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The XX Files 

For that special someone

            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.

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