Body Wisdom: What could your body be telling you?
By Gretchen Fermann, MD
We make healthy lifestyle choices regarding diet and exercise, we don’t smoke, we practice safe sex, and we get a PAP smear as recommended. We should be pretty safe from getting a gynecologic cancer, right? Not really. Sadly, cancers of the female reproductive tract can happen to any woman. And although admittedly surprising and possibly dismaying, the only gynecologic cancer screened for is cervical cancer, through the PAP and hrHPV co-testing as previously reviewed. Screening means a test to look for disease before there are symptoms. And a useful screening test looks for something in a pre-cancerous state so as to be able to treat that and reduce the incidence of cancer. It works for cervical cancer because there is a pre-cancerous state (dysplasia) that can be screened for by a PAP and readily treated by minor outpatient surgery.
What about the other gynecologic cancers? Why aren’t we screening for Uterine, Ovarian, Vulvar, and Vaginal cancers? The answer lies in a combination of the low incidence of some of those cancers, the lack of an appropriate test, and, as in the case for ovarian cancer, the lack of both an adequate test and a precancerous form. Despite the lack of screening for these cancers, it is useful to review the early signs and symptoms of these conditions so abnormalities can be found at the earliest possible stage when treatment can be the most effective. That is where listening to your body and knowing what to look for and report to your doctor can literally be a lifesaver.
Here are some common signs to be aware of:
• Abnormal vaginal bleeding: This is bleeding that is unusual for you either because it is heavier than normal, longer than normal or coming at an odd time, like in between periods, after sexual intercourse, or after the menopause. ANY bleeding after menopause (a year of no periods) is abnormal and needs to be worked up. Most of the time, benign causes are found, but it always needs to be looked into.
• Abnormal vaginal discharge: This is discharge that is unusual for you and hasn’t responded to either over the counter remedies or prescribed medications over the phone. Again, many benign conditions are still the usual culprits, but visualization of the tissue is recommended if things are not clearing up.
• Pelvic pain or pressure: The pelvis is the region below the belly button and the location for the female reproductive structures. Persistent pains or pressure in the pelvis should be investigated to look for a gynecologic cause.
• Urgency or Constipation: How common are these, right? But we’re talking about a change from the norm with persistence, unresponsive to the usual remedies.
• Early Satiety: This means feeling full when you haven’t eaten much and it may be associated with the sensation of bloating.
• Itch, Burn, Pain, Tenderness, or Bleeding of the Vulva: Of course these symptoms can be caused by plenty of benign conditions, but if over-the-counter remedies or prescribed regimens are not helping the situation, the tissue should be inspected.
• Changes to the Vulvar skin, like rash, sore, growth, or rough area: As with the symptoms immediately above this, many women seek care early because of the pain, burn, or itch involved or the fear of an STD. Nonetheless, if an abnormal area persists for more than two weeks, especially for women who are smokers, have had a history of abnormal PAP’s and/or hrHPV, or have had previous vulvar diagnoses, seek evaluation of the skin change.
So pay attention to your body. Know what is normal for you. Trust your intuition, but be smart about it; know what to look for and bring to the attention of your provider.
Gretchen Fermann, MD, is a board-certified gynecologist practicing with Seven Hills Women’s Health Centers in Cincinnati, OH.