"Uncomfortable position" saves women's lives

Conveying to women the importance of getting a Pap smear is close to Judith Petterson's heart. Her mother died of uterine cancer because she refused to see an OB/GYN in later life.

"The Pap smear is the first entry into identifying changes in the cervix," says Petterson, MSN, certified perinatal nurse practitioner at Medical Group of Northern Nevada in Reno. "It's valuable because it's simple to do and doesn't take very long. But getting women to have a Pap smear is a big issue."

Petterson, who developed and teaches a course on women's health issues at the Univer sity of Nev ada in Reno, reaffirms what is commonly known: "Women don't like to have this exam. It puts them in an uncomfortable position."

Another reason women ignore regular screening is because "they can't see that part of their body, so they don't notice when any changes occur," she says. "And, because of the high threshold for pain and discomfort in that area, women wait until they experience great pain before seeking help."

Petterson says women of childbearing age often see an OB/GYN for the first time when they obtain contraceptives. However, this isn't necessarily true for teen-agers who are sexually active.

"Unfortunately, many teens don't use contraception and don't want to discuss their personal sex life with a physician, so they don't see an OB/GYN," she says.

Avoiding Pap smears is not limited to teen-agers. "Many post-partum women don't get regular Pap smears, either," she says, explaining that many older women are misinformed in thinking they don't need screening after the childbearing years - when it's during this time that the risk of cancer increases.

To make the Pap smear process easier, Petter -son tries to give her patients a positive experience. "First, I acknowledge that it's not a comfortable experience. Then I walk them through what I'm doing and what I see, and I do the examination as quickly as possible. As soon as I'm finished, I have the patient sit up so they feel back in control."

She also recommends that physicians be extremely sensitive when asking patients personal questions.

Petterson's office sends patients regular reminders about getting pelvic exams. Those who don't respond are sent another notice. To reach women who don't see OB/GYNs, Petterson says family practitioners play a key role. She recommends communicating with family practitioners and even pediatricians about the need to discuss Pap smears with teens and older women and encourage OB/GYN visits. She also advises women's health centers to reach women through community lectures and literature about the importance, simplicity, and painlessness of Pap smears.

"Family practitioners are the gatekeepers for OB/GYNs," she says. "They're the ones who are seeing the people we need to reach. Physicians should ask all their female patients - particularly teenagers - every time they visit if they've had a Pap smear in the past year."