Re: Paps after hysts
From: Anna Meenan, MD (annam@uic.edu)
Tue Jan 30 09:35:46 2001
Actually, our teen and adult populations in this little farm town are
fairly different, and our teenagers are much like those in the rest of
the country, but none of them have had a hysterectomy so that is not the
question. My adult population tends to include a high percentage of
monogamous farm wives, some of them married as long as 68 years. In
making the decision whether to continue paps or not after a
hysterectomy, I take it on a case by case basis, but I don't assume that
just because they were alive in the 60's that they were promiscuous, and
I don't assume that there is no such thing as a low-risk patient. I
review their old paps, outline the risk factors, and let them decide.
And knowing that even dysplasia of the vaginal cuff is exceedingly rare
in a high-risk urban population in the 90's, I am comfortable with that.
--
Anna Meenan, MD
At Mon, 29 Jan 2001, Joanne Bulley wrote:
>
>Sexual Revolution - I guess I am starting with the mid 60's - as the
>various hippy stuff and VietNam stuff and OCPs became available. Current
>surveys indicate that by age 18 about 80% of males and 70% of females
>have had sexual intercourse with at least one partner. That includes
>here in New Hampshire - where we happen to be around 48th in teen
>pregnancy rate. Are you certain your high school population is that
>different from the rest of the country? I have had a lot of women in
>their 40's - children of the 60's - ask for advice on talking to their
>kids when the kids ask about mom & dad's sexuality because they do not
>want the kids to follow what they did in the 60's and 70's. Are you
>certain your adults are that different?
>
>I have been quite surprised in this community how many of my 60-80 year
>olds "come out" to me about their sexuality and I am surprised. It
>comes from being very open to the patients. And from a Sexual Attitude
>Reassessment workshop our Reproductive Physiology Prof in Med school
>made sure we had in the curriculum.
>
>If your teen and adult populations are that different - then you do have
>a different risk population and can approach them in the most
>appropriate manner for a low risk population.
>
>However, if you approach everyone (and you may not but it seems like
>that is what you assume is the norm) as "we in this community don't do
>those things and are low risk" you may project an image that will not
>get them to confide in you and the screening will be biased. You don't
>have to approach them as "lying sluts and scumbags" - for the majority
>of the patients are neither - even if they have had 3-5 partners during
>their sexual life between the two of them.
>
>Joanne
>
>At Mon, 29 Jan 2001, Anna Meenan, MD wrote:
>>
>>What exactly do you consider predating the sexual revolution? And which
>>sexual revolution are we talking about? The most recent studies I've
>>seen are from AJOG 1995 and NEJM 1996 and both conclude routine paps
>>after hyst not warranted if there was no CA or dysplasia before the
>>hyst. Natural hystory of vaginal dysplasia unknown and it's extremely
>>rare in women who never had dysplasia before the hysterectomy anyway.
>>And yes, there are low-risk women out there. Lots of them in my neck of
>>the woods (rural Illinois), including myself (hence my earlier question
>>about annual paps in low-risk women on OCP's). I discuss risk factors
>>with women (I never assume that all my patients are lying to me about
>>their lifestyle or that they all have scumbag partners who are lying to
>>them.) and together we decide whether we need to continue paps, though I
>>always continue them if there is any history of dysplasia, Koilocytes,
>>HPV, whatever. Pearce et al did their study on 9610 papsmears collected
>>from women at Charity Hospital in NOLA who were avg. age 52, 83%
>>African-American, and 99% at or below poverty level in 1993 and 1994, a
>>fairly high-risk population if you ask me. Found 0.05% mild to moderate
>>dysplasia and no malignancies after a mean lag time of 19 years since
>>hysterectomy. I'm just not seeing anything but anecdotal evidence that
>>we need to keep doing paps on them. Just my humble opinion.
>>
>>--
>> Anna Meenan, MD
>
>--
>Joanne Bulley, MD, FACOG
>Keene, NH, USA
>
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