The XX Files

            To Sir with Love

            You were gentle for my first time,

            Kind and self-assured.

            It wasn’t that bad but it wasn’t
sublime.

            Just something to be endured.

            Every woman remembers her first
experience — the apprehension, the thrill of embracing her womanhood, and the
slightly queasy feeling afterwards.

            Here’s what it was like for me: I
was lying on my back and he put his hand ever so gently on my bare knee. Then,
in the kindest voice he said, “First you’re going to feel some pressure. That’s
the speculum going in. After that it only takes a moment to get the Pap smear.”

Obviously,
this isn’t about first sexual experiences. It’s about women and preventive
health care. Sorry for any confusion.

            For many women, regular pelvic and
breast cancer screenings are routine, like getting the car’s oil changed or
making a hair appointment. But some women don’t get Pap smears and mammograms
on a regular basis, and others have never had them.

            Why? There’s a whole raft of social,
cultural, and economic reasons for this. Undocumented immigrants, for example,
might avoid public health clinics for fear of detection and deportation.

            Lack of transportation is another
problem. Women without access to a car have a hard time getting to a clinic or
doctor’s office. Even with a car I
have trouble getting to my doctors’ offices nestled in suburban medical parks.
The access roads are like those handheld maze toys and I’m the little metal
ball rolling around cluelessly. I can’t fathom what it’d be like to try to get
there on foot from some distant bus stop.

            There are also language and cultural
barriers to getting good medical care. Imagine taking two buses to the hospital
and then not being able to communicate once you’re there. Or what about mothers
who neglect themselves and put their kids first — for food, health care, and
other necessities? Who’s going to take care of everyone when Mommy becomes ill?

            Healthcare experts say some recent
immigrants, especially Asians, tend to shy away from doctors’ examinations more
than we brassy Americans. And who can blame them? It’s hard to sit in a cold
little room telling a relative stranger when your last period started.

            Now that I think of it, why do I have to come from a culture where all
this stripping and spreading and Pap-smearing is considered normal?

The main
reason women don’t get regular pelvic and breast cancer screenings is
lack of insurance. In a nation where over 41 million people are uninsured —
with more joining their ranks everyday — we’re talking a lot of people.

            For example, 33 percent of Latinos
(a group that includes Puerto Ricans, Mexicans, Cubans, and Central or South
Americans) lack insurance nationally. Locally the picture is a little brighter;
21 percent of local Latinos are uninsured. But, of course, that’s still
unacceptable.

            Fortunately there are lots of people
in Rochester who are working to bring affordable health care and coverage to
the uninsured and underinsured population here — doctors’ offices, clinics,
referral services, and insurance facilitators.

            So let’s dedicate this Valentine’s
Day column to them. To the men and women who are working hard to get you to
submit to regular medical poking and prodding. To the Women’s Health
Partnership (274-6978), where bilingual operators can refer you to a doctor
who’ll charge you only what you can afford. To the Ibero-American Action League
(256-8900, x39) who’ll help anyone without insurance sign up for a reasonably
priced plan, make doctor appointments, and arrange for transportation by bus or
private car. To the Rochester Primary Care Network (325-2280), which runs
affordable medical clinics in several city neighborhoods. And especially to the
health organizations, insurance companies, and government agencies who provide
grants to fund all this medical care.

Even with
these services available, women still don’t get screenings. Let’s face it; going to
the gynecologist is no picnic. First of all, it’s just plain icky. Secondly,
it’s scary — what if they find something wrong? And finally, not all doctors
are as sweet and thoughtful as my first one. I’ve met some doozies in my
travels.

            There was the gynecologist at
college who showed my roommate a ping-pong paddle with a sad face drawn on one
side when she was diagnosed with a yeast infection. “No sex for a week,” he
said in a baby voice. He flipped the paddle to reveal a smiley face. “When
you’re all better, you can have sex!”

            With any luck, you’ll have a great
doctor who’s kind and listens to your questions. Chances are you won’t get one
like the nervous medical resident I saw once. I was his first patient. I wrote
this Valentine poem for him:

            Upon my back I lay a-quiver

            Wearing a johnny in the cold air.

            You shoved the speculum up to my
liver,

            And I think you left it there.

All
complaining aside, we still have to make that appointment and go. No use
whining about it. Think of the alternative (this is the scary part, girls): a
full half of cervical cancers occur in women who have not had Pap smears.

            That cultural reticence to go to the
doctor really hurts recent Asian immigrants who end up having higher cervical
cancer rates than whites. Instead of being caught in the early stages by a
pelvic screening, the deadly disease is found later, sometimes when it’s too
late.

            And consider this: Although Latinas
get breast cancer less often than white and African-American women, they are
more likely to die from it. That’s because they’re not getting mammograms
regularly; consequently the cancer is caught at a later stage.

If this isn’t
enough incentive, I don’t know what is. Valentine’s Day is coming and you
know what that means. Make a date with someone who really knows how to treat a
lady: your gynecologist.

This article appears in Feb 12-18, 2003.