Wednesday, September 1, 2010

Delaying Routine GYN Care

Aldrich T, Hackley B.  "The impact of obesity on gynecologic cancer screening: an integrative literature review." J Midwifery Womens Health. 2010 Jul;55(4):344-56.


INTRODUCTION: Evidence indicates lower rates of breast and cervical cancer screening among obese compared to nonobese women. This integrative review examines the association between gynecologic cancer screening and body weight, as well as potential barriers to screening.

METHODS: A literature search of standard computerized databases was conducted for peer-reviewed articles published between 1950 and January 2009.

RESULTS: Twenty-three studies met the criteria for review. Of the 17 studies that evaluated rates of cervical cancer screening, 13 found obese women significantly less likely than their nonobese counterparts to have had a recent Papanicolaou test, a trend that was stronger in white women when compared to African American women. Eight of the 15 studies examining routine mammography found an inverse association between increasing body weight and recent screening, although findings generally pertained only to women who were white and/or severely obese. Possible barriers to care included embarrassment and perceived weight stigma in the clinical setting, lack of appropriately sized examination equipment, and poor patient-provider communication.

DISCUSSION: Further research is needed to clarify the challenges that obese women face in accessing care and to evaluate strategies such as ensuring the availability of appropriate equipment and supplies, the use of alternative screening methodologies, and more culturally sensitive counseling approaches that may improve screening rates in obese women.

PMID: 20630361

*Have you delayed or avoided gynecologic care because of past size-negative encounters with healthcare providers?  Or because of lack of appropriately-sized equipment?  Or other reasons related to size or weight bias?


Anonymous said...

Yes I delayed getting a pelvic exam for three years because my GP who otherwise was ok, treated me with such disgust that she had to look at my fat nethers. She then recommended WLS.

Janeen said...

Have you delayed or avoided gynecologic care because of past size-negative encounters with healthcare providers? Or because of lack of appropriately-sized equipment? Or other reasons related to size or weight bias?

How absolutely ironic that you posted this today. I had my six week postpartum check-up today. In the past, I have not delayed or avoided gynecologic care. I have always gone to my yearly exams. I didn't get one last year but it was more because I didn't feel comfortable going to a doctor in South Korea than anything else. After today though, that may end up changing. I left feeling like a puppy that had gotten kicked. As a mother to a newborn who is struggling with single parenthood at the moment, I did NOT need to have harped on me how important it is for me to lose weight and various suggestions on how to do so including bariatric surgery. And if that wasn't enough, he told me I needed to get a two hour glucose test done because the skin under my breasts feel velvety and that's a sign of blood sugar problems. And this was only a SMALL part of what I got from him today. Makes me wonder if he's all sore at me for not ending up with a cesarean.

Heidi said...

When I moved back to the States, I did put off finding a doctor and having an annual exam done because it can be so hard to find a size-friendly provider. I did end up dragging myself a year later, and this year had my exam on schedule, but I hate going, even with a reasonably size-friendly practitioner, with the fire of a thousand suns, because doctors' offices are so triggering for me.

Rosa said...

It's only one part of it - I also delay my paps because of casual pain-causing by a doctor who assured me it would just "pinch a little", and because our insurance changes every year so I'm always trying to find a doctor who takes new patients.

But the fact that the "you should lose weight" talks from the gyn started when I weighed 60 pounds less than this definitely plays a part in my procrastination.

DJ said...

Yes, I haven't been in years since I became plus sized and menopausal - most OB/GYN really seem to want to focus on pregnancy rather than older well women care and I am so self concious that I don't do any of my routine healthcare visits because all I get is suggestions on how to loose weight - I know how, following the guidelines is another whole matter. I once had a cardiologist that told me I "Had" to be on the South Beach diet - when I told him that wasn't going to happen he yelled at me as I walked down the hall "Have a short, fat life!" I honestsly haven't been to a doctor since then :(