Appointments with a gynecologist are rarely comfortable – whether it is a Pap smear, IUD insertion or biopsy, among other procedures – but for some women, the experience can be so excruciating that they give up further appointments, putting their health at risk. By making matters worse, this pain can often be minimized by primary care physicians. Dr Rachel Spitzer, an associate professor at the University of Toronto and an obstetrician at Mount Sinai Hospital, told CTVNews.ca that there are “many risks” to degrading pelvic pain and painful experiences in the gynecologist’s office, including cancer or an underlying disease. could be prevented if arrested early. “If we minimize the experience of pain in our office, then we will not understand what may be hidden behind us and we will be missing things,” Spitzer said in a telephone interview on Wednesday. Spitzer said having a bad or painful experience in the gynecologist’s office and then feeling that these concerns are not being taken seriously can alienate people from care, making them reluctant to return for further appointments or routine checkups. “When we minimize their experiences at any level, whether we minimize their pain or minimize the description of another kind of difficult experience, we potentially lose that person from care,” he explained. Spitzer said there are a number of factors that contribute to how a person feels pain when it comes to pelvic exams, including pain threshold, previous painful experiences with doctors and a history of sexual abuse or other trauma. However, it can be difficult to treat the root cause of discomfort or severe pain. Spitzer said this may require finding a doctor or specialist who understands trauma-related practices that focus on safety, choice, collaboration, reliability and empowerment. Spitzer said patients should feel supported in discussing their reproductive health with their doctor, not being blamed for their painful experience. “I inform my patients that if they ask me to stop, I will stop. You do not want to ask your doctor to stop and [they say]”Just a moment, I’m almost done,” he said. “There has to be trust and respect and recognition that some people may have had difficult experiences in the past that may make this particularly difficult for them.” While doctors may suggest taking ibuprofen before a pelvic exam to help, Spitzer said there are other options for those who do not find over-the-counter pain relievers, such as topical freezing agents and gel numbness, such as and conduct repressive proceedings in certain scenarios with explicit consent. However, Spitzer said that the doctor’s priority should be to understand why the pain occurs and how to treat it in the long run. Dr. Sukhbir Sony Singh, a gynecological surgeon at The Ottawa Hospital and a professor at the University of Ottawa, says the treatment of pelvic pain begins with training, followed by medication and alternative therapies in some cases, such as pelvic floor physiotherapy, exercise and exercise. “Recognize the pain. Work with the patient to educate them about what pain is, because pain is very complex and there are many reasons to have pain. Then start treating the pain,” Singh told CTVNews.ca in a telephone interview on Wednesday.
TRAINING AND EDUCATION
While he may feel that a doctor is dismissing someone’s concern right now, Singh said the burden is not solely on doctors. He said society often rejects reproductive health in general, especially women’s issues such as infertility, menstruation and endometriosis. When a woman’s pelvic pain is rejected, Singh said it can limit “their ability to truly reach their full potential in life.” Evidence has shown that painful periods can lead to girls having to miss school, hindering their education, and women with endometriosis reporting being promoted for career advancement because they have to manage their symptoms. “Once we are open as a society to discuss this, we will see it reflected in the emergency rooms, GPs and gynecologists’ offices,” Singh said. Singh said an important issue is that there are not enough specialists for pelvic pain and that more doctors need to be trained in up-to-date trauma care. When he was a gynecologist, Singh said he was taught that if someone came to the emergency room with pelvic pain, he should have an ultrasound and if he did not show any abnormalities, send the patient home. Singh has spent the past 15 years working to address this, helping colleagues and residents better understand gynecology education principles worldwide. “We teach our students in our home to do better – how to get a proper pain history, how to examine them properly to determine what kind of pain they have, where the sources of pain, ultrasound imaging has greatly improved… and “then how to interpret all this to provide the patient with the best options,” he explained. While acknowledging that there is more education about pain and reproductive health now, Singh says there is still much for doctors as well as patients to learn. “Everything goes back to training,” he said. “From a patient’s point of view, do the research to find out what kind of pain there is. And yes, if you do not get the answers, support moving on to the next level.”
SEND FROM PAP TEST
Researchers say the human papillomavirus (HPV) smear test will soon replace the Pap smear for primary cervical cancer screening in Canada. Dr Amanda Selk, a gynecologist who runs the Gynecological Dermatology Clinic at Women’s College Hospital in Toronto, told CTVNews.ca that the HPV test is more sensitive and has proven to be cost-effective and safe. “When you do a Pap test, you are looking for cells that are already potential precancerous cells. When you do an HPV test, you are actually looking for the cause of the cancer. So taking an earlier step on who is at real risk of developing cervical cancer.” Selk said in a telephone interview Friday. Some counties that have said they will be tested for HPV by Pap smears as the primary screening for cervical cancer include British Columbia, Saskatchewan, Ontario, Quebec, Nova Scotia and Prince Island. However, no timetable has been set for the change. Selk said this would not be a “quick change”, as provincial health authorities need to make changes to laboratory procedures and documentation, as well as training. Selk said HPV tests are more effective at detecting those at risk and also have the ability to self-monitor at home, addressing some of the concerns for those experiencing painful experiences when visiting their gynecologist. However, switching to HPV tests as the main form of screening for cervical cancer does not mean that Pap tests are completely gone, Selk said. “If you show negative control, it’s really safe to stay five years without being shown,” Selk said. “[But] If you do an HPV swab on yourself and it is positive, the next step still involves a gynecological examination with a speculum. “ While Selk acknowledges that this would actually be an extra step for those who are positive, she said overall it is a better way to prevent cervical cancer than other than the HPV vaccine.
