Woman; 023; Self Examination Part 2: Another View

No. An in-depth look we're going to be with. Last week. If you're watching this program you would have heard a discussion on menstrual extraction self-examination and the self-help groups which are growing up all over the country. Our two guests at that time were feminist mother and daughter team lolly and Jean Hutch. This week we're going to present the other side of the picture and our guests two doctors Dr. Theodore Shulman who is an obstetrician gynecologist and doctor of Virginia Rubenstein

his a practicing psychiatrist. When you first saw last week's show Shulman as a medical man what did you think of the show from the point of view of self examination self-help groups what do you think of this concept. I think it's very difficult to have any quarrel with self-help or with self-examination. We do encourage women to examine their own breasts. This self examination of the pelvic organs is new. However I think that some of the points raised by the hearses I felt could be dangerous such as the particular question the one that sticks in my mind is the early detection of cancer by examination of the cervix. I don't feel that you can detect cancer of the cervix in the early stages simply by looking at it through a speculum as they said you could you had.

What about other infections perhaps infection such as men in there. Or Seven scientists. Do you think that a woman can by Reeky observation of her set X detect such changes which might give rise to these infections. I think that in the case where the infection is full blown and she had enough experience and learned what the normal appearance was versus the abnormal appearance I think in some cases she could find these infections early. However very often. Even we who have extensive training in this find it difficult to determine these infections and have to use culture methods were examined. Tiriel had a microscope in order to determine if there's an infection. Do you think that or that there would be any headlong tips that a woman might have over the gynecologist if she herself is exempt. Observing her 70s on a week by week basis so that she is familiar with the color the tone the texture and so on whereas you perhaps see how once a year and you don't know the norm for how well the

color and texture and tone really don't vary that much. So that one could determine a great difference I think in the presence of an early infection. The color changes can occur related to a menstrual cycle and it's through the various phases of menstrual cycle when it might be able to detect what phase she's in but I think it would be very difficult to detect very early infections by herself. Dr. Lynn Stein is a psychiatrist and securely as a woman. What do you think about these groups of women setting up and establishing clinics so that they can familiarize themselves with the technology of the body is and familiarize themselves with their own reproductive and sexual guns. Well I think the consciousness raising movement is excellent. I'm unsure how they progress from this to an anatomical examination of themselves or the reason they feel compelled to follow it up so regularly.

Well what do you think the reasons. What what would your interpretation as a psychiatrist be this. I would personally feel that there's a basic insecurity there with when is the need to check when cervix so frequently wondering about changes would start to show man has told us the not so gross. I think the reassurance of having a cervix perhaps examining it once learning of the anatomy should be enough for a woman. So you don't feel that there's any real advantage on a week by week basis. Not that the hearse was presented when we were talking before the show. You raised an Aesir you said that things late as might have some problem with gender identity. Would you would you care to elaborate a little bit on this. I can think of very few analogous situations where a group of men could sit around and think of examining their own male genital organs where their motivation wouldn't be subject to question whether one would question

some latent homosexuality or really question their purpose in this type of examination I don't think there's anything so private or secret in a female examination but would you also question young doctors who wanted to specialize perhaps in neurology. Why have that proximity to the prostrate organ in the male genitalia is perhaps lightens. Well I think then they would consider going on through the training and the detecting disease treating disease and have a real purpose behind it. I couldn't understand the woman's purpose. If it was curiosity I didn't see the need to satisfy it. And week to week. Well the purpose is presumably preventative health care. I assume I know it's preventative health care but my own feeling is they might be lulled into false security by watching something develops the incipient only to their idea of normal begin to extend and they accepted pathology a little pathology as normal perhaps a bit more as normal thinking at an individual change for themselves.

Thank you said. I'll know on the one hand examining one's breast is is quite acceptable. Why shouldn't you take it one step further and examine a suffix for the same reasons. Well changes in the cervix and I think possibly Dr showmen should answer this do not occur quite so radically from month to month as changes in the breath. Do you think that non medical personnel do have this ability. To perhaps detect something such as savvy scientists which then you know if I could eliminate the weights before they have to before they get in touch with the gynecologist because very often there is a time lapse isn't there between noticing the first songs and experiencing the symptoms and perhaps during that time they could then make an appointment to go to the gynecologist and you know at some time I ordered some time delay. Well I think service side this is a poor example Samantha because an enormous percentage of women have service situs for anatomical

reasons and it's not what we would consider really a disease or pathological entity. But perhaps they could determine some of these changes. The early infections of the vagina earlier that way. But we're certainly not sure of the time elapsed between the onset of these early changes and when symptoms appear and it's very difficult to quarrel with the argument that they would find them earlier. Perhaps they would but I don't really feel that that that's significant because these infections are common infections of the vagina that we see are not would never trouble a woman to the extent of causing her any illness or decrease her lifespan or make her ill in any way. Most of them are annoying to really scientists feel that there's any one personality type that might be more attractive to this sort of thing than any other. There I really had to generalize from the personalities we saw or attach a label.

Sure man how bout that. The files they mention they keep files not only on doctors but on themselves. Would this not be a benefit if a woman were to come to your with her whole medical history of that said Last year the last two years both internal and external already charted for you. Yes but it depends upon the quality of the observations. This is where the problem lies. Random and casual observations I don't think are particularly valuable. We depend very strongly on a patient's history but not not really on the technical information ball but simply telling us how she feels and what her symptoms are rather than telling me that her cervix was blue three days before a menstrual period each month. The last 15 months I don't think that would be particularly helpful information. I think this if this becomes a tremendous problem of half our population going around examining each other or themselves and

keeping an enormous amount of paperwork in themselves which I think for the most part would not be particularly bad. You might possibly interpret this is rather a Tantalus take attitude what would your response to that. I suppose I have to interpret it as they will. That's my feeling it's a part of my feeling would be that all this attention to themselves could be directed more at their personality as a whole and understanding of perhaps a brief education into anatomy or a detailed education into their anatomy. Then they should move on to our other elements of their personality capabilities. If you can logically extend this argument to two other areas of body as well. Maybe they can learn just as well that examine their own abdomen three to four times a month to look in their throat to determine any changes. So why is no one more normal. Although it is more acceptable than they are is it

more acceptable right now simply because we have more about it which is more except I don't. Well when you examine your throat until you add in the know whatever this is considered normal when you examine your cervix this is a little sort of strange Did you feel that your reaction is perhaps a sort of phobic reaction to the unknown. I'm afraid I'm going to try to induct Rubenstein's very little better really put it in the form of a question. Do you think it's normal for any individual to examine any part of his body regularly. Now this is why I was looking at Samantha questioningly. I wasn't sure which she was referring to is more normal. I don't think that being the female genital organs makes it any more strange any stranger than not seeing any other part of one's body we had the emphasis on breasts even when I sort of picked up there from him.

I thought this was your feeling and I don't know I hadn't regarded the other examinations repeated examinations as normal. How about the s attention that the allegation that pregnancy can be detected within three to five days of conception. Do you feel about this. I don't feel you can do that there. The basis of the changes were that the cervix and the other a vagina turned blue. This occurs because of increased blood flow venous congestion congestion in the veins of the pelvis which do occur with pregnancy and it is a a sign of pregnancy. However in many women you can detect this just prior to any menstrual period so I feel it's highly unreliable and I think it would certainly be reluctant to. Say that any woman is pregnant based on that change alone. What about the softening that I mentioned as well I think the same thing is true of the uterus and lower uterine segment become softer just prior to the menstrual period too because it becomes

congested with blood. So this could either be the onset of the next repaired or the onset of pregnancy. How about syphilis they have a kind that they can detect stiffness and its incipient stages. Syphilis is a present first presenting sign in both male and female in say ulcerated area the genital organs and female on the Volga. And I don't think it's very incipient at that point it's there I don't know of any other earlier changes that occur. What do you think might be a possible psychological reaction amongst sex partners husbands and so on. To a woman getting complete autonomy over her body from the threat of part of this gaining to complete autonomy is a way of isolating oneself from their emotional response of miss the sexual response of lets you feel that good husbands might feel threatened by this film.

Well with the emotional detachment that often goes along with the sort of attitude. So so what. To sum up do you feel other limitations than self help. From a psychological point of view and from a medical and some psychological test from a psychological point of view I feel there is so much more constructive things that their energy could be directed to rather than learning the techniques of examination and following them through. Even in the context of preventive health care I don't think it's true that that's a benefit. You don't. If that were documented benefit I think it might be overwhelming and might overwhelmingly support the kinds that didn't did the examination. I'm not aware of any studies that prove it is and that's a shame and a medical point and I think from a medical point of view I think it's it can be falsely reassuring and that I think on the one hand

people will feel women will feel that they're perfectly normal when they might not be because they're simply not well enough trained to detect the abnormalities which can occur. And on the other hand that might come make them go to doctors more frequently for changes which are which are perfectly normal. You can the body is fairly good at telling you when there's something wrong. There's also the phenomenon of women in examining their breasts noticing a lump in a deliberately skipping the normal checkup where it would have been detected. Yes that's right. We've all seen putting on treatment for two or three years but this is not the norm and not the desired norm but it does happen when people feel this something that they'd like to do before they go in to have their suspicion confirmed. We see many patients who will tell us they have been examined for any given number of years sometimes it's an incredibly long time that they haven't been to a doctor and say why

and they say well I was afraid of certain length of time went by and they and they realized they didn't do it and then they become very fearful of what might be found. However you were doing it on a week to week basis. You didn't have this problem. That's not those who are surly to this very recent case of a very prominent woman who has reported herself that she carried through her business it and loving a trip abroad before presenting herself to treatment for breast cancer. Granted. They also mentioned the five minute menstrual extraction the what three basic reasons for doing this one for convenience. One is a backup method of birth control so that you could use the safer methods such as the rhythm diaphragm and so on and the other is simply an abortion. But actually before we get into this for the benefit of any of us who are not watching Lost weight perhaps you could just give a very brief explanation of what Master extraction is contained.

As I understand it it's simply a using a sterile plastic. Can you lower the catheter which is placed inside the uterus and. The debris the menstrual debris which would normally be shed would be removed rapidly you can suction it to prevent the immensities from coming on its own doing time. Or it could be used in that case it would if the patient was pregnant. Of course it would be a very early abortion and this could be up to one of which is a very simple procedure and last five minutes time. As I understand I have no. Now what are your objections first of all that they talk about doing it on a monthly basis from a convenience point of view doctor and someone about this. I feel very strongly about this point I think that a mature woman has learned to handle the inconvenient aspects of menstruation in some satisfactory way without menstrual expection.

What about as a backup method of birth control. There I react so strongly to the medical aspects of it that I find it difficult to think of the psychological aspects we're talking about as abortion I can only say that the very long term studies in a bush can show that the women who have the least psychological sequela are the ones who freely choose abortion knowing they're pregnant and choosing. How do you know that. Well with respect to it I agree with what Virginia said completely. I think there is great risk theoretically at least in repeated instrumentation of the uterus. The whole question arises as to how sterile this equipment is that they're using. Do they know how to sterilize their equipment and repeated instrumentation of the uterus we know the result result in infections and theoretically doing this 12 times a year for convenience might very well be very dangerous. It might.

I could at least as I say on a theoretical basis imagine that one could extract too much and eliminate the base of the enemy trio glands from which the tissue grows and result with no periods at all in a starved uterus. And perhaps that's going too far I don't know that that's the case but at least theoretically I can imagine that this could happen. But even more than that is we do know that repeated instrumentation does result in infection but which can be quite an uncomfortable thing and can result in hospitalization for a matter of a week or so in order to cure but it is the incidence of infection perhaps on a power with that of a IUD they made up a car lie here between the string of the IUD and instrumentation and they say that the

string is is a conduit for infection. We do know that that patients who have eye you'd need to tend to have a higher incidence of low grade infections and which need treatment. Probably due to the strain but I think there's a great difference between something which is there all the time and something which is being moved in and out of the cervix I think the incidence of that would be much higher. You said there's a danger of removing too much. Is there also a danger of doing an incomplete job. Yes but I think then of all it would happen the woman would continue to menstruate rather than a menstrual period over within five minutes. That's right winger on the frightening thing they suggested about this though which I believe they said was that one just did the procedure again. Now this is where your risk of infection sorcery. They seem to be unaware of the fact that while perhaps one other they haven't proved it the risk from one instrumentation might be acceptable followed by another 24 hours later

when they feel quite liable to infection. How about a danger have her handwriting but I think that exists. 2 there not too likely to perforate a uterus which isn't pregnant but I think the risk of purple perforation exists of creating false passages of thinking inside the circuits but really creating an extra tunnel which series do things that interfere with with subsequent fertility and with childhood diseases and a greater danger or less a danger though of having a perforated uterus with the common carrier which is plastic and flexible and that having a perforated uterus with the metal sound that which is put into the uterus to determine the size of the uterus on a regular D and C of O is one of the great maxims of medicine was never do harm. Or if there's a possibility of doing her make sure that you're able to handle it.

And I don't see how these girls would handle perforation if it occurred. Well I grace under better effect you know. And non-pregnant uterus and most of the time is totally benign. You will see all over him. He'll might be painful shortly but of course you see patient I'm going to need to do something and the abdominal cavity produced per night is good. I understand most of the clinics have the backup of one doctor one gynecologist presumably on hand for such emergencies but I don't see how these self-help groups could know. Right. Now I'm talking more in a context of a behind I think clearly to it right. What about the possibility of entering the uterus it is is this a realistic possibility of creating an air bubble which would then perhaps get into the bloodstream. Certainly if the the if rather than extracting one injected Yes particularly in a situation where the patient was pregnant even early pregnant the risk of error embolization would be worrisome.

Certain charges were. Made against they had set to code gynecological professional on this last show which perhaps you might like to ask someone with a quote which Gene hash made from Fortune magazine she said. Gynecologist over paid over scales and under utilized Jack's comment I don't feel that way at all. Certainly our air utilization seems to be very good we all the gynecologist's in Buffalo that I know seem to be as busy as they can be taking care of patients. I think that quote was probably taken out of context in some way I m not familiar with it. Do you know what the entire room. I think it was in connection with quotes occasional complication or majesty which might arise and assuming that that everything goes smoothly and abortions can be handled by

paramedics and so I think this was this was the context. Well if that kind of argument goes two ways because the tendency in the country is to provide more and better medical care for everyone. And it's true that probably we as gynecologists practice a great deal of so-called prophylactic medicine where we're looking seeing patients who basically have nothing wrong with them and reassure them there's nothing wrong. We don't turn up a great deal on our PAP smears. Even in a totally unscreened population of patients that have not who have not had pap smears for many years the chance of finding an abnormal Pap smear is only somewhere between 9 and 11 per thousand which is not very much. However the significance of to these individuals to this 9 11 per thousand is very great because if you don't do them if they're left alone probably the great majority would be dead within

70 years. So that this is true to some extent. But on the other hand how can one justify stuff stopping. What do you think about the idea of reintroducing nude with her and legalizing nude limes and having baths in the home and this sort of thing. I think particular on the births in the home. I think this is this would be a very dangerous concept if you follow the maternal mortality in the United States and watch it drop it was something like 40 per 10000 live births in in the 1920s when there were a great many deliveries at home in about 900 60 it was somewhere of the order of three to three and a half per 10000 live births which is a tremendous change. Now paralleling the use of hospitals where of course came medications out of biopics particularly to combat infection of blood

transfusions but you can't use antibiotics that effectively at least in the home you certainly can't give people blood transfusions in the home. This requires a delicate cross matching of donor blood and patient's blood in order to be sure that you're not going to cause a transfusion reaction. It is that hole that frequent a necessity. No except that you can't predict when it will mean necessarily And this is this is the whole idea certainly roughly 90 percent of deliveries that are perfectly normal. And and require don't do NOT require a highly skilled individual to perform it because they always have the feeling that for any individual woman would always say Well give me the most qualified person in the best best facility you can find. It comes down to just what do you feel about PAP's me as being analyzed or perhaps being just a tank through the Board of Health and time and then sent back to the Board of Health for analysis I the one you feel

this is possible feasible. I feel that it would have to be followed up by one. Done and done in the proper kind of procedures that the new melodies were the same as the routine examinations which are done on admission to the hospital were nurses who are more trying to do this aspart examination. If they're abnormal the fellow to buy a Pepsi or cart or inside of a Sherman thank you both very much. Thank you for being with us. We'll be back again next week. Good night. Hello I'm Samantha Dane moderator for woman each week. I'll be talking to national

and local figures on that as consenting woman as wife woman as mother and woman in the 70s. Join us this week on woman. Wednesday nights 10:30 channel 17.