# Pap Smear Questions (A RECTAL EXAM???!)



## Turquesa (May 30, 2007)

1. Has anybody heard of a rectal exam being a _routine_ part of an annual exam? I just had my pap/pelvic on Friday. The NP had just finished with the pap and pelvic part when she started putting on a new latex glove. "OK, so let's go ahead and get into your rectum. "

I popped up from my helplessly supine position, "Rectal exam? I haven't heard of doing that as part of an annual."

"Oh yes, it helps me feel things from behind."

"You know what? I think I'll pass for today, thank you." (As if I were declining an hors d'oevres tray







)

She sighed and removed her glove, "OK, I guess it's your choice."

Is it now normal for HCPs to do this routinely? Should I have consented?

2. My British sister-in-law told me that Europeans only do these exams once every three years. Is that all that women need? Do U.S. doctors do them more often for the insurance payments? Do U.K. doctors do them less often because NHS doesn't want to pay for any more? Do either do them on an evidence-based time frame?


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## the_lissa (Oct 30, 2004)

I haven't heard of the rectal exam, but I have heard of the 3 year recommendation. If you have had normal paps for a certain amount of time, then a pap every 2-3 years is recommended here too.


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## KatWrangler (Mar 21, 2005)

I have had it with a pregnancy exam, but not annual.


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## AutumnMama (Jan 2, 2004)

I've never had that offered to me.


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## Village Mama (Jul 22, 2004)

It is supposed to be part of the exam.... but I have never ever been offered one!


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## dynamicdoula (Jun 11, 2004)

I don't hear about rectal exams as much with PAPs as it used to be, you of course have the right to refuse.

I just have to say...

"get into your rectum?"







:


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## Village Mama (Jul 22, 2004)

Quote:


Originally Posted by *dynamicdoula* 

"get into your rectum?"







:


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## Amylcd (Jun 16, 2005)

I've never had a pap smear _without_ a rectal exam (many different doctors)


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## amcal (Jan 13, 2003)

A rectal is important. It allows the doctor to feel both sides of your ovaries. The will put their fingers inside and push on your stomach to get a good feel of your ovaries. They may also put a smear on a slide to check for blood.

I'm very much on the side of preventative medicine so if a dr. wants to do a fairly benign test/procedure which could possibly show serious issues that would otherwise be hard to find, I'm all for it.


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## kate3 (May 4, 2007)

It's actually suppose to be part of the exam, but it has nothing to do with the pap.

There are 2 parts to a gyn exam: the speculum exam, which allows providers to see your cervix and do the pap, and the bimanual exam, which allows providers to feel internal reproductive organs for shape, size, abnormalities. The reason for the rectal part is because the wall that devides the vagina from the rectum is very thin and during the rectal you can actually feel the back of the uterus and often an ovary that may be tucked away.

So in defense of the NP, she was actually being very thorough. Her choice of wording may have been a little off but she knew what she was doing









I did not routinely do a rectal as part of an annual gyn exam with a couple of exceptions: pateints over 50 who have not had fecal occult blood testing with their primary provider (many of my patients do not have regular health care), and patients with complaints of pain or abnormalities on exam that may need further assessment.


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## philomom (Sep 12, 2004)

Quote:


Originally Posted by *Amylcd* 
I've never had a pap smear _without_ a rectal exam (many different doctors)

Yep, same here.


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## BookGoddess (Nov 6, 2005)

I've never had a rectal exam offered with a pap smear/gyn visit.


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## rabbitmum (Jan 25, 2007)

Quote:


Originally Posted by *Turquesa* 
2. My British sister-in-law told me that Europeans only do these exams once every three years. Is that all that women need? Do U.S. doctors do them more often for the insurance payments? Do U.K. doctors do them less often because NHS doesn't want to pay for any more? Do either do them on an evidence-based time frame?

Every three years is the recommendation in Norway too. BUT I had my last pap smear three and a half years ago and a month and a half ago I was diagnosed with cervical cancer for which I'm now going through radiation and chemo therapy.









I don't really think there's an economic reason for the three-year recommendation, as anybody can have their check-ups more often if they wish. I think the reasoning is that cervical cancer usually takes a long time to develop, so it will generally be caught at a very early stage with this interval.

In a few cases it's fast, though, as in my own: I went from a completely normal smear to a tumour more than five centimeters in diameter in less than three and a half years.







So no, every three years is apparently not often enough.


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## LittleBirdy (Apr 28, 2008)

I did have one dr. who wanted to do a rectal exam as part of the annual, but he must have been used to people's reactions because the way he put it to me was, "I recommend it but you have the option to decline." Which I did. I know he was just being thorough, but I was 21 at the time with no issues or family history of cancer or anything so you can just stay out of my bum thankyouverymuch.









As for the three years thing, my doc said offhand once, "Come back next year, but these tests are so good these days you could even go as many as 3 years before your next pap." I still go every year - why risk it?


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## texaspeach (Jun 19, 2005)

in our bodies, our selves, it says that a finger in the bum is part of a thorough bimanual pelvic exam, not in those exact words









and yes, a pap every 3 years is recommended for certain women (over a certain age, I think it's 30) with a history of normal paps, but they still recommend you go in for an annual exam (breast exam, pelvic exam) just no pap.


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## nalo (Oct 25, 2005)

I've actually never heard of this. I have never been "offered" it by my MD nor was I ever offered it by my midwives.


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## lindberg99 (Apr 23, 2003)

My doctor has done it. But I just had an exam the other day and she didn't do it. You know, maybe she has just done it when I had a postpartum exam? I can't really remember.

I get a pap every year and I'm 42 and have never had an abnormal one. I've heard about the every 3 year thing but I go in once a year anyway to get an exam and a referral for a mammogram and the doctor does the pap every year. I guess she figures she might as well do one as long as I'm there.


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## eleven (Aug 14, 2004)

Nope, never been offered. Perhaps I should be offended?









I've heard of the 3 year spacing with a history of normal tests and no special needs (birth control, etc.).


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## BellinghamCrunchie (Sep 7, 2005)

My doctor said it was standard procedure once you turn 40 to add the rectal part to the annual pap. I've always declined, though.


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## SevenVeils (Aug 28, 2006)

Quote:


Originally Posted by *BookGoddess* 
I've never had a rectal exam offered with a pap smear/gyn visit.


Quote:


Originally Posted by *LittleBirdy* 
you can just stay out of my bum thankyouverymuch.

















:

Quote:


Originally Posted by *DoulaMary* 
I've actually never heard of this. I have never been "offered" it by my MD nor was I ever offered it by my midwives.

And that.


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## dynamicdoula (Jun 11, 2004)

I've never been offered either but I also know that it's a normal part of the exam and it varies by practitioner. I think I'd probably ask for it after having had a benign tumor removed from my ovary 7 years ago- once you have one, you're higher risk for more, might as well be thorough. My male OB is practically a girlfriend (he's not gay, there's just no weird male/female tension) anyway so it's not exactly threatening.


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## Turquesa (May 30, 2007)

Quote:


Originally Posted by *rabbitmum* 
Every three years is the recommendation in Norway too. BUT I had my last pap smear three and a half years ago and a month and a half ago I was diagnosed with cervical cancer for which I'm now going through radiation and chemo therapy.









I don't really think there's an economic reason for the three-year recommendation, as anybody can have their check-ups more often if they wish. I think the reasoning is that cervical cancer usually takes a long time to develop, so it will generally be caught at a very early stage with this interval.

In a few cases it's fast, though, as in my own: I went from a completely normal smear to a tumour more than five centimeters in diameter in less than three and a half years.







So no, every three years is apparently not often enough.

Oh, mama! I'm so sorry you're going through this!!







Hearing your story made me rethink the 1 v. 3-year rule. If you don't mind my asking, how is your prognosis?

I'm 32, in a monogamous relationship, have never had an abnormal pap, and (eta) had never before that exam been offered an "anal" during my "annual." I believe that the anti-HPV vax has been approved for my age group, but that only prevents 70% of cervical cancer cases. I have a cystocele (bladder prolapse) but that's a little far from the, um, cavity in question.







I agree with the PP that the nurse could have explained herself a little better! thanks for the feedback, everybody.


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## rabbitmum (Jan 25, 2007)

Quote:


Originally Posted by *Turquesa* 
If you don't mind my asking, how is your prognosis?

It's good, all the doctors say I will probably be completely well and never get the cancer back. I'm actually half way trough my treatment already and feeling optimistic.









Quote:


Originally Posted by *Turquesa* 
I believe that the anti-HPV vax has been approved for my age group, but that only prevents 70% of cervical cancer cases.

Yes, but 70 % is not so little. In Norway 270 women get cervical cancer every year. 70 % less would mean that 189 of them would not have to go through this!

I think it's strange that it's not common to test if a woman has the HPV virus or not. If that was checked, women who weren't already infected, could choose to be vaccinated, and the ones who were, could have more frequent pap smears. Surely it must be possible to check.
Is it the same in America, i.e. no testing for HPV?


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## harrietsmama (Dec 10, 2001)

I've had it a few times, my midwife did it after my stitches also to make sure none went too deep.

Just a thought for those of you who are bum shy, I lost my grandma because she was bum shy. She didn't know she had rectal cancer until she had a bloody stool, and it was too late. Please be proactive about your bodies, even the parts that make you feel shy - they seem to be especially prone to developing killer stuff like cancers - perhaps it would be less prevalent if we just gritted our teeth and got it over


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## Mosaic (Jun 20, 2005)

I was surprised once during an annual exam, but it didn't bother me. Well, it did catch me enough to ask, "_*WHAT*_ was that for?!" but she told me, so all was good.







I figured, heck, I was already in position, might as well rule out something else, right?


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