Thursday, January 5, 2012

Things we rarely talk about

There are a lot of things that we never really talk about openly.  Most women I know have been taught from a young age that they will have a yearly exam that includes checking their breast and vaginal health, but we don't really talk about it openly.  It's an important part of our general health, but gods forbid we talk openly about something that keeps us in the know about the likelihood of having cervical cancer, which can be a silent killer.  Breast cancer is a huge concern and yet, many of us don't do monthly exams at home which means that unless we get lucky, the yearly exam from our OB/GYN or the clinician at Planned Parenthood might be the best chance to catch the tell-tale lump early enough to do some good.  In the interest of opening things up and bringing important issues into the light, I'm going to share about my annual exam that I had just this week.

I go to Planned Parenthood for my sexual health needs, and have since I was in high school.  It's the most consistent health provider I've ever had.  Because of the nature of the clinic, it can take a long time to actually be seen by the clinician.  In other words, make sure you have a lot of time for your appointment.  I had the added joy of having to deal with some insurance issues, which did nothing good for my state of mind.  I've had an annual exam every year since I was about 16 or 17, and yet I still view them as an evil, a necessary one, but still.  Between the fact that my mom had pre-cancer of the cervix and that my grandmother died of lymphatic cancer that spread to her breast, long before I was born, I'm both afraid of the results of the tests that are done at these exams and am realistic about their necessity.

After waiting longer than I liked, I finally got called back.  First there was the weighing, which is never fun.  Then I got to talk to the medical assistant about why I was there that day.  An annual exam is also a great time to have STI testing done, the most commonly offered tests being for chlamydia, gonorrhea and HIV.  The testing for the first two involved peeing in a cup, which is one of those times most women wish they had different plumbing because it's not easy for us with girly bits.  The HIV testing is now easy, but kinda painful. All it takes now a days is a finger stick test for HIV and get you the results in 10 minutes.  The possible results are Reactive, Nonreactive and Inconclusive.  Nonreactive is the result you want.  For the other two tests, you have to wait something like two weeks, and hearing nothing is a good thing.

I told the MA that I was wanting to talk about switching my birth control to NuvaRing from the pill.  She gave me some info on it and walked me through the important points.  Hormone-wise, there's not much difference between the two, but the NuvaRing has a much lower dose of hormone, since it's being more directly absorbed.  I had done some research on it on my own, but talking to someone in person helps with all the niggling details.  I also was asked if I wanted any emergency contraception or condoms.  Since I've still got a number of condoms, I just opted for the EC.

After all this, it was time to meet with the clinician and get to the meat of the appointment.  For those who haven't had or heard about what happens at an annual exam for women, it involves stripping down completely and wearing nothing but a paper sheet across your lap and a paper vest over your chest.  This makes for easy access for the exam, while maintaining an illusion of modesty.  After talking to you for a few minutes about your medical history and your other concerns, the exam itself starts.  The clinician examines your thyroid, listens to your lungs, your heart, and your belly to make sure your organs and lymph nodes are all doing fine.

Then comes the breast exam.  This starts the part of the exam that's both intensely personal and yet very impersonal.  The clinician examines each breast individually to check for lumps or anything out of place.  This involves flat fingered pressing over every inch of the breast and then checking the nipples for discharge.  My husband had found something about a month ago that didn't feel quite right and so I made sure to tell my clinician about it so she could check it out for me.  Turns out it is just part of the muscle that's more pronounced on the right because of my righthanded-ness.  Huge relief for me and she gave props to the hubby for his catch.

After the breast exam, comes the dreaded stirrups.  This is the pelvic part of the exam.  I was informed that because of new guidelines and improved testing, I didn't have to have a PAP smear done, unless something didn't look right during her exam of my cervix.  This meant (maybe) no giant q-tip on my cervix!  The pelvic involves an external and internal examination of the pelvic region.  The internal exam involves the use of a speculum, so the clinician can get a good look at the cervix and see if there are any abnormalities.  After the speculum is removed, then the clinician checks to see if there's anything abnormal with the ovaries and uterus.  This means having one hand inside the vagina and one on the outside over the target organs and kinda squishing them to make sure they're in the proper places and haven't become painful or malformed.  If this sounds uncomfortable, that's because it is.

After that, the exam is over and I could finally get dressed again as the clinician went to get my new birth control.  No PAP smear for me until my next annual!

This is the yearly ordeal that women go through.  It's not fun, it's not comfortable, but it is necessary and very, very important.  It's equally important for guys to have a yearly exam that I'm sure is equally fun, but many of them aren't conditioned to it like a lot of women are.

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