Although some discomfort is expected when visiting a gynecologist, experts say more education is needed for doctors and patients to better understand physical examinations, they should not cause severe pelvic pain that could injure and injure women. repel from worries.
Meetings with a gynecologist are seldom comfortable – whether it’s a pap test, IUD or biopsy, among other procedures – but for some women the experience can be so excruciating that giving up extra appointments puts their health at risk. To make 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-gynecologist at Mount Sinai Hospital, told CTVNews.ca that there are “numerous dangers” that reduce pelvic pain and painful experiences in the gynecologist’s office, including cancer or major a disease that can be prevented if caught early.
“If we minimize their pain experiences in our office, then we will not understand what may be behind it and we will be missing things,” Spitzer said in a telephone interview Wednesday.
Speaker said that if you have a bad or painful experience in the gynecologist’s office and then feel that these fears are not taken seriously, it can take people away from care, which makes them hesitant to return for follow-up appointments or routine examinations.
“When we minimize their experiences at any level, whether it’s minimizing their pain or minimizing the description of another difficult experience, we are potentially losing that individual concern,” she explained.
Speaker said there are various factors that contribute to how someone feels pain when it comes to pelvic examinations, including their pain threshold, previous painful experiences with doctors, and a history of sexual abuse or other trauma.
However, getting to the root of whether it is discomfort or severe pain can be difficult to deal with. Speaker said this may require finding a doctor or specialist who understands trauma-informed practices that focus on safety, choice, cooperation, reliability and empowerment.
Speaker said patients should feel supported in discussing their reproductive health with their doctor, and not be blamed for their painful experience.
“I am informing my patients that if they ask me to stop, I will stop. You don’t want to ask your doctor to stop either [they say]”Just one more moment, I’m almost done,” she said.
“There must be trust and respect and it must be acknowledged that some people may have had difficult experiences in the past that may make this particularly challenging for them.
While doctors may suggest taking ibuprofen before pelvic exams to help, Spitzer said there are other options for those who don’t think over-the-counter pain medications don’t relieve pain, such as topical freezing agents and painkillers. .к. as well as performing sedation procedures in certain scenarios with explicit consent.
However, Spitzer said the doctor’s priority should be focused on getting to the bottom of why the pain occurs and how to treat it in the long run.
Dr. Suhbir Soni Singh, a gynecological surgeon at Ottawa Hospital and a professor at the University of Ottawa, says pelvic pain treatment begins with education, followed by medication and alternative therapies in some cases, such as pelvic floor physiotherapy, exercise and attention. .
“Acknowledge the pain. Work with the patient to teach what pain is, because pain is very complex and there are many causes of pain. Then start treating the pain, “Singh told CTVNews.ca in a telephone interview Wednesday.
TRAINING AND EDUCATION
Although at the moment it may seem that the doctor rejects his worries, Singh said that the burden is not only on the doctors. He said society often rejects reproductive health in general, especially women’s issues such as infertility, menstruation and endometriosis.
When the woman’s pelvic pain was ruled out, Singh said it could limit “their ability to truly reach their full potential.” Evidence suggests that painful periods can lead to girls having to miss school, making it difficult for them to get an education, and women with endometriosis report missing out on career advancements because of the need to deal with their symptoms.
“Once we are open as a society to discuss this, we will see that this will be reflected in the emergency department, in the offices of family doctors and gynecological offices,” Singh said.
Singh said the main problem is that there are not enough pelvic pain specialists and more doctors need to be trained in care informed about the trauma.
When he was a gynecologist, Singh said he had been taught that if someone came to the emergency room with pelvic pain, he should have an ultrasound and, if he showed no abnormalities, send the patient home. Singh has spent the last 15 years working to address this, helping colleagues and residents better understand gynecological educational principles around the world.
“We teach our students in our residence to do better – how to take the right history of pain, how to examine them properly to identify what kind of pain they have, where the sources of pain, ultrasound images have improved … and then how to interpret all this to give the patient the best opportunities, “he explained.
While acknowledging that he now has more education about pain and reproductive health, Singh says doctors still need to learn a lot, as do patients.
“Everything goes back to training,” he said. “From the patient’s point of view, do research to find out what types of pain there are. And yes, if you don’t get the answers, recommend going to the next level. “
I REJECT FROM PAP TESTS
Researchers say testing for high-risk human papillomavirus (HPV) tampons will soon replace the Pap test for primary screening for cervical cancer in Canada.
Dr. Amanda Selk, a gynecologist who heads the dermatology gynecology clinic at the Women’s Hospital in Toronto, told CTVNews.ca that the HPV test is more sensitive and has proven cost-effective and safe.
“When you do a Pap test, you’re looking for cells that are already potentially precancerous cells. When you do an HPV test, you’re actually looking for the cause of the cancer. So you’re taking an earlier step toward who is at real risk of developing of cervical cancer, “Selk said in a telephone interview Friday.
Some provinces that have said they will switch to HPV tests from Pap tests as primary screening for cervical cancer include British Columbia, Saskatchewan, Ontario, Quebec, Nova Scotia and Prince Edward Island. However, no timetable has been set for the change.
Selk said it would not be a “quick change” as provincial health authorities have to make changes to laboratory processes and documentation, as well as training.
Selk said HPV tests are more effective at detecting those at risk, and also have the potential for self-testing at home, addressing some of the concerns for those suffering from painful experiences when visiting their gynecologist.
However, switching to HPV testing as the primary form of screening for cervical cancer does not mean that Pap tests are completely disappearing, Selk said.
“If you screen negatively, it’s actually safe to last five years without being screened,” Selk said. “[But] if you get an HPV swab and it is positive, the next step still involves a gynecological examination with a speculum. “
While Selk acknowledged that this would essentially set an additional step for those who test positive, she said it was generally a better way to prevent cervical cancer, in addition to HPV vaccination.
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