This is the first post in a series on preventative health care for people living with RA. Today's post is about women's healthcare, marking Cervical Health Awareness Month and the coming weeks will explore colonoscopies, endoscopies, bone density test and stress tests.
It is an unfortunate fact that many people with RA have gaps in their primary health care.
When you live with a chronic illness, you are part of a never-ending carnival of doctor's appointments, tests, more tests and more appointments. RA takes up so much room that taking care of the other parts of your health can fall by the wayside. Another aspect that can cause gaps in preventative healthcare is that many of the screening tests seem designed for contortionists and healthcare providers may not be aware of alternatives to the standard tests. If RA has affected the mobility of your joints, how can you take care of your health?
A Pap test checks for changes in the cells of the cervix, which can indicate infection, abnormal cells or cervical cancer. It is your best defense against cervical cancer. The American College of Obstetricians and Gynecologists recommends you have your first Pap test at 21 or within 2-3 years of becoming sexually active. How often you should have this test on depends on your individual situation, but under normal circumstances it's usually recommended for every two or three years. However, if you take immunosuppressants, such as methotrexate or the Biologics, it may be a good idea to be tested more often.
Normally, getting a Pap test involves removing the clothes on your lower body and hopping up on an exam table. Once there, you scoot down so your bottom is at the edge of the table and place your legs with bended knees in a pair of stirrups in a sort of frog-like position. Pain, contractures and limited mobility in your knees and hips can affect your ability to get yourself in this position. To find out alternatives, I spoke to Janis Macdonald, NP at the Anne Johnston Health Station (AJHS) in Toronto which specializes in healthcare and other services for people with disabilities.
In it turns out that there is indeed an alternative to the traditional position and an easy one, at that. Janis first learned this procedure from a colleague who had learned it in Australia and described it as follows: "the patient rolls over on their side and moves their top leg closer to the wall. If needed, a staff member can assist with holding the leg. This position allows you to see and access the vagina and it is almost easier to find the cervix this way." After the Pap test, the health provider will do a "bimanual check, in which they insert one or two fingers into the vagina to check the cervix and ovaries." This can easily be done with a woman lying on her back, no froggy position needed.
If the results of your Pap test are abnormal, there are a number of options for following up, including another Pap test or a colposcopy. Should you require further testing to investigate concerns about the uterus or ovaries, your doctor may order a vaginal ultrasound. In this procedure an ultrasound probe is inserted into the vagina.