the pill for purposes other than birth control, your regular (non-gyn) doctor will prescribe them for you, as long as he or she feels that it would be good medical practice to postpone the pelvic exam. that's what my doc did for me, anyway.)
------------------ if you want to kiss the sky, you better learn how to kneel (on your knees, boy) -U2
I really think that a full general exam, pelvic and breast exam should be mandatory before going on birth control. Some people can't take birth control for medical reasons - I know that right now, doctors are concerned about blood clots and some other stuff which are symptomatic of lupus with me (taken from a family medical history during a regular exam) and I'm going to a special doctor in a few weeks for it. Also, I have my first 'real' - ie pelvic exam - coming up in a few months to check that everything's okay, too. So for me, having a full gyn consult and pelvic could have been life saving, since blood clots can be fatal in some cases.
Posts: 164 | From: U.S.A. | Registered: Apr 2001
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I don't mean to be Heather the Big Meanie here, but in all honesty, when it all comes down to it, having your genitals and reproductive system taken care of should be no different than having your eyes or teeth examined.
You *NEED* to do it to stay healthy, ESPECIALLY if you are sexually active, and only a GYN exam can discover things which may make certain types of birth control unsafe for a given person. So. while some docs may have other feelings, a lot of those docs may not be GYNs and may not be thinking in the best interest of women's health. And you know, if you wind up with cervical cancer or cystic ovaries that go untreated, they'll kill you. And that makes birth control more than a little moot.
But ultimately, your body is your body is your body, and no one part of it is any more sacred or intimate than another, certainly not from a doctor's perspective, or from a health perspective.
A great part of the reason people are reticent about sexual health is because of shame and embarassment attached to genitals. And that certainly isn't something we'd ever support here at Scarleteen.
And from a sex-positive perspective, and looking at negative effects of sexual shame and genital shame in history, it's something I'd encourage all of you to really think about. It is a far greater issue than feeling embarassed, or rationalizing why one might not need a pelvic exam. And on a lot of levels, it has to do with how much you are buying into very misogynistic ideas, like the archaic idea that women *should* be ashamed of their genitals, simply because they are female.
Shame isn't really a good thing period, but it certainly isn't worth gambling your life and health for. And thankfully, even for those of us who are low-income or have no insurance, right now most women in most countries can get low-cost or free exams and gynecological health care. And really, it should be used, because that is a great gift. Take a look at women's health (and a serious lack thereof) a couple hundred years ago and how much of a gift it is should be patently obvious.
No matter what this study concludes, I Ėpersonally- am against supplying women with hormonal birth control without a pelvic exam (and when I learned, by accident, that some Planned Parenthoods already do so, I almost threw a fit).
Why? Because I simply think that if youíre sexually active and need birth control, you need a full check of your sexual health, and for me, that does involve a pelvic and breast exam And above all, I wonder: Where is the big deal in a pelvic and breast exam anyway?
I don't get AT ALL why people make a big deal out of gynaecological exams. Itís a doctors exam. Itís over quickly. It doesnít unnecessarily hurt, even though it is, admittedly, not the most comfortable of all medical exams. Why are breast exams scary? Because a doctor is touching my breasts? Because he shows me how I have to do my breast self exam? Why is there a difference if someone is examining my genitals? My dentist has to touch my teeth, my ENT looks down my throat, my GP checks many spots on my bod, so the doc responsible for my reproductive health can touch my genitals and my breasts. There really is no difference for me. A gynaecological exam is like any other exam at the docs. Medical pros (good medical pros) look at bodies without evaluating their beauty and in such a way, that no exam is shameful and that it is normal, and I donít get why docs are apparently sending the message that pelvic exams are something to be scared of by supporting the subscription of Hormonal Birth Control without a full gyneacological exam first. That adds to the fear, and to the shame and whatever else apparently surrounds gynaecological health in some countries. And where is the big deal in a pap smear? Itís over within 30 seconds, flat.
The main reasons why women and girls are scared of the exams (and why people think you should make hormonal birth control available without them) seem to be that they are told that they need to be ashamed of their genitals, hence a medical exam during which their doctor touches and examines their genitals is shameful and because women are misinformed or uneducated about what actually happens during a pelvic exam and led to believe it is painful, embarrassing and horrible. Instead of offering birth control without pelvic exams, those people should be out there educating people on what pelvics actually are like, and how important they are.
So why do I think pelvic exams are necessary for women and girls who want to go on the pill? ĖMainly because there are some things that can only be discovered during a full pelvic exam. And because giving a medical history isnít the most accurate thing ever.
Let met tell you about my experience of getting the pill. This wonít put me in a good light, because I quite obviously made a grave mistake here, but Iíll still tell this, because I know I am probably not the only one. When I went to the gyno for the first time, I was 18, had been sexually active for ages, and finally wanted to go on the pill. I had been suffering from irregular periods ever since I started menstruating but had not dared to go to a doc about it. So I was sitting in my gynoís office, nervous as hell, too, because I went there without my parents or anyone else knowing. He asked my medical history. I gave it. But not correctly. Yup, I was stupid enough to lie. My Gyno had asked me ďSo how long is your cycleĒ Ė and I, as nervous as I was, somehow just said ď29 daysĒ, even though I hadnít really ever had a cycle in the past 4 years. Well, I had bleedings, but they were unpredictable. In my head, I somehow justified my dumb, wrong answer, I canít remember how; probably because I indeed had had some bleedings about 30 days apart sometime in the past years, but not really. I didnít mention the irregular bleedings, I didnít mention the pain I sometimes felt in my lower abdomen, I just somehow thought Ė ďthis isnít important, letís just get this over withĒ.
Later, when we proceeded to the actual exam, my doc very quickly discovered something was wrong with me. The pelvic exam and a following ultra sound revealed that one ovary was enlarged, and the other had a cyst of the 11cm to 7 cm. Because I had not mentioned any menstrual probs, my doc assumed I had a dermoid cyst (they already form when youíre still an embryo and are scary little masses that can contain everything from teeth to hair to just odd tissue). He wasnít exactly sure what could be up with the other ovary, but because the left one had this massive cyst on it, he ordered a laprascopy and a hospital stay for me. The prognosis for my left ovary wasnít very good, even though they would do laser surgery on it, in order to save as much as possible. Dermoid cysts are usually benign, but I was informed that there was a slight chance it wasnít benign, and yes, my ovary was in danger, too. It was just before Christmas, and due to holidays and stuff, I got two weeks to think about this prognosis. Well, before that, I had to confess to my parents not only that I had been to the gyno without them knowing, but also that I would need surgery and a hospital stay. Yay! I tell ya, always great to break lots of news together. So tell you rents in advance.
I went on holidays, everywhere reading reports on ovarian cancer. I was convinced this could only get worse. After my holidays, on what was supposed to be my final visit to the docs before I was admitted to the hospital, the ultrasound showed a surprising change: the cyst had almost halved in size. I finally told my doc that I hadnít been honest, that I had had all those menstrual probs and that I just had (on my holidays) experienced a pretty large amount of spotting after being sexually active and after another ultrasound and comparing those results to my previous one, he concluded that I hadnít had one giant dermoid cyst on my left ovary, but rather two medium sized cysts one of which must have collapsed during the sex that I had (hence resulting in the spotting). Telling my doc that I had lied (omitted info) wasnít the easiest thing ever. It was damn hard, because I knew I had simply made a mistake that let to a misdiagnosis by my doc. He wasnít mean with me, he was quite understanding, but I realized that that lie had endangered my health. A closer look at my other ovary then showed, that indeed, there were several small cysts on them (hence the enlargement) and after some more tests, it was concluded that I was suffering from Poly cystic ovarian syndrome (PCOS), even though my ovaries did not look like those of a typical PCOS patient. Anyway, I donít want to bore you with the details of my medical history, but to sum it up: if it hadnít been for the pelvic exam, any pill my doc would have prescribed to me (with my wrong medical history) would have further messed up my already messed up hormones. Women with PCOS need pills with a pretty high level in progesterone (just so that the nasty side effects can be combated) and any pill that hadnít been right for my body could have put me at risk. And just to add: these days, my doc and I have a great relationship, indeed, and not being honest would never ever come to my mind. And I enjoy going to his office and getting my check ups, because he is the best doc that I have.
So whatís the conclusion to my ramblings?: Pelvic exams simply are necessary for women who are sexually active no matter whether you need hormonal birth control or not. You will have to have them as a woman sooner or later and why not sooner rather than later? There can be diseases and conditions that donít show up through a medical history (and yup, sometimes because patients donít give it correctly) and through simple blood pressure taking. The fact that Planned Parenthood in some places already offers the bcpill without one makes me very very angry, because it just doesnít work like that over here and because it furthers the idea that gynaecological exams are somehow different from other medical exams.
I seriously hope all Scarleteeners are clever enough to not buy into this propaganda but instead spread the news that gyno exams arenít horrible at all and that they always opt to have a pelvic exam when they are given a choice of yes or no when they want to go on hormonal birth control.
------------------ "We must become the change we want to see." Mahatma Gandhi
[This message has been edited by Alaska (edited 05-09-2001).]
The more I look at that article, the more it pisses me off.
quote:Further, STD screening, which sometimes takes place during a pelvic exam, can be done with a sample of urine or blood.
That, for example, is patently false. You cannot test for HPV that way, for instance, which is one of the most common STIs around. Same goes for genital Herpes. You have to look at the genitals and do scrapes. You also cannot check for PID without a pelvic, which can render a women permanently infertile and cause a massive number of health complications. Amd many vaginal infections just beginning to crop up can only be found by a visual exam, and lemme tell you, you want to take care of bacterial vaginosis before it gets to the point that a doc can tell you have it without a pelvic.
Really, I'm done ranting, I swear. I just find this to be misogynistic propaganda from hell. It might really benefit everyone if people spent more time thinking about how to make women feel better about their genitals and health than about ways to simply avoid addressing negative feelings.
Hmm ... I honestly don't know what to think of all of this.
*I* went on the bc pill in July of '99 w/o a pelvic exam. My periods were extremely heavy and i was knocked on my behind for a good 2/3 days of the week. It was horrbile. Though i have yet to find the "right" bc pill, they do offer some comfort. I'm no longer trapped in bed for what's supposed to be "normal" for a woman. And if my doctor had forced me to go through w/ a pelvic first, there is no way in h*ll i would've gone for it. No way. I was scared outta my mind.
Why? I don't know. My mom has never made me feel that our bodies are something to be ashamed of. My mom, sister and I walk around the house half naked (when it's only us, of course). No one cares. It's just like any other part of the body. But somewhere along the line i picked up this fear ... I think it was just of doctors in general. My medical history is pretty darn long for someone my age (or anyone, really), and doctors have always equaled bad news.
I was on the pill for about a year and a half before i became sexually active. Then it was unavoidable. I had to go. I waited and waited until it just kept bugging me ... I can't possibly come here and tell other young women they need to have PAP's and yet still be putting it off. So 4 months after losing my virginity, i went. B/c of my moms medical history (cancer of the cervix and other internal stuffs), it made it all that more important to me. It wasn't fun by any means, but i made it.
I think the doctors really need to pick one definate age that women need to have one. But there's many different ages going around. Some say when you first menstruate, others say 16, and 18, and after you first engage in any kind of sexual activity, and others say only if it's sexual intercourse (this was my dr's advice) ... It just leaves you feeling really confused. I went w/ my doctors advice.
Point being ... Girls will be having sex anyway. Just b/c they can't get on the pill w/o a pelvic won't stop them. Sure, some girls will go along w/ it, just for the fear of getting pregnant and being "found out" but what about those who wont?
------------------ If you choke a smurf, what colour does it turn?
Want the honest answer? Many women and girls who cannot manage their own health care and the small amount of chutzpah required for a GYN exam (and believe me, having even had exams in the smarmiest clinics imaginable when I was at my lowest with no money, I assure you, it is really not a major trauma), likely aren't going to have the chutzpah to insist their partner use a condom or dam. Or be with it enough to take their birth control pills every day, or to tell the truth to their docs about being depressed or being smokers. Or learn to use a diaphragm correctly. Or report to their doc when their implant is making them terribly sick.
In other words, the medical community and sex educators really have to bear in mind we're accountable. And flatly, I am NOT comfortable helping a women to make herself sick or infect someone else, or treat her body like crud for the sake of conveniience and embarassment. I just am not.
I also do not think (and Alaska's case is a good one, as are some of your health problems, Smurf, and the fact that a GP knowing your family history and other repro. problems put you on the pill without a pelvic is insanity) that it is prudent nor ethical to prescribe forms of birth control which can worsen or complicate other conditions for the sake of avoiding an accidental pregnancy. Pregnancy very rarely kills people outside the third world anymore, in comparison to previus times in history.
I cannot say the same for STIs and STDs, for PID, for cervical and uterine cancers.
And flatly, my very strong feeling is this: if you CANNOT have a qualified doctor looking at your coochie, saying you;re ready for a boyfriend of a few weeks to do so just strikes me as really ludicrous, and a pile of you-know-what.
Really, there arre a lot of poetential traumas in life. A GYN exam isn't one of them 99.9 percent of the time.
And menstruating women should be having pap smears. Period. Don't ask a GP (especially one who don't WANT you to have a GYN exam or refer you elsewhere). Ask a GYN or heck, ask a nurse. Nurses are highly objective people.
Or read a book, for crying out loud. But just do it. Almost anywhere, it is cheap or free.
I think that, after the misogynistic shame/genitalia issues, one of the problems here is that people don't consider birthcontrol pills 'real' medication. And they are, as medicine goes, they're a big deal. Combinations of hormones, affecting numerous systems in the body, taken every single day for months or years at a time. They're mostly safe for most people, but there are some people who shouldn't take them. It would be ridiculous not to try and figure out who those people are.
(When I went to the gyne and asked for a diaphragm, she asked why I wasn't on the pill. I said that I wasn't comfortable with the risks. She said, it's as safe as asprin! But you know what? I'm 19. Asprin could -kill- me...)
A pelvic exam is not a big deal. It's not painful, invasive, or potentially damaging. It's quick, it's inexpensive. You know what I think would help women be more comfortable with them? I think there should be more encouragement for women to do their own pelvic exams too, just like there is for women to do their own breast exams. If you could go to a regular drugstore and buy a speculum, the world would be a better place... It would totally demystify the experience... you'd know exactly what the doctor does when she's looking at your vagina, and exactly what she's seeing, because you'll have done the same thing and seen the same thing.
Also, please everyone, stop talking like a woman should wait until she's sexually active for a gynecological exam. You don't have to have sex to have cervical cancer ...
when i went to my local planned parent hood to go on the pill, she said we could skip the pelvic exam since i've never had sexual intercourse. now that i think about it, any scared girl coulda got out of the exam by saying they were a virgin. she just performed an outer pelvic and breast exam. i didn't mind much either way. but my doctor and i went did go through my family history as a way to prevent any complications that could've occurred. i am going to have the full pelvic done in about 2 months (she said after 3 on the pill to go back). i am to also have a cholesterol test done bc of heart attacks in my family history. what i'm saying is, any scared girl could lie her way through things she's scared of at a gyno exam for the pill in a lot of cases. i don't see any reason to be scared though. you should be mature enough to handle your own sexual health before you start dealing with someone else's.
Posts: 6 | Registered: May 2001
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Mmhmm ... I agree w/ a lot of what's being said.
And you're 100% right, 10*9*00 ... girls lie. I know i didn't. I was too scared to. But just today i went to the sexual wellness clinic w/ one of my friends and she admitted that she had lied on the form thing that first timers to the clinic have to fill in. When they asked what age she started having sex at, she lied. For whatever reason ... I'm not even sure. But it certainly does happen.
I remember this 'pill = real meds' conversation from before, Eclipse. I think it's kidna been pounded into my head now. I never thought them to be real medication before, tho. The doctor and nurses at the sexual wellness clinic i go to discussed it w/ me and some of the side effects that go along w/ it ... And i had every one of them. My body doesn't like meds and reacts heavily to most of them. So now i've learned my lesson. BCP = real medication. Yessirree Bob!
As for what age you should go for your first Pap test ... I think that is still highly debatable. You suggest reading books, Heather, and I did. Reproductive health seems to be something i'm interested in (as well as other aspects of medicine) and i *did* read up on it. And i got various answers. My family has been going to the same doctor clinic thingy since my mom was 3 (she's 37 now long time huh?), so i went w/ their advice. I wasn't sexually active at the time, and no one else but myself (and only a few times, if that) had ever seen my genitals. If the doctor told me I could wait, i wasn't about to argue it. When i did become sexually active, i took my butt down to the sexual wellness clinic on my own, and took care of business. And now i'm good til Feb.
The speculum in the drugstore idea is excellent. I know it sure as h*ll would've helped me a lot. I have no problem w/ the breast exam. I have a big problem w/ the pelvic exam. I've seen my own breasts more times than i can count ... But i have yet to see my cervix. People are scared of the unkonwn. I don't know what it looks like down there and I don't know what s/he will be poking at and how it's going to feel ... I also read an article online about women doing their own visual pelvic exams. Basically just looking at the labia and feeling for lumps on the outter part of the vagina. Sounds just dandy to me.
------------------ If you choke a smurf, what colour does it turn?
Random speculum note: If your gynecologist uses a "disposable" (hard plastic) speculum instead of one of the metal ones, ask to have it after the exam. It'd just be thrown out otherwise, and it will only have been used on you, and it will last for months or years. I know of two places they can be bought on-line. They're still not things you can find at wal-mart though, and I still wish they were.
Posts: 257 | From: Sarasota, FL | Registered: Jan 2001
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If given the choice to get a pelvic or not get one to get birth control, I'd STILL get it. I'd rather be safe, plus I'd be able to find out if there were other problems with me while getting the birth control. If you have breast cancer, you shouldn't take hormonal contraceptives. So what if you do have breast cancer, but they never check? I wouldn't want to even risk that. Not to mention catching the cancer early could solve a lot of problems.
Posts: 304 | From: Pittsburgh PA | Registered: Aug 2000
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The speculum idea sounds really cool, I wish they were in drug stores too. I've never seen my cervix and I really want to, but I'm way too embarassed to ask to see at the gyn. I guess I'm not ashamed of my genitals to the extent that I can't get an exam, but I feel weird about asking to see. Like it's a totally odd request. I mean, it is, isn't it?
Nah, I don't think it's such an odd request. Isn't it just natural that you want to see something you can only feel otherwise?
My gyn asked me during my first exam whether I wanted to take a look (during the entire exam), which was very funky, even so it's kinda difficult to orientate when you see your privys in odd positions through a mirror.
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