Suck it up, buttercup

This post is not going to make you feel good. It will not mince words. It will not play devil’s advocate. The topic hits home on a very sensitive subject for me, and I’m not in the mood to play nice. Forewarned is forearmed.

Proceed at your own risk.

The American College of Physicians has released a recommendation that advises women to forego their annual pelvic exam because such exams cause “emotional distress, pain, and embarrassment.” As the ACP’s former president, Dr Sandra Adamson Fryhofer, stated, “The pelvic exam has become a yearly ritual, but I think it’s something women don’t necessarily look forward to. A lot of women dread it.”

The ACP also says that in non-pregnant, asymptomatic women with no known cancer risk, pelvic exams don’t often detect disease or save lives, and that the exams do more harm than good. Pap smears are still recommended, however, because they do in fact detect cervical cancer. It’s the “no known cancer risk” part that really galls me. How do we know what our risks are if we can skip out on unpleasant tests?

Despite the ACP’s “feel-good” stance, the American College of Obstetricians and Gynecologists continues to recommend pelvic exams and says that eliminating the exam would mean “providing women with less comprehensive care.” In addition, the ACOG recognizes that many women don’t mention symptoms in their nether-regions until a doctor finds an abnormality, and that many women receive peace of mind from knowing that everything is normal below the belt.

Gynecologists agree that pelvic exams are not good tools for screening for ovarian cancer, which is notoriously difficult to diagnose. But, they say, experienced physicians can use pelvic exams to find other problems, such as noncancerous fibroids, and to identify changes linked to urinary incontinence and sexual dysfunction. And equally importantly, to establish a baseline of normality so that a change is easier to detect.

Dr Barbara Levy, vice president for health policy for ACOG says, “Not everything we do in life can be studied in a randomized trial powered to find a scientifically valid answer one way or another. I’m not sure there’s evidence to support most of what we do on physical exams. Lack of evidence does not mean lack of value.”

 Anyone who has ever undergone a pelvic exam knows it’s not pleasant. No doubt. But guess what’s also unpleasant? And dreadful? Reproductive cancers. And if doctor’s groups are recommending women be spared from unpleasant exams today, who’s to say that similar recommendations against other unpleasant screenings won’t follow? Residents of cancerland, raise your hand if you find routine visits to your oncologist unpleasant. Raise your hand if those visits and the requisite exams produce anxiety. Now let’s have a show of hands for those who find the frequent port flushes to be unpleasant and painful. But we do them anyway, don’t we? We suck it up and get it done, despite the anxiety and the fear and the pain.

My sweet mama was one of those who didn’t like to go to the doctor and who put off going as long as humanly possible. She was tougher than a $2 steak, but she didn’t like to go to the doctor and would find any excuse to skip it. In fact, when she was being eaten alive by ovarian cancer and had a belly so distended she looked 6-months’ pregnant, and when she had raging “tumor fever” from the unwavering progression of her disease, she still didn’t want to go to the doctor.

She would have loved to hear recommendations like that of the ACP, saying “Don’t worry about it. Don’t put yourself through any unnecessary discomfort — physical or emotional.” And I would love for her disease to have been caught sooner, and to have her still here, still with me. Instead, I have a hole in my life and a missing piece in my heart. I have no patience for recommendations and doctors who say it’s ok to skip out on tests/screenings/visits/checkups because they’re no fun.

IMHO, the ACP’s latest recommendation is akin to the “everyone’s a winner” mentality that pervades our society. Here we stand, handing out trophies to both winners and losers and telling women that it’s ok to skip an unpleasant exam. We’re inundated with messages that we “deserve” more — whether it be a house we can’t afford or a luxury item we don’t need — and we forget that life is sometimes unpleasant. Certain aspects of life can be painful. It’s not all smooth-sailing. In a whacked-out effort to avoid hurting anyone’s feelings, we lean too far the other direction. Instead of building ourselves up, these misguided efforts have the opposite effect: eroding self-esteem, self-worth, and self-confidence by failing to learn how to weather storms. suck-it-up



6 Comments on “Suck it up, buttercup”

  1. Eddie says:

    It sure seems to me that the ACP must have better and more pressing matters to address than sparing women an unpleasant but essentially harmless exam. I cannot speak firsthand to the discomfort of a pelvic exam but have seen enough genuine suffering to know that an opportunity to preempt true harm should not be lightly dismissed. A pelvic exam may be unpleasant, but so is watching a loved one die. I am certain my dad would’ve endured the male version of a pelvic exam to avoid an agonizing death at 59. ACP really should find a better use of their time.

  2. David Benbow says:

    I can’t put myself in your shoes, nor would I want to, but I also wish your mama had gone to the doctor earlier. That’s argument enough for me.

  3. Jody Hicks says:

    I can still remember very clearly your sweet mom remarking wistfully to me one day, “I knew I’d waited too long,” and I felt so sad, because that’s when I realized she probably wasn’t going to make it. But fortunately these days there are now plenty of female gynecologists, so women who are uncomfortable going to males for their exams have no excuse. Seems to me this kind of report could do the same kind of harm that that false report about vaccines did several years ago.

  4. Excellent post! I hate this kind of crap. It’s like the argument that women shouldn’t undergo mammography because of the distress of false positives. (Now there are other issues with mammography, but that’s a different thing.) Lots of screening tests give false positives. They are screens. Why is it the screen used routinely for women that is bad because it is hurting our feelings?

    And yes, medical assessment and care is embarrassing and invasive. That doesn’t mean we need to be spared if it is necessary.

    I find this whole stance to be paternalistic and sexist. “We don’t want to give those frail ladies the vapors! You know how emotional women are!”

  5. Reblogged this on beatingcowdens and commented:
    I don’t often reblog. But I reread this a bunch of times and decided it’s well worth sharing. The Pink Underbelly has some excellent insight!

  6. Really felt the need to reblog. Hope you don’t mind. You have a aSy with words!

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