Seeing your gynecologist is not just for a Pap smear

Some days, I get so frustrated at work. Yes, we all have our frustrations. Maybe traffic is slow, and you get to work late. Maybe you spill your coffee on your work clothes as you walk into your office. Maybe someone calls in sick, and you are short help at work. But this is big! Like so big, it can impact the trajectory of someone’s life. They, in turn, are forced upon a difficult path that may have been avoided. With healthcare reform on the forefront currently, this impacts every single one of you.

Many of you have heard that you don’t need a Pap smear every year, that you just need one every 3 or 5 years. These recommendations shared by social media, and pushed by insurance companies and politicians, don’t reflect individual patient needs. Although, in a perfect world, one without HPV, currently the most common STD, this may be true. However, human relationships are not always so simple, and you could be exposed to HPV (human papilloma virus) by a partner that unknowingly carries the virus or is unfaithful. Thus, timing for your Pap smear is an individual decision made between you and your gynecologist based on many factors. But, more importantly, there are other reasons you need to see your gynecologist every year. A Pap smear is just a minor part of what we do as it only screens for cervical cancer and STDs. There is more to your female health care than that. And so, I just want to shout:

“Ladies! It’s not just about the Pap smear!”

Recently, I diagnosed three uterine cancers and a vulvar cancer within a four-month time span. They all had the same story, they all hadn’t seen me in years because they heard they didn’t need a Pap smear regularly anymore. Sadly, these are not isolated stories, but are becoming more common as women see their gynecologist less.

This spate of diagnoses started in November, when I walked into my office and greeted my new patient sitting with her back to me. As she turned, I realized she was my patient from years ago.

“Where have you been?” I asked her with a smile. “You disappeared on me,” I teased her.

Although she had put on some weight, she looked well at 60. As I sat down, I noticed her face was tense and she was fidgeting in the chair.

“I heard I only need a Pap every few years … something like that anyway. And my internist said she would do my PAP whenever it was due. It seemed easier that way.”

“So what brings you in to see me today?”

“I had spotting a while ago, sometime last year. And then I had some more bleeding recently. I finally decided maybe it was time to see you again.”

As I probed her with questions, I finally was able to get the whole story and fill in her health history. She now had diabetes and high blood pressure, and over the years, the weight just gradually came on. As she talked, alarm bells were going off in my mind. My concern, uterine cancer. Her story fit the signs and symptoms, but I would need to do more tests to confirm my suspicions. After her exam, I explained my concerns and the tests that would tell us what was causing the bleeding. “I was afraid you were going to tell me something like that. I should have come sooner, but I thought if I didn’t need a PAP, I didn’t need to see my gynecologist.”

So within a month, I was sending her to a gynecologist oncologist for cancer treatment. If only she had come in earlier or seen me more frequently, maybe she would have been diagnosed earlier, even perhaps at a precancerous state rather than stage 3. Somewhere along the line, the medical community failed her in letting her believe she didn’t need to see a gynecologist anymore. Her PCP (primary care physician), who had been doing her Pap smears, may not have known signs to identify uterine cancer or know that with her diabetes, high blood pressure and obesity she was higher risk for uterine cancer or that any spotting after menopause needs to be addressed. Or the patient might not have known the importance of telling her PCP about the spotting.

As I said before, seeing your gynecologist is not just for a Pap smear. Birth control counseling, STI counseling, screening and treatment, preconceptual counseling, genetic counseling, cancer screening, osteoporosis screening, monitoring fibroids, ovarian cysts are just a few examples. In questioning you during the visit, we are searching for any signs or symptoms of problems with your health or health issues that we may be able to improve. And no other type of doctor will do a comprehensive pelvic exam which includes more than your cervix.

Nearing 80 years old, my new patient slowly made it down the hallway with her walker. Before she even came into view, I overheard her talking to my medical assistant, and I knew I knew her from before. She had been a patient for many years with my previous partners and then gradually switched her care to me. Watching her walk, I knew her health had declined in the years since I had seen her. She always struggled with her weight, but despite that, was active and involved in her community. Today, she looked defeated, huffing and puffing with the effort it took her to walk down the hall.

“I had a Pap smear three years ago with my primary care. I felt like he pinched something on my skin and ever since then I have bleeding once in awhile when I wipe. I didn’t want to go back to him; it hurt too much. Since I was told I didn’t need Pap smears anymore, I never came back here.”

When I asked her more about how she was doing, every sentence started with a sigh. She went on to describe her medical issues, the struggles getting her medications paid for by Medicare, how she moved into a senior living apartment and hated it. “No one wants to do anything!” She looked tired and worn out from life. Her usual animated and energized demeanor was extinguished. How sad it was for me to see her like this.

In the exam room, it took no time for me to figure out where this spotting was coming from. She had a marble size mass extruding from her vulva near the clitoris. This beefy red, angry looking mass easily bled when I barely touched it. “I can see what is causing the bleeding and it isn’t because of your last exam. You have something growing here that I need to biopsy.” She didn’t want me to do the biopsy that day. “I have too many things to do today.” But it seemed she was postponing the biopsy out of fear.

A month later, she finally came back for the biopsy. I helped her make a follow-up appointment since I was nearly certain the growth was cancer. When I got the biopsy results my first thought was “this could have been caught so much earlier if she had yearly gynecology exams.” But here she was, with multiple health issues, difficulty getting around, and now vulvar cancer with a disfiguring, painful surgery ahead of her.

Beyond Paps, your gynecologist can do so much more for you. Many symptoms that you may attribute to your “female” organs are actually symptoms of other underlying illnesses. I have diagnosed high cholesterol, low Vitamin D, overactive thyroid, underactive thyroid, diabetes, bladder infections, appendicitis, gallstones, colon cancer in addition to vaginal atrophy that leads to painful sex, fibroids that lead to anemia, ovarian cysts that can torse or twist, breast lumps that are cancerous, weak pelvic floors that lead to incontinence.

Don’t let politicians, insurance companies, social media dictate your health care needs and interfere with your relationship with your doctor. Don’t let them take away your right to have regular preventative health visits, family planning choices and cancer screenings. Listen to your body, listen to the signals it is giving you, listen to your gut telling you “go see your doctor.” Don’t get fixated on whether you need a Pap smear or not. Your gynecologist will tell you if you do need one and, in the process, will also take care of your other health needs.

Andrea Eisenberg is a obstetrician-gynecologist who blogs at Secret Life of an OB/GYN.

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