Ever wondered about any changes your body is undergoing? There is a good bit of focus on body changes at puberty, but little emphasis on what changes to expect during the aging process. During our lifetime many physical, emotional and developmental stages have some predictability and could benefit from information. I’m going to address the issues common to women because that is the population I have worked with professionally. I am concerned about the educational silence because lack of accurate knowledge can lead to problems.
No matter what their age, I have found that most people have little understanding of some of their body parts — particularly those categorized in school as part of the “reproductive system.” To compound the lack of knowledge, cultural norms have made “sexual” organs a taboo topic for intelligent discussion — however, sexual innuendo abounds.
I say this because I have examined many patients who have experienced childbirth and many other “female” issues, but honestly had little clue what was going on with their body. Invariably, when women arrived for their annual GYN exam, they stated how much they dreaded this exam. Interesting … and pervasive in our society.
In contrast, there is no correlating dread to having the inside of their ears or throat examined, or having a stethoscope put on their chest or even having their abdomen touched. This reticence is unfortunate because women need to undergo this type of exam most of their lives. I believe the approach to this exam could and should be different.
The way the first GYN exam experience is perceived can color future attitudes and health behaviors. Since many life stages require such an exam, consumers and healthcare providers should seriously consider how to have a positive impact. In nursing we call preparation for such experiences, “anticipatory guidance.” This means a person should get some preparatory information about what to expect before being thrown into a procedure.
My women’s health nurse practitioner program insisted that we do “teaching pelvics.” It was stressed that the exam should not only determine normal from abnormal, but served as an opportunity to inform patients about their own bodies. I learned to always give patients undergoing a pelvic exam a hand-held mirror so they could see what I was doing. Women, don’t freak out!
This approach came as a revelation — even to many women who had already had children. They invariably wanted to refuse using the mirror. I gently encouraged them to just try and they usually did “take a peek.”
What happened was their dread was replaced by interest when a matter-of-fact “show and tell” approach accompanied visualization of their previously unseen parts as they were examined and procedures were done. I could show and explain each anatomical part and procedures being done, e.g. where the Pap stick was going, what their cervix looked like, where sperm went in and babies came out and other normal features.
This resulted in a much clearer understanding of what a cervix is — why cancer may occur there, the process of dilatation in labor and delivery, and normal vs. abnormal findings. It also resulted in them focusing on looking at what I was doing and being less jumpy when being touched for lab swabs. Now they could actually see what was being done to them. They calmed down and became focused on what they were learning. It was almost always a first for them.
Another major gap in understanding of the bodily changes occurs with older women. I have taught Lamaze classes to prepare women for the childbirth process and menopause classes for that normal stage. Now I am focused on developing a workshop for the special needs and changes of the postmenopausal woman.
This life phase is somewhat like thinking about puberty in reverse. Now the hormones are going away and there are some changes to the genitals and urinary tract that are predictable. Ageism also gets in the way of perceiving older women still as sexual beings. If you doubt this, just ask your children!
Women frequently do not understand that some bothersome symptoms (vaginal dryness, painful sex, incontinence, etc.) can develop — and they are hesitant to bring up these personal issues unless specifically asked if they are occurring. Many health care providers are also uncomfortable bringing up these issues.
This is unfortunate since many annoying, worrisome or embarrassing symptoms might have simple remedies or be fixable. Additionally, the guidelines for Pap smears and breast and pelvic exams have changed and many women are unfamiliar about when to have screenings done.
I founded the Women’s Information Network Inc. 28 years ago to provide an interactive forum that brings together health professionals and consumers for dialogue. It is much easier to learn when the environment is set for education and questions — rather than trying to take in new data with no notes, no clothes and limited time while on an exam table.
We provide speakers from a variety of specialties to talk about health issues. Our goal is to provide participants with accurate information, reputable resources and a venue to comfortably ask questions that facilitate personal decision-making.
We are now planning a workshop called “Issues Below the Belt” for February that will address the issues of postmenopausal women. I hope health professionals and consumers will help us develop this program by sharing feedback about this article and topics you want discussed. Thanks for the opportunity to speak openly on sometimes sensitive subject matter!