I've been reading the posts and articles about pelvic exams. There's really a thing I do not understand. We've got a pretty good health care system in Holland (or so I'm told ;)) But pelvic exams are not part of the system (just pap-smere's when you're 35). You couldn't even go to a gyneacologist if you'd want to. First you'd have to get permition from your doctor Which is; when there's a specific indication that there may be something wrong. Not just because you'd want to have an expert look at you in a overall fasion if everthing is ok down there and get more information. And I wouldn't trust my doctor with this; I had to tell him that the position of the cervix varies with your cycle (I use NFP). I'm not saying this to be offensive. He's a great guy, really listens to you, does not simply send you home, best doctor I've ever had! :) I'm just saying he's not an expert (and as a matter a fact; he could simply not know it all)
To illustrate this, I'd like to tell a little story: I was 11 when my menstruation started. I had cramps, long bleeds. After a year, without any physical examination, I got the aniconception pill to help me with this 'illniss'. And since doctors are not obligated to do any check-ups, I simply took my medicin for 10 years, without anyone asking (of course I didn't even knew at the time that in the old days it was normal for a doctor to at least ask you if everything was ok). Four years ago I had severe pain in my lower abdomin. Medical cause has never been verified. They've checked everything, accept for my reproductive system. All this time I was a virgin (I'm not anymore and I'm no longer taking any pills because it totally confuses my body and I've switched doctors :)). And all the sudden, just last year after another episode of pain, my doctor decided to feel my ovaries. There's nothing wrong with it (thank god!), but it suprised me so much no-one had thought of doing that before.
If I read the importance of pelvic exams, I guess I'm actually feeling a bit mad. In a way I feel like everyone has been denying I simply am a female and as so have specific needs when it comes to medical care. Is the system so f*cked up here? Or is it just my frustration that makes it seem this way?
I've seen that there are MD's at this forum. What would be your reaction/opinion on this story? Thank you very much :)
Your English is quite acceptable. I wish native English speakers did as well here. I am licensed actively in UK and Germany and formerly held a temporary medical license in Canada. In those three countries, a pelvic exam in the teens is strongly recommended. Given that Holland has possibly the best sex education in the world, a high level of sexual activity among teens and the lowest teen pregnancy rate outside of Japan, I am very surprised that this is not a normal part of growing up.
Stop by the local clinic where your doctor is located and strike up a conversation with one of the older nurses. I suspect that the policy you are citing is not real and you will find out how to get a proper gyn exam.
My reaction to your story is that we have screw-ups with medical degrees and I hope it is not the system. Holland has a very good reputation for health care and this simply does not track. Then, I have a colleague down the hall who is not the best doctor in the UK NHS. All systems have good ones and bad ones. Sometimes you have to shop and the nurses know where to shop.
I don't know how much things have changed here in Australia over the last 26 years but when I first went on the pill at 19, I'd never heard of pelvic examinations. The GP I saw just took my blood pressure and that was it. In fact, even now this site is the first place that I'd ever heard of anyone advising one before becoming sexually active.
When I went for a second prescription (at the Family Planning Clinic rather than the GP), I was told I needed to have a Pap smear before they would provide the script. This would have been the first I'd even heard of a Pap smear and I considered myself pretty knowledge for my age at the time.
Thank you both for your replies. And thanx for your compliment, Brandy :) I just know I sometimes mix up words, so that the result is not write, uh: right, left; hi, hi! ;) And thanx for your advice. We do not have nurses at most clinics. We've got doctor's assistants (which takes a considerable lower education than you'd have to take when you want to become a nurse). But I'll ask around :-)
Yes, I know; we're quite peculiar here in Holland. It's a bit of a contradiction, is it not; "a high level of sexual activity among teens and the lowest teen pregnancy rate outside of Japan". About sexual education; at age 12 we're told about all the risks of sexual contact. And pregnancy isn't the first to be discussed at school ;-) I think most of us learn where babies come from long before 12 (not at school, though, but from our parents) Most girls take the pill and use condoms to prevent std's (I think it's even called 'Double Dutch'), so that might explain why pregnancy rates are low :)
Maybe I'm spoiled, but I think our education is mostly about fighting the consequences or symptoms. Thing I really have been missing; how important it is to get to know your own body. (which might explain no attention to pelvic exams). Because it's so normal to use the pill, you don't get to know your own 'natural' body. I always felt like it wasn't explained properly what that medicine does to your body. "Take this and you won't get pregnant. And whatever you do, use a condom!" No explaining what would actually get you std's, simply what the consequences are and what you could do to prevent it. Also a thing I would have liked to be part of the education: the fact that having sex is mostly something lovable you share with another person. It all becomes something a bit plastic/unnatural (like it's something you buy in the store and throw away after use). When I started cuddling with my (more experienced) bf, I asked him to do an std-test, before we were even having sex. While cuddling, it was constantly on my mind how close his thing was to mine and it simply scared me (I must admit). I really love him for taking that test, without even hesitating. Even though he wasn't worried about it at all. (test was all ok :))
Two years ago I started using NFP. And I really feel like I'm getting to know my own body. I actually got most of my information from sites in Belgium. Most health information is available in Belgium. Dutch website are mostly about symptoms, medicines. Their sites also explain what actually is happening to your body. But, like I wrote, maybe I'm spoiled ;-)
All day long, this thread has been bothering me. It is especially disturbing because the posters, Dutch and Ozzie, both live in what are respected NHS nations. Both nations have published guidelines for Gardasil that include young teens. When better to have the first exam?
I finally found an article in a 2001 issue of European Contraception and Reproductive Health that gives a bit of insight but I must look further. An interview based study was done in the UK at reproductive health clinics asking young women some questions about their first pelvic exam. The median age was 17.7 years at the first exam. This must be viewed cautiously (and I will dig deeper) simply because of the setting in which the interview was done but it included all women under 25 who entered the clinic.
About one-third of them had their first exam with their own GP; about a third in a women's clinic and about a third in hospital because they were there for some malady. Most of them sought the exam on their own and some were dragged in by their mothers. Some few had the exam because they thought they were pregnant.
The comfort and satisfaction women expressed were, at least, encouraging. Those with female doctors had the best experience; same without chaperones and the older they were, the better the experience was. OK, I digress.
I have not located specific guidelines for the first gyn exam in other nations but I shall keep looking and take some advice: All women should have their first pelvic exam before starting an active sex life.
Even though the thread is exactly a year old, I'd like to share my findings since I did do some digging on this:
National Health Program for PAP-smears
We have a national program for pap smears;
Who? For women between 30-60; they will receive an invitation each 5 years. It is free of charge and you're free to chose on whether or not to go.
Why this agegroup? Because there is evidence this agegroup is most at risk of cervical cancer. For women younger and older than this; there is no evidence that national research will cause less deaths of this decease. There's no national program considering the pelvic area for the younger age group the asses sexual development.
Who does the exam? The papsmears are not done in the hospital or by a gynocologist, but at your local physician. Most assistants also acquire a special certificate to perform this. If there are findings (possible pre-stages of cancer), you will be referred to a gynecologist for further examination.
(This is information according to the RIVM; Dutch governmental institute for health and environmental hygiene; they do a lot on risk-assessment.)
Individual exams
Off course one can make use of individual health care:
What happens if you'd like to have a pelvic exam or pap-smear at an earlier age? You go to your local physician. It is not considered regular to get such a physical exam when in adolescence. You will only get an exam by your local physician, when (s)he considers this appropriate. Opinions may differ, but the standard is when you experience specific complains, such as: menstrual problems, your menstruation and/or breast development hasn't started, tummy pain, etc or any other concern something may not be physically ok and your physician considers a physical exam appropriate.
Why is a standard pelvic exam in teens not considered appropriate? I mentioned this pelvic exam in teens to my physician. He wasn't much interested in these pelvic exams. The stress it brings to a girl in puberty (plus the time needed from a physician) compared to the number of girls with which there truly are findings, makes such exams as standard care overdone. He wouldn't even do a pelvic exam as standard procedure of prescribing birth control, only when he considers it needed. This is the standard in Holland, because the WHO doesn't support standard pelvic exams (found an article that indeed backs-up his remark; [url=http://www.medicalnewstoday.com/articles/209302.php]Women Often Required To Get Unneeded Pelvic Exams When Seeking Birth Control)
He did agree there should be more preventive care; these days physicians have too little time to really monitor their patients. In the old days; they did. Now they only see patients when they are already feeling ill. He would opt for a girl to come by at her physician just to have a talk on her sexual development and to look into the specific things she may be troubled or insecure about. He would gladly welcome it if that would be standard health care.
(this information I derived from my local clinic's assistants and physician)
To a gynecologist
Can you go to a gynecologist directly? Setting an appointment directly at the gynecologist will be trouble, but it can be done. Down side: you will have to pay for all of it yourself. And those amounts are huge! :eek: The insurance requires a referral by a physician, unless you visited the hospital for an emergency.
So: you go to your local physician first. Your physician will only refer you to a gynecologist when there is sufficient probable cause of decease, unusual development or anything out of the ordinary that needs a specialist. Not "just" to check the physical development in a girl that appears healthy. Maybe, some will give you a referral if you seem really desperately concerned. Every physician will be careful with this; hospitals and their specialists are busy enough as it is and precious time is needed for those in need.
What if your physician isn't cooperative? Your best shot would be the physicians practice that is connected to the hospital; you can get a second opinion and maybe they will refer you.
What about the gynocologist? Question would off course be how your gynecologist will react to this request, given how unusual it is to have this as a standard exam. Most likely; you will be put in the group of overly concerned patients. (off course: not officially ;))
(this information I derived from my local clinic and the insurance company. This policy is general at all insurances)
Personal note
Last year; my physician did check on me at my request. He didn't see any reason to get a speculum. Especially because I have been sexually active for a relatively short time (then: 2years). He did consider it a good idea to check out my ovaries (since I've had cramps in my abdomen for a long time). And he answered a few question on the shape of my vagina; esp because I found it odd the urethral sponge had grown ever since I started having sex. The shape had probably changed a bit after losing my virginity, but looked perfectly fine. There was nothing abnormal to any of it :)
I do feel that my physician is no specialist in this area. A clue: he listened to me enthusiastically as I told about NFP and how the shape of my cervix noticeably changes over my cycle (he didn't know the latter). But I did feel reassured enough by this visit.
So, in short: my impression as described in the first post on the Dutch healthcare system appears to be true, as confirmed by several organizations. And no, despite today's date, this is not a joke! ;)
Since we're in the anatomy section of that Human Sexuality class I'm taking, I thought I'd share what I just read:
*The authors recommend that a woman have her first Pap no more than 3 years after her first sexual activity, or no later than age 21.
*Thereafter it is the doctor's discretion how often the Pap should be performed--anywhere from every 2 years, to every 6 months or more often.
*Since its inception in 1941, the Pap has helped to lower the US death rate from cervical cancer by 75%.
*On the other hand, the survival rate from cervical cancer in developing countries averages 41%. Thailand 58%, sub-Saharan Africa 21%.
I'll cite you sources if you'd like LOL
I love sources, Int :)
Though the authors recommend this; I do wonder why they do so. Since the RIVM states that for women younger than 30 and older than 60 there is no evidence that preventive standard PAP-smears will cause less deaths of cervical cancer. This could mean that if you divide the stated 75% drop of death rates as mentioned into agegroups, it could be relevant only for the agegroup of 30-60.
I do like to have resources. So far I see no reason why my physician wouldn't be right on that the nihil risk in these agegroups defies preventive exams. To me it would be weird to do something or press for it, without knowing why.
Don't get me wrong; I would hate to find out that I've got it and are too late to treat. But then again; people don't do a standard sigmoidescopy to check for cancer in the colon. You only do so at a certain age (above 50 years old). And otherwise; only when there is any sign of colon-complaints or when you have a decease that increases risk of such cancer. There are tons of preventive physical exams you could do! And I do know of people that do a total body exam each 5 years and have a major insurance on health care and/or they save money and plunder the savings each time. My salary wouldn't cut it ;) And question is; would you want it? For most of us; you don't live in fear of risk all the time.
double post, sorry!
They say in that section that the Pap isn't always accurate, so testing more often gives a greater chance of discovery. They also say that testing for HPV is more effective than Paps are.
[SIZE="1">Stats from previous post:
Parry, J (2006) Controversial new vaccine to prevent cervical cancer. Bulletin of the World Health Organization, 84, 86-88. (This was the developing world stats)
Dolgoff, S (2008) The best (and worst) moments in women's health. Health, September, 138-141. (US stats)
This post:
Felix, J (2003) The science behind the effectiveness of in vivo screening. American Journal of Obstetrics and Gynecology, 188, S8-S12. (Pap accuracy)
Mayrand, M et al (2007) Human papillomavirus DNA versus Papanicolaou screening tests for cervical cancer. New England Journal of Medicine, 357, 1579-1588. (HPV effectiveness)
All are cited in Crooks, R. & Baur, K. (2011). Our sexuality (11th ed.). Belmont, CA: Wadsworth, 76[/SIZE]
These studies that show no differential death rape because of ...... put me round the bend.
My new auto has a manual that states no interval to change oil; only change when the light comes on and that is determined by driving conditions that the computer measures. I asked the bloke who cares for all our cars. His response was that I should think as I do for preventive medicine! No need for the additional oil changes but many more serious problems are detected during the service.
So, that puts me in a circuitous mess comparing my car to our bodies. We willingly have the car inspected or, in some countries, are forced to have it inspected. That is not because there is anything wrong with it but it is an opportunity to avoid more serious issues. That is the purpose of preventive health care. We usually find nothing wrong; we sometimes find disasters just in time. I had a patient with a clean mammogram. Two months later holding her daughter she felt a "bump" in her chest. Her locating a quite aggressive tumour on her own saved her life. Recent studies have shown no change in death rate to breast cancer because of self-exam. Therefore, should she have ignored it?
I continue to be surprised at what Red is saying about Dutch health care. The German system is based on preventive care. Both are very good health care systems. I hope sexism is not present here because our "women's problems" have been on the back burner for too long.
Women should demand a gyn exam. If the NHS involved requires Gardasil (quite expensive), it is worth twenty additional minutes of the doctor's time to check things out and, usually, give reassurance that we are good to go. Any doctor worthy of the name can identify some strange code to list the service and give women the preventative care they deserve.
I don't think there is any sexism. The system of so called "gatekeepers" works the same for just about everything. Exceptions are for example: abortion clinics, sexual health centers (cut-backs sadly took a lot) and physiotherapists. The advantage of gatekeepers is that physicians are rather high standard and are licensed to do a lot of screening and treating at their own insights with a complete overview on the patient's medical history. For certain things; they may even send you to the hospital to do a screening which requires special equipment, but you will be treated by your own physician and not by a doctor in the hospital. Which you could opt for as more personal and therefor better care. The downside is that getting to a specialist is harder. And though local physicians know a hell lot; you can't blame them for not knowing it all in detail when they cover so much...
Actually; women could be called privileged since in national health care programs more women's problems are being addressed than typical men's problems ;) There are national health programs on:
-cervical cancer; as mentioned :rolleyes:
-breast cancer; for women between 50-75 years old
-pregnancy care; monitoring of the health of both mother and child
-preventive youth care; which involves a series of check-ups in the first year and another few check-ups over the years until puberty, including vaccination programs.
(-coloncancer; they are working on a national health program for those over 50, coming soon).
For specific risk groups, we have:
-inherited high cholesterol screening
-preventive annual flushots.
Off course for more specific deceases there are regular check-ups which the specialist or physician may prescribe (not under national health programs for the groups are too small).
You could say the men are being discriminated; I had expected there to be a national health program on prostate screening for men over 40-ish, but there is none. Apparently; you first have to feel trouble with peeing or other concern, before you go to the doctor on this as well. I know there used to be a specific check-up in puberty on the boys' balls. But I can't find that in any national program anymore... What I read on forums of youngsters in the current day is that some school physicians do, some don't, some youngsters ask: what school physician? I know there have been a lot of cut-backs on school physicians too :(
The thing with "gatekeepers" is NOT about sexism - it is about MONEY.
Part of the NHS ethos (Medicare & Medicaid in the US) is all about saving money - so services are set on a "as required" basis with anything considered "optional" being at YOUR own expense.
Planned Parenthood, as I remember, gave me a pelvic exam, and almost too much information when I first went on BCPs a great many years ago - and from what my daughter tells me - they still do.
The exception to the "as required" ethos is the military health system which has to do more than just keep you alive - they have to keep you fit to fight - so they do whatever it takes to get you there.