The U.S. Medical System's Obsession with Pelvic Exams

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A study published in JAMA Internal Medicine reveals a no-brainer: girls and women are traumatized by pelvic exams and avoid seeking care which involves them. Further, the study finds that many of these exams are unnecessary.

I've always wondered about the necessity of frequent pelvic exams. I have a history of sexual trauma, and I find those exams very traumatic. In fact, I went for almost 30 years without getting one. The only reason I ever went back to an OB/GYN was that I was experiencing post-menopausal bleeding. A D&C determined that I had simple endometrial hyperplasia with normal cells which means I have only a very slightly elevated chance of developing endometrial cancer (1.6%, that's one point six). I did not deem it necessary to have the radical hysterectomy which was being pushed at me. Had the D&C revealed complex hyperplasia or abnormal cells, that pushes the chances of developing endometrial cancer to 36% greater than normal, and I would have had the hysterectomy.

I refer to 2018 as the year that revolved around my uterus, and I do not see the reason to go through another battery of invasive pelvic exams and transvaginal ultrasounds which leave me feeling as if I've been raped by a robot. I've never had an abnormal pap test, I'm beyond my reproductive years, and I'm not sexually active. Further, the endometrial hyperplasia has resolved. I see no reason to submit myself to this humiliating procedure again. I'm not sure why the U.S. insists that women have this procedure every year when other first world nations do not.

"The American College of Physicians and the American Academy of Family Physicians advise against pelvic exams on women who aren’t pregnant and don’t have symptoms," Qin added.

Agreed.

I don't have any problem with getting a mammogram although I put that off for years. It's mildly embarrassing and sometimes slightly uncomfortable, but it isn't painful or invasive. Also, I can see a clear need for it. Someone in my age range is at a higher risk of breast cancer than someone in their twenties.

~Sly Has Spoken~

Image copyright juliahenze @123rf.com

No Great Loss

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So I went to the ob/gyn today and discovered that my endometrium has become thick again. The doctor told me that she had removed 2 cm of the endometrium when she did the biopsy last year which has now grown back. She says the reason it is growing back is that it's being stimulated by the fibroids, and this is the reason I had such heavy periods back when I still got periods. 

My periods were so heavy that I didn't bleed, I hemorrhaged. I easily went through a heavy pad every two hours if not sooner.

I honestly don't care if anyone is a squeamish little lily-livered crybaby about periods. Suck it up, Buttercup. Periods are a thing. They aren't going to disappear just because you think they're icky-poo. 

The doctor really wants me to get my uterus removed because although the cells are currently normal, she thinks that the constant stimulation may push them into becoming cancerous. I thought about it, and I say "fuck it." It isn't as if it would be any great loss if I were to get cancer. It would just mean that I'd die of cancer rather than something else. So what?

Everything dies. Some things make positive contributions. Those things are worth saving. I contribute nothing worthwhile, and there's no chance that I ever will. My death would be pretty much wart removal as far as society is concerned. Best lose the dead weight.

Perhaps that is what should be put on my tombstone, although it is unlikely that I will have one.

No great loss.

~Cie~

Sly Speaks: Why I Noped Out of my Hysterectomy

I'm 53 years old and I have a history of sexual trauma and issues with my endocrine system including my reproductive system. I have PCOS. I have a degree of endometriosis, and I have polyps and fibroids in my uterus. The fibroids are small, not some grapefruit-sized thing.

I avoided having pelvic exams for close to 30 years because of past sexual trauma and fear of being shamed for being a larger person. I finally found a doctor I could trust to be honest with about my plumbing problems, so to speak. I see her quarterly because of my endocrine issues. When I told her that I had my "annual period" and was hoping this would be the last year for that mess, she said that wasn't normal and referred me to a gynecologist.

The gynecologist was a very sweet person who made me feel at ease. She never shamed me for my size. She did a D&C, which sucked because I felt like someone had been up in my business with a cheese grater, but I wanted to rule out cancer. The biopsy showed that I have simple endometrial hyperplasia with no cellular atypia. My risk of developing uterine cancer is 1.6% greater than the risk for someone who has no hyperplasia.

Hyperplasia is par for the course in someone with diabetes and PCOS. I produce too much estrogen. My primary care doctor is having me try a bio-identical progesterone, which may reverse some of the issues with my plumbing. One can always hope.

I was scheduled to have a hysterectomy, but I canceled the night before. Let me be clear that I'm not fanatical about women keeping their uterus come hell or high water. My son's best friend's mother had such horrible endometriosis that it had invaded her digestive tract. Some people have fibroids the size of a full-term fetus. There is no reason that these people should be forced to keep an organ that is malfunctioning to that degree. But this is not my case.

I always had miserable periods from hell and was glad when they came to an end. Initially, I was gung-ho to get rid of my reproductive organs, but after doing some research I realized I might be trading one problem for another (i.e. my incontinence could get significantly worse) and the inside of my hoo-hah could turn into the Great Southern Desert for the remainder of my life. In the end, it didn't seem worth it to undergo major surgery for a 1.6% higher risk of possible uterine cancer down the line.

Although two of the doctors involved in the process are women themselves (the person who would have done the surgery is a man) and they were all respectful to me, not a single one of them said a thing about the downside of having a hysterectomy. I think that doctors are taught to have this attitude that post-menopausal women are no longer able to have children, so why not just take the uterus out? But major surgery comes with risks. For me to agree to it, the risks have to outweigh the benefits, and they simply do not in this case.

~Sly Has Spoken~

Image copyright Juliahenze @123rf.com

Realizations about My Surgery

Trigger warning for mention of sexual assault, eating disorders, and medical procedures.

I am realizing that part of my issue with this surgery has to do with PTSD rather than the fact of having surgery itself. I must say that berating, belittling, and terrorizing a person in a vulnerable situation can have lifelong consequences.

I had my first surgery when I was eight years old. I had multiple ear infections as a child to the point where hearing loss was a real possibility if something wasn't done. They removed my tonsils and adenoids and put drainage tubes in my ears.

The protocol in those days was to send the family home, so I was this dumb 8-year-old kid left alone in a hospital with strangers. I wandered down to the playroom and was approached by a nurse. He told me to come back to my room so I followed him. He proceeded to bring out what looked to me like the biggest needle in the world and tried to draw my blood.

I had quite a needle phobia and I screamed and pulled my arm away and tried to hide. He called another nurse in and he held me down while she drew my blood. He said "Look at what you did. Now we have to do this again. Shame on you!"

I had this dreadful roommate who delighted in telling me how much the surgery was going to hurt. To this day, I think shared hospital rooms are an awful idea.

When I had to have a c-section, I knew that I was going to be poked with needles and have invasive exams so I was steeled for it, but this (rhymes with hunt) of a nurse added insult to injury by treating me with disdain, trying to force a catheter on me, and throwing the emesis basin at me in disgust when I felt nauseous after being given magnesium sulfate because I had toxemia. This bitch should not have been dealing with people in any capacity, let alone a medical setting.

I have a history of sexual trauma, and I did not even get one of "those" exams for close to 30 years. After my son was born, I said: "to hell with this, nobody is digging around down there anymore." 

The only reason that changed is that I finally found a doctor that I could trust not to shame me for my body type and who I felt comfortable talking about the plumbing with. I have quarterly visits with her because of my endocrine problems. During my April visit, I mentioned to her that I had my "annual period" and lamented that I thought I was done with this crap but every year for the past couple of years I had one very heavy period. She said that wasn't normal and referred me to a gynecologist.

Thus began the year of my life revolving around my plumbing.

I don't want my life revolving around my plumbing anymore. I no longer have a need for my plumbing. In truth, most of my life has revolved around my plumbing. I always had miserable, heavy periods. I started having issues with overactive bladder and urge incontinence (not the more common stress incontinence) when I was in my late thirties. Not the dainty "light bladder leaks when you sneeze or exercise" that the advertisements like to talk about in a sweet and discreet way. Full-on flooding. NOT FUCKING FUN! Highly embarrassing. But I figured it was something I'd just have to live with because I had no intention of letting anybody root around down there.

So, this past year I went through feeling like I was being raped by a robot for a half hour (that damn vaginal ultrasound) and feeling like someone had gone up in my business with a cheese grater (that damn D&C). I do not EVER want to feel either of those things again as long as I live.

While the risk of endometrial hyperplasia becoming cancer is low in my case because the cells are normal, there is a degree of increased risk. I also have fibroids and polyps. I have cystic ovaries, so there's no reason those shouldn't come out too. The tubes serve no function if both the ovaries and the uterus are gone, so there's no reason not to take them as well. The only thing I am going to ask about reconsidering leaving is the cervix because it presents as normal and, apparently, it provides the stuff that allows the plumbing access to be a self-cleaning environment and not become the great Southern desert of the anatomy. Then again, I don't want to have to risk having to have it taken out later, so...I don't know.

I had a person say to me that all women over 40 have fibroids and polyps, implying that I was being foolish for agreeing that this surgery is the correct option in my case. Maybe that is so, but not all of them have endometrial hyperplasia. That is actually the issue of concern, not the fibroids, although they have been causing me trouble for years.

I have honestly never known anyone who had a hysterectomy who regretted it. Everyone I know who has had one has either been neutral about it or said they felt a lot better after it was done. I'm hoping to be in one of these categories. I don't feel sad about losing my reproductive organs. I can't use them anymore and they are causing me trouble.

I'm sure my business really doesn't look that much different from anyone else's business. I don't know. I don't much make it my business to look at people's business. The people who will be doing the surgery see such business repeatedly. It's just business. But, as I said, I do have PTSD and I do have a lot of dislike for my own body because of being shamed for my physical appearance for as long as I can remember. I am also having to fight the disordered eating tendency which is telling me I should maintain my pre-surgery fast even after the surgery is done.

I am having a difficult time with this, and there are no resources.

~Cie~

Unique and Unusual Gifts: I Heart Guts Plushies

Cuddly Uterus by I Heart Guts

This is not my uterus. My uterus resembles a Lovecraftian horror, which is why it is being removed.

This is my gift to myself for undergoing the procedure to remove said eldritch horror.

They have a lot of other viscera and offal made adorable as well, a perfect gift for your weird friends and family members who may be having to endure miserable medical procedures and need a little cheering up, or for aspiring medical students.

I have been enduring a range of unexpected emotions regarding this procedure, even though I have been putting up with issues caused by the eldritch horror for quite some time and it's time for a resolution to those issues. Anxiety about the surgery is to be expected, but I have also been experiencing feelings of remorse and anger as well as bouts of weepiness, which is not par for the course for me. So I bought myself a cuddly uterus to cheer myself. It is due to arrive on Christmas Eve.

Get your own friendly viscera and offal by clicking one of the links below!

Your Hostess Soon To Be Down One Womb,

Cie

A Very Personal Post: My Hysterectomy and Sub-Par Treatment of Women and Larger Patients

Ragen Chastain of Dances With Fat, a blog which people of every size should read

I normally try to keep my money-saving and life hacks blog confined to products, recipes, and apps which can help put money in your pocket and keep it there. However, sometimes I feel it is important to share personal and societal issues. This is one of those times.

I have blogged recently about having my eldritch horror of a uterus removed on December 17th. My uterus is full of polyps and benign fibroid tumors. There are other treatments for this (ablation, breaking up the tumors with ultrasound, hormones), but they tend to have to be repeated down the line. I no longer have a need for my uterus in this life. I feel that the most efficient course of action at this point is a once and done option: take it out and be done with it. Then there will be no future ablations, no future d and c's, and no more pap smears ever again in this lifetime. Weighing the pros and cons, I believe this to be the best option in my case.

Reflecting on the situation, my uterus probably should have come out ten to fifteen years ago. I always had brutal periods. I do not joke when I say I didn't bleed, I hemorrhaged. However, due to past trauma (sexual assault) and fear of being shamed for my body type (I am built similarly to Ragen, but am nowhere near as beautiful and graceful), I avoided having any sort of "well woman" type of exam for close to thirty years.

I feel like the current approach to focusing on a patient's weight first and, often to the exclusion of all else, is lazy medicine. Doctors fail to take into account that weight is only one part of the equation and correlation is not causation. There are multiple factors at play in a person's body type. DNA is the first and most powerful of these. 

Repeat after me: a rhino is not a unicorn. A rhino does not even know what a unicorn is. I doubt there is a rhino anywhere in the world that dreams of being a unicorn. Also, unicorns aren't real, much like the ridiculous appearance ideals that we learn to impose on ourselves from a very young age.

Dr. Oz (Oprah's pet snake oil salesman) once said that he never sees a fat person who doesn't have cardiac problems. What he neglected to mention is that he never sees a thin person who doesn't have cardiac problems either. He's a cardiologist. But there isn't a big market for weight gain products. There is a multi-billion dollar industry built on convincing people that their bodies are wrong and it's their fault that diets fail time and time again.

Doctors don't tend to see (or notice) healthy fat people, because when a person avoids the doctor's office like the plague for fear of being shamed and lectured about their weight, they tend not to seek medical treatment until the situation becomes catastrophic. Further, poor people regardless of size often can't afford medical treatment and thus avoid seeking medical treatment until the situation becomes catastrophic.

Teaching doctors to shame and scold patients for their physique (or anything else) leads patients to avoid seeing doctors. This is counterproductive. The Western medicine focus also tends to be on treating illness rather than maintaining health. This is counterproductive. The U.S. medical system is broken, and the definition of insanity is insisting on doing something that doesn't work and hoping it will work this time. It doesn't work and it isn't going to work this time. The dead horse needs to be replaced rather than flogged and shocked in hopes that it will wake up and gallop around the pasture like a healthy young colt.

In any case, after many years of going to a doctor who wasn't the worst but seemed to be burned out and going through the motions, I was doing a search for doctors with a Health at Every Size approach. I hope the future will present with many, many more such doctors, but currently, such a search can be extremely frustrating. I happened on a doctor in my general area who stated that she provides a safe space for patients of any race, sex, orientation, or size. I made an appointment right away.

Even though I got on well with this new doctor and trusted her, she had a difficult time examining the plumbing, so to speak. However, we got through it. The results of the dreaded pap smear were normal. But there was more to come.

I see my doctor quarterly because of my endocrine problems. During my April visit, I told her that I'd had my "yearly period." I said it was frustrating to me because I thought I was completely done with the blasted thing, but every year for the past couple years I had a really dreadful, heavy, but fortunately painless period. 

My doctor said that this wasn't normal and referred me to a gynecologist. I was extremely worried, but this incredibly kind and wonderful woman never once shamed me about my body. She focused on the issue at hand and was compassionate about my fears. After performing a biopsy and examination of the inside of the troublesome organ, I was informed that it was housing numerous fibroids and polyps and was sent for a consultation with a surgeon who specializes in gynecologic surgery.

My case is a walk in the park for this fellow. He has a lot of patients dealing with various cancers and severe pathologies. I present with a straightforward, uncomplicated condition, and the surgery should take less than an hour. I'm still terrified and want to run screaming. I hate going under anesthesia. 

The doctors involved in this chain of events have all done things right. They have treated me with respect and not shamed or scolded me for having a body which does not fit society's definition of "ideal" by any stretch of the imagination. This means that I listen to them rather than saying: "well, fuck this shit, I guess I'm going to just have to live with my problems because I don't want to deal with these assholes."

I worked in the medical field for most of my working life. There are patients who are frustrating to deal with. They are noncompliant and expect miracles. There are patients who demand antibiotics for the treatment of viruses. There are patients who seem to believe that doctors are hiding secret cures in their doctor arsenal. There are patients who can't stop smoking even though it's killing them. All of these people need to be treated with kindness and respect, even if the medical staff feels the need to headdesk repeatedly following a visit with said patient.

I've known more than one person who was so addicted to smoking that even though it had serious negative health consequences, they were unable to stop. One was my maternal grandmother, who died in 1992 at the age of 75 from complications of alcoholism. She had emphysema and couldn't make herself stop smoking. She successfully stopped drinking once, but then my cousin (a very broken person) brought over a six-pack one night, and she was right back at it. 

My grandmother had a hard life. It would be frustrating to treat a patient who is committing slow suicide, but it would never be appropriate to belittle or berate such a person. My grandmother only had an eighth-grade education, but she was by no means a stupid person. She had a lot of "horse sense." She was also deeply conflicted and had a very low self-esteem and untreated mental health issues.

I don't know the other person's backstory. She was a customer who came into a restaurant where I worked as a bartender and waitress. She would get coffee and stay for a long time in the afternoon, chain-smoking, reading, and drinking her coffee. She was a social worker who was getting ready to retire. She had a daughter who had borderline personality disorder.

This woman eventually had to have part of one lung removed. She tried to quit smoking, but people would see her around town hiding behind buildings for a puff, even though she had to carry an oxygen tank at that point. She died within a year of the surgery.

Scolding this woman would not have made it easier for her to quit smoking. She wasn't stupid. She knew that smoking was causing her health problems. Addiction is a complicated and misunderstood issue.

Some people equate having a large body type with addiction. This is erroneous. Some people with larger body types have binge eating disorder, as do some people with slender and medium body types. Binge eating disorder is not an "addiction to food," it is a pathological relationship with food. Even if it was "an addiction to food," scolding and shaming a person suffering from said disorder will do nothing but make that person withdraw and stop listening. Nothing good ever comes from scolding and shaming a patient.

What I am getting around to is that I have a health issue which should have been dealt with years ago, but I avoided exams that might have revealed the problem sooner because I was embarrassed and afraid of being shamed for my body. This should never be the case. All patients have the right to compassionate, respectful treatment. 

Pathologizing certain body types doesn't work. Health at Every Size does.

This is why I am committed to never deliberately advertising or promoting weight loss products on the Deliver Me blog. I struggled for 33 years with disordered eating and low self-esteem because of society's attitudes towards people with larger bodies. I went on diet after diet and "failed" every time. Any weight lost always came back with friends. I literally had to stop dieting so I wouldn't gain more weight. 

It wasn't until I discovered size acceptance and Health at Every Size that I realized I hadn't failed, the diets failed. The diet industry thrives on two factors:

Diets don't work

Dieters believe that they, not the diet, are at fault for the diet not working.

I will never knowingly sell snake oil or false promises. 

I will only promote products and services which I believe can be helpful in some capacity. Diet and weight loss products never are.

~Cie~