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

post #1 of 25
Thread Starter 
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?
post #2 of 25
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.
post #3 of 25
I have had it with a pregnancy exam, but not annual.
post #4 of 25
I've never had that offered to me.
post #5 of 25
It is supposed to be part of the exam.... but I have never ever been offered one!
post #6 of 25
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?" :
post #7 of 25
Quote:
Originally Posted by dynamicdoula View Post

"get into your rectum?" :
post #8 of 25
I've never had a pap smear without a rectal exam (many different doctors)
post #9 of 25
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.
post #10 of 25
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.
post #11 of 25
Quote:
Originally Posted by Amylcd View Post
I've never had a pap smear without a rectal exam (many different doctors)
Yep, same here.
post #12 of 25
I've never had a rectal exam offered with a pap smear/gyn visit.
post #13 of 25
Quote:
Originally Posted by Turquesa View Post
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.
post #14 of 25
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?
post #15 of 25
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.
post #16 of 25
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.
post #17 of 25
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.
post #18 of 25
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.).
post #19 of 25
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.
post #20 of 25
Quote:
Originally Posted by BookGoddess View Post
I've never had a rectal exam offered with a pap smear/gyn visit.
Quote:
Originally Posted by LittleBirdy View Post
you can just stay out of my bum thankyouverymuch.
:

Quote:
Originally Posted by DoulaMary View Post
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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