Tag Archives: women’s health

Pap Smears Come with an Expiration Date: Who Knew?

Debbie says:

medical cross-section of female reproductive system

I was completely surprised to learn a couple of weeks ago that virtually all medical experts suggest that most women stop getting pap smears (vaginal tests for cervical cancer) at age 65. I had one last week at age 64, and it’s probably my last one.

The basic reason for the recommendation to stop is that very few women over 65  develop cervical, ovarian, or uterine cancer.  A review of several studies concluded that the risk is quite small:

According to this review, fewer than 1 in 1000 (and possibly as few as 2 in 10,000) women aged >60 years with a history of a normal baseline Pap smear will develop cervical intraepithelial neoplasia (CIN) 3 or cancer. By comparison, women being screened for the first time had rates of CIN 3 or cancer at 2.3 per 1000 for ages 50 to 64 years, and 1.7 per 1000 for women aged 65 years.

Because this is a literature review, all of the studies had different methodologies and participants, but it seems likely that the participants were not screened for level of sexual activity, because that would probably be called out if it had happened. Since I can’t find any studies that specifically did screen for sexual activity, each of us has to make our own decision without much data.

As I’ve dug further into this, I’ve been interested both in what I can find out, and what I can’t find out, which pretty much reflects what has been studied and published, and what has not.

Here’s what I’ve gleaned:

Cervical cancer specifically is caused by human papilloma virus (HPV). Ovarian and uterine cancers, which also become less frequent as women age, are not HPV-related. All three of these are slow-growing cancers, which means that if one begins to be detectable in your middle 60s, it may not become any kind of a problem until you are 80 or older, at which point many people decide against aggressive cancer treatment.

Some reputable groups and clinics specifically recommend stopping testing regardless of sexual activity. Some recommend continued testing only if you have new or multiple partners. In a New York Times story from 2011, a gynecologist relates a delightful anecdote:

Dr. Feldman was surprised to see an abnormal Pap result in an 80-year-old patient who had been a devoted caregiver for her husband of 55 years, who had dementia. “It seemed like an odd finding,” Dr. Feldman said, until she learned her patient was having an affair with a young man she had met at Starbucks.

You have to pause for a moment to be happy for her; what a way to balance a life with a demented husband! What’s more, both the article and the rest of the literature make it clear that an “abnormal result” is not a cancer diagnosis, though we don’t know what happened to this particular woman.

But back to pap smears. For myself, with no family history of gynecological cancers, and no abnormal pap smears, I’m just done. I can stop putting my heels in the stirrups and scooting my ass down to the edge of the table. And the evidence regarding sexual activity isn’t conclusive enough for me to change this if I suddenly find new partners.  Other women may, of course, make different decisions.

 

 

 

Beauty and the Expression of Emotion: Cosmetic Botox

Debbie says:

picture showing points on the face where Botox is injected

Botox is botulinum toxin, and the reason you don’t eat food from a can that has swelled or been broken open. It’s an extremely dangerous poison, which also has some substantial medical uses, generally relief of nerve pain. It functions by paralyzing the nerves in the skin, so it limits skin motion and skin feeling. It is hugely popular for managing wrinkles and face changes in aging women. As you see above, Botox clinics are very precise about “fixing” a woman’s face.

Jean Marie at Millihelen has tried it twice:

I’d been asking various dermatologists for years if they thought I was “ready” for Botox. I never knew exactly what I meant, but hoped the experts would have an opinion, which of course they did not.

“Do you feel ready for it? What issues are you trying to address?”

I didn’t really feel ready for it. And the issue was aging in a society that cannot wait to toss me in a dumpster at the first sign of decline….

Long story short: the actual procedure takes about five minutes and a tiny bit of the type of pain we are all used to—that of a typical injection. In my hood, it costs anywhere from $200 to $500 a pop, give or take, depending on your proximity to Beverly Hills.

How much  a woman needs to worry about signs of aging varies based on lots of circumstances, but one of them is surely where she lives. As Jean Marie says, Southern California is an extremely looks-based area, and plastic surgery is common and comparatively inexpensive. As a beauty editor, she faces a different set of expectations than someone in another profession, or another part of the world.

All I really wanted was a little eye opener and maybe for that permanent, angry crease between my brows to be softened. When I smile, my crows feet are long and prominent, but they are also the signature ingredient to the outward expression of my happiness. The reverse is true of my scowl lines, or “the 11s,” as Botox marketers have rebranded them. I wasn’t interested in stunting my full smile capabilities, but maybe not being able to scowl could win me some new friends, or a promotion, or some sex, or something? …

The past few weeks have actually been not just physically odd, but emotionally trying. I’m severely self-conscious for the first time since high school. Not being able to feel a part of your body that you use constantly as a means of relating to other people is intensely frustrating. (Scarily, there’s evidence that not being able to express empathy through mimicry and mirroring inhibits the ability to feel empathy. Yikes.) … I can’t really explain to my two-year-old why her mom’s face doesn’t move the way it used to; why I can’t do any of this fun stuff she’s so fond of.

What interested me the most was Jean Marie’s conclusion:

I’ll present a half-baked theory to you here: I believe it is a tool of oppression, no less sinister and insidious for the fact that its users willingly self-administer. The primary function of Botox is to paralyze faces, locking our feelings and natural reactions inside stony facades. And it is overwhelmingly women’s faces being frozen…. And, yes, obviously, contrary to my experience, many of those women believe it does make them prettier (or have pursued it for reasons that aren’t strictly cosmetic). Fair enough. But hidden in that belief is the nefarious notion that stifling our ability to express emotion is a key ingredient of beauty.

Jean Marie is exactly correct. Despite the “you’re beautiful when you’re angry” cliche, our media-managed cultural definition of beauty doesn’t only depend on those dozens of specifics of face, hair, age, height, bodily structure, and so forth. It also depends on radiating a particular relaxation, calm, and balance. You might be thought beautiful when you’re a little bit angry, and your eyes sparkle and your cheeks brighten, but you are never going to be conventionally beautiful when you are in a fury and your face is beet-red and all your facial muscles are working overtime to keep you from crying with pure rage. You are never going to be conventionally beautiful in deep grief, when your eyes are leaking and your skin is blotchy from crying. You are never going to be considered beautiful in depression, when you can’t be bothered to manage those facial muscles the way you’ve been trained. “Beauty” of this sort is about being an easy object for the gaze (usually male) around you, and making no demands on the gazer. Emotions are demanding, and beauty can’t be.

I hope Jean Marie takes these thoughts into her work as a beauty editor; if she can find a way to write about beauty in the context of strong emotion, the ripples from that change could be significant indeed.