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Is the foot rest always used?
This
is traditionally used with the physician standing
between the legs, but there are other positions that can
be employed. Dr. Cracchiolo mentioned the Hand’s
position (sorry, I couldn’t find it online, so I will
ask Dr. Cracchiolo). Also, in
Britain
the physician stands along the side of the patient and
not in between the legs…basically do whatever makes the
patient most comfortable!
What
about patients with disabilities?
Same
answer - do what makes the patient most comfortable!
Just ask the patient how they want to be positioned,
since they will most likely know the best way!
How
does menstrual flow affect timing of the pap smear?
Usually the pap smear and breast exam are preferred to
be administered just after menstruation. But be aware
that there may be some residual cells found on the pap
if it is done then.
Are
pap smears scheduled?
Yes,
they are considered part of the female physical exam and
done along with the pelvic and gynecologic exam.
What
is the next step after an abnormal pap smear?
Usually, the physician will do a colposcopy, which is a
directed biopsy to find the exact location and histology
of the lesion. Then, the abnormal tissue is usually
removed by a procedure known as LEEP (loop
electrosurgical excision procedure). This is usually
all you need. Then, the pathologist would stage the
cancer (this is done clinically) and make sure it has
not spread!
The
cure rates are very high is caught early enough.
Whether the patient has a radical hysterectomy or
chemotherapy for Stage 1 cervical cancer, there is about
a 98% cure rate!!! This is why it’s so critical to make
sure our patients have this screening test!
What
are the legal aspects of gynecological exams and male
physicians?
In
the state of NJ, a female patient has the right to have
an escort present. If the physician is a male, there
must be a female escort, however if the physician is a
female, the escort can be male or female. As a 3rd
year medical student, you MUST have an attending or
resident in the room for a pelvic or breast exam, even
for females!
**Take Home Message: Pap smears are life saving
screening tests! There is NO excused for letting
cervical cancer get to progress to later stages, like
Stage 4. Most abnormal pap smears are only in stage 1,
so you MUST influence your patients to have them done to
prevent this cancer!!! It is your duty as a physician
to advocate for pap smears!!! Education is key – tell
your patients, friends, family to get their pap
smears!!! There is NO EXCUSE!!!
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