'Uncomfortable position' saves women's lives
For Judith Petterson, conveying to women the importance of getting a Pap smear is close to her heart. Petterson's mother died of uterine cancer because she refused to see an OB/GYN in later life.
"The Pap smear is the first entry into identifying changes in the cervix," says Petterson, MSN, certified perinatal nurse practitioner at Medical Group of Northern Nevada in Reno. "It's valuable because it's simple to do and doesn't take very long. But getting women to have a Pap smear is a big issue."
Petterson, who developed and teaches a course on issues for women in health at the University of Nevada in Reno, reaffirms what is commonly known: "Women don't like to have this exam," she says. "It puts them in an uncomfortable position."
Another reason women ignore regular screening is because "they can't see that part of their body, so they don't notice when any changes occur," she says. "And, because of the high threshold for pain and discomfort in that area, women wait until they experience great pain before seeking help."
Petterson says it's often when women of child-bearing age obtain contraceptives that they see an OB/GYN for the first time. However, this isn't necessarily true for teen-agers who are sexually active.
"Unfortunately, many teens don't use contraception and don't want to discuss their personal sex life with a physician, so they don't see an OB/GYN," she says. But avoiding Pap smears is not limited to teen-agers.
"Many postpartum women don't get regular Pap smears either," Petterson says, explaining that many older women are misinformed in thinking they don't need screening after the child-bearing years - when it's during this time that the risk of cancer increases.
To make the Pap smear process easier, Petterson says she tries to give her patients a positive experience.
"First, I acknowledge that it's not a comfortable experience," she says. "Then, I walk them through what I'm doing and what I see, and I do the examination as quickly as possible. As soon as I'm finished, I have the patient sit up so they feel back in control."
She also recommends that physicians be extremely sensitive when asking patients personal questions.
Petterson's office sends patients regular reminders about getting a pelvic exam. Those who don't respond are sent another notice. To reach women who don't see OB/GYNs, Petterson says family practitioners play a key role. Petterson recommends communicating to family practitioners and even pediatricians the need to bring up Pap smears with patients who are teens and older and encourage OB/GYN visits. She also advises health care providers to reach women through community lectures and literature about why a Pap smear is important, and that it's simple and painless.
"Family practitioners are the gatekeepers for OB/GYNs," she says. "They're the ones who are seeing the people we need to reach.
"Physicians should ask all their female patients - particularly teen-agers - every time they visit if they've had a Pap smear in the past year."
[For more information on encouraging women to get Pap smears, contact Judith Petterson, MSN, Certified Perinatal Nurse Practitioner, Medical Group of Northern Nevada, 75 Pringle Way, Suite 801, Reno, NV 89502. Telephone: (702) 789-3003.]
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