Rectal exam during gyno visit? (symptom, versus, medical, feeling)
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As to the medical professional who has been posting replies, I feel that you are not really hearing me. I recognize your argument that a rectal exam can detect cancer, but I disagree with the fact that you insist the procedure is necessary on a young woman who has no family history or symptoms. Also, it seems that many doctors disagree with you.
By your reasoning, why go the gynecologist at all then? Very few women in their teens/20's get breast or ovarian/uterine cancer, but they are still recommended to get annual gyn exams--complete breast and pelvic exams starting at age 18 or first becoming sexually active. These exams are recommended for all women, regardless of family history or symptoms.
khp - I realize that you are uncomfortable with this procedure. I believe that you had asked for opinions on this thread, which you got plenty of, including from at least one medical professional. You did not like the answers, because while they acknowledged that it was uncomfortable, distressing, embarassing, etc., most recognize the need and good judgment for doing so. If you have been unhappy with your docs for either not explaining the procedure before, during or after, then you need to keep looking for one whom you will be comfortable with. In my opinion, a physician that is remiss on this (letting you know what it is for) is doing you a grave injustice just to make you feel comfortable. Most docs will not "force" you to have a procedure, but it is incumbent upon them to discuss the risks. From the docs point of view, there may have been instances where they were sued for errors of omission. I'm sorry that you did not get the validation you needed (as to whether this was necessary or not), but opinions are exactly what you got, so I hope you take it for the intent it was given...with your interests at heart.
khp, not having any history of cancer on either side of your family is absolutely no guarantee that you won't get cancer. Niether is living a very clean healthy life. I have absolutely no cancer on either side of my family. I never eat junk food, take vitamins and have a very good daily exercise routine. Yet, I was diagnosed with ovarian cancer last winter. This is a very hard disease to diagnose. However, it makes sense not to skip your gyno exams. The rectal/vaginal exam is no big deal. It is quick and no more invasive or uncomfortable than a pap and pelvic. I certainly wouldn't skip either a yearly gyno exam or a mamogram. I'm doing very well but I shudder to think what MIGHT have happened.
A rectovaginal exam is the correct, complete method of performing a gynecologic exam, as taught in med school. The doctor who performs only a vaginal exam is actually the one who is deviating from the correct procedure. Many doctors skip the rectal part of the exam due to their own discomfort about the procedure. I remember my own queasiness over it when I was a med student that I skipped the rectal exam on one patient, and my proctor reprimanded me for doing an incomplete job.
Heather, first I would like to say that many doctors believe that a rectal exam helps them better feel the back sides of the ovaries and uterus, not to mention the wall between the vagina and the rectum.
That being said, I am glad to finally see someone on this thread who agrees with my feelings of violation.
Even though I am on vacation, I have been researching the digital rectal exam procedure and become more and more firm in my decision NOT to have one performed.
I know the medical professional on the thread disagrees with me, however I have read tons of articles that suggest that a digital rectal exam is essentially worthless and can detect less than 10% of any cancerous or precancerous polyps. Also, these articles claim that the fecal test performed with the feces from a digital rectal exam often comes back with false positives, which result in young (under 40 years old) patients getting expensive, invasive, and uncomfortable tests that are unnecessary.
For example, the Journal of Family Practice claims that a DRE rarely uncovers any hidden diseases. The American Cancer Society recommends it only in people with familial history (starting at age 40) or those over 50. Finally, the US Public Health Service says there is no evidence to support that this is a necessary test at any age and that tests for fecal blood (beginning at 40) combined with colonoscopies (beginning at 50) are the only valid detectors of colon/rectal cancer.
These are RELIABLE sources. I am not being hoodwinked by some blogsters. How much more reliable can you be concerning cancer than the American Cancer society?
I believe that DREs are performed because doctors want to be thorough; but this seems to be an "old school" practice that an increasing number of women are speaking out against.
You should have spoken up at your last gyno appointment. As you can see from my other responses, I am firm about patients voicing their right of denial. Next time, you should mention that you were extremely uncomfortable with the procedure and perhaps show her some of the articles at the end of this post. (You will have to copy and paste. I cannot seem to get the hyperlinks to work). Remember, if you feel uncomfortable, you can always go back to the doctor if you change your mind.
Thank you for making me feel like I'm not the only one out there...
khp, not having any history of cancer on either side of your family is absolutely no guarantee that you won't get cancer. Niether is living a very clean healthy life. I have absolutely no cancer on either side of my family. I never eat junk food, take vitamins and have a very good daily exercise routine. Yet, I was diagnosed with ovarian cancer last winter. This is a very hard disease to diagnose. However, it makes sense not to skip your gyno exams. The rectal/vaginal exam is no big deal. It is quick and no more invasive or uncomfortable than a pap and pelvic. I certainly wouldn't skip either a yearly gyno exam or a mamogram. I'm doing very well but I shudder to think what MIGHT have happened.
I do not and have never skipped my pap, pelvic, or breast exams. I feel very comfortable with these being performed by my doctor.
khp - I realize that you are uncomfortable with this procedure. I believe that you had asked for opinions on this thread, which you got plenty of, including from at least one medical professional. You did not like the answers, because while they acknowledged that it was uncomfortable, distressing, embarassing, etc., most recognize the need and good judgment for doing so. If you have been unhappy with your docs for either not explaining the procedure before, during or after, then you need to keep looking for one whom you will be comfortable with. In my opinion, a physician that is remiss on this (letting you know what it is for) is doing you a grave injustice just to make you feel comfortable. Most docs will not "force" you to have a procedure, but it is incumbent upon them to discuss the risks. From the docs point of view, there may have been instances where they were sued for errors of omission. I'm sorry that you did not get the validation you needed (as to whether this was necessary or not), but opinions are exactly what you got, so I hope you take it for the intent it was given...with your interests at heart.
Some clarification: I have never had a rectal exam; that response was from a different poster. I was asking if this procedure were standard, because in all my years of gyno appointments, I have never even had one suggested.
I am not offended by anyone's opinion, and am sorry if it seems so.
The only offense I take is in the tone that accompanies some of these opinions.
By your reasoning, why go the gynecologist at all then? Very few women in their teens/20's get breast or ovarian/uterine cancer, but they are still recommended to get annual gyn exams--complete breast and pelvic exams starting at age 18 or first becoming sexually active. These exams are recommended for all women, regardless of family history or symptoms.
You are right; very few young women do get cancer. I probably could go through life until age 40 without having a gyno exam.
To explain myself, there are two reasons that I get annuals: so I can renew my birth control prescription and because I am not uncomfortable in doing so. If I'm not uncomfortable, why not?
(By annuals, I mean the annuals my two gynos have performed: pelvic, pap, breast, and urinalysis).
By the way, I believe that medical professionals should be taught to do DRE's, because they will certainly need to perform them on some patients. That does not mean they should perform them on all patients.
No doctor I know wants to do a rectal exam because we somehow derive any kind of pleasure doing it. Believe me, most doctors would rather not do it. But standard of care (and threat of litigation on those who deviate from this standard) dictates that thoroughness be part of the physical exam.
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Finally! (and reliable sources)
