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on lubrication

Tuesday, November 10, 2009


image: a normal pap test. pretty, eh?


i've been working on a few posts about my parental culture shock. they're coming, but instead i have to write today about a different kind of total, utter shock.

perhaps it's 'just' culture shock - something i didn't know about life in argentina until just now. i don't know, you tell me.

i can't seem to scoop my jaw up off the floor or stop asking my partner, incredulously, "but, can you believe it?"

i wake him up in the middle of the night: "i mean, really, how can this be?"

i call him when he's working: "am i crazy, or is this not absolutely and utterly shocking and unacceptable and unbelievable and...um... shocking?"

i didn't expect to write about pap smears when i started this blog, but i am shocked!!! so i just have to share.

*****

i casually mentioned to my friend that i needed to get a pap done sometime soonish, and could she recommend a doctor. (this was before i realized that my health coverage doesn't let me choose my doctor.)

she was happy to recommend her gynecologist: "he's pretty good. and he uses lubricant."


WHAT?? you mean that some gynecologists DON'T USE LUBRICANT? when they're putting a speculum inside you?

she found my bewilderment shock to be pretty amusing.

"they usually just tell you to relax and to breathe." AS IF. well, i guess i'm glad i asked.

*****

i mentioned this conversation to my only other female friend here. and get this:

she had never even heard of the use of lubrication for a pap test.

my outrage doesn't know whether to boil and sizzle or try to snuff itself out in the name of 'adapting to cultural differences'.

*****

i'm normally pretty chill about these things. though it's slightly uncomfortable, i've had no negative experiences, i don't even particularly mind if a man does the exam. i find it a lot more challenging to get blood taken than to have a pelvic exam.

but come on.

how hard can it be to put a little gel on the speculum, or on the gloved finger, that is going to be inserted into a part of my body that is so clearly meant to be lubricated before anything goes in there? no gel? warm water even. something!!!!

it would be like men getting prostate exams with no lubricant. they do use lubricant for those exams, don't they?

the more i think about it, the more outraged i get (and i'll admit it, nervous. i still have to get this done, and i have no idea what kind of experience awaits me).

the more i think about it, the more it seems to me like a total lack of respect, a total unwillingness to do anything at all to make life, and health, a little more comfortable. i can't help but think that this is about women's dignity. like the whole epidural-and-lie-on-your-back-for-labour routine vs. get-a-midwife-and-make-your-own-choices.

maybe i've been living in an oasis of lubricated pap smears all my life, i don't know. though i've lived in different countries, i've always saved things like pap smears and bra shopping for trips back to canada.

i couldn't post this without a little bit of research, so i did quickly google -pap exam lubrication-, and it turns out there is was a debate on the issue. on the first page of results, every site but one (called 'military obstetrics & gynecology') seems to either be about a different topic or to endorse the use of lubrication. this 2003 study claims to lay to rest the concerns that lubrication could contaminate the results (check out the editor's note at the bottom).

i had no idea there was ever any question about this. i've been getting regular pap smears since my very first one - oh so memorable - back in 1989(!). the planned parenthood folks at the youth clinic didn't seem to have any concerns about using lubricant, nor have any other doctors or midwives since. my last midwife even warmed the gel and the speculum, for my added comfort.

so what is going on?? i still can't get over it, but all i get around me is a giggle and a shrug of the shoulders. then google goes and makes me question my outrage. am i way off? i really don't know anymore.

*****

here's how you can help, if you feel so inclined:
  • help me get my bearings:  tell me if you are as shocked as i am, or if you're not surprised or appalled at all. am i making too much of all this?
  • share any advice or experience that could help me get prepared for my pending, potentially non-lubricated doctor's visit
  • help me think of other comparisons (like the prostate exam one) so i can better explain my shock and disbelief

7 comments:

Deborah said...

I'm crossing my legs and wincing just at the thought. Ouch!

Hobo Mama said...

Ouch! It does just seem like insensitivity on the doctors' part, kind of like historically not giving pain medication for circumcision (but don't get me started on that topic...). I have a friend who couldn't psychologically or physically (not sure which) manage a pap smear with lube; I just think it's a given that they should try to make it as easy as possible. I would bring my own lube with me in case!

P.S. I glanced in the sidebar and was amused. Google Ads is trying to sell me a "speculum large on sale " -- disposable! Now all your readers can have their own!

Anonymous said...

at age 65yrs. i had my first pap test i assume without a lubracant. the pain was unbelieveable!! this had never happened to me before. the dr. said i'm sorry and continued with the internal exam. she said she didn't know what was causing the pain. how could she not know? this was a young woman!

Anonymous said...

Apparently, most of the docs lube only with warm water. I think it is a disgrace. But, the example of the rectal exam is a little off... the rectum has no natural lubrication at all. Also, the gloves cause friction and are not naturally smooth as a stainless steel or plastic speculum. Still... IT OUGHTA BE LUBED! If water would not distort the exam, why would a water based lubricant???

Michelle Overby said...

Great post; saw your blog on Science and Sensibility. Studies show that the use of water-based gel lubricant on the vaginal speculum does NOT appear to affect the rate of unsatisfactory Pap test results compared with water-moistened speculums alone. As a nurse-midwife student in the States who finished her last clinical today (yeah!), I can attest to the fact that women do notice a difference when the speculums are both warmed and lubricated AND the right size. It was once thought that the lubrication affected the pap or STD results, but this is NOT true. Also, the some women have smaller vaginal openings and only need a Peterson speculum which has a smaller blade. By all means, you have the right to tell your provider to warm and lubricate before doing exams! Do you not have midwives that do pap smears? Also, love your post on pushing! Thanks for sharing.

Hathaway, J.K., Pathak, P.K. & Maney R. (2006). Is liquid-based pap testing affected by water-based lubricant? Obstetrics and Gynecology, 107(1), 66-70.

Griffith, W.F., Stuart, G.S., Gluck, K.l. & Heartwell, S.F. (2005). Vaginal speculum lubrication and its effects on cervical cytology and microbiology. Contraception, 72(1), 60–4.

Michelle Overby said...

Great post; saw your blog on Science and Sensibility. Studies show that the use of water-based gel lubricant on the vaginal speculum does NOT appear to affect the rate of unsatisfactory Pap test results compared with water-moistened speculums alone. As a nurse-midwife student in the States who finished her last clinical today (yeah!), I can attest to the fact that women do notice a difference when the speculums are both warmed and lubricated AND the right size. It was once thought that the lubrication affected the pap or STD results, but this is NOT true. Also, the some women have smaller vaginal openings and only need a Peterson speculum which has a smaller blade. By all means, you have the right to tell your provider to warm and lubricate before doing exams! Do you not have midwives that do pap smears? Also, love your post on pushing! Thanks for sharing.

Hathaway, J.K., Pathak, P.K. & Maney R. (2006). Is liquid-based pap testing affected by water-based lubricant? Obstetrics and Gynecology, 107(1), 66-70.

Griffith, W.F., Stuart, G.S., Gluck, K.l. & Heartwell, S.F. (2005). Vaginal speculum lubrication and its effects on cervical cytology and microbiology. Contraception, 72(1), 60–4.

macondo mama said...

Wow, thanks for these great comments, everyone.

I am curious about the post by Anonymous 2 (on March 30) - are you referring specifically to Argentina when you say that they use warm water? My understanding was that they use *nothing* at all, hence the extent of my alarm. And thank you for setting me straight about my rectal exam comparison.

Michelle: Congratulations on finishing! Thank you for all the excellent information and links. When I lived in Canada, I had never had a non-lubricated pap, and when I was pregnant and post-partum, midwives did all of my exams.

HOWEVER, I now live in Argentina, and in a very small town, at that. Aside from the lack of lubrication (and warm water, as far as I know), it is a very rare doctor here who does not take total offense to a patient having any opinions or preferences about their own treatment. I have faced this with pediatricians for my kids, and anecdotes abound about how it is simply taken as offensive, arrogant and ridiculous for a patient to "intervene" in their own treatment.

In a bigger city, I would try to fight this and bounce around from doctor to doctor until I found someone remotely tolerable, but here I don't have that option. So here I am, 6 months later (!!!) and I still have not gone for my overdue pap. I don't know if I will eventually just get through it with some focused breathing, or if I will take this on as an issue and fight for my right to some lubrication.

I will keep y'all posted, though. Thanks for reading.

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