Health: Get your hands off me!

Well-woman screenings save lives but can cause untold stress.
IN HER sixties my mother used to take herself along to the clinic for cervical smears with cheerful pragmatism. She had been a doctor's receptionist for 20 years and life to her was too precious to waste through a bit of embarrassment.

In my thirties fertility problems made internal examinations a way of life. I lost count of the number of times I had had a speculum inside me. Several years ago I needed a minor gynaecological operation and insisted on having it performed under local anaesthetic because of chronic asthma. Two painful injections into the cervix were required, but I coped well and there were none of the after-effects associated with general anaesthesia.

At my next smear the doctor thought she could feel an ovarian cyst. I was referred to hospital and had a vaginal probe scan, but nothing was found. Some time later, I underwent a hysteroscopy without anaesthetic - an unpleasant experience. Finally, I developed an aversion to the speculum, seizing up every time one came near me. Even so, when the next smear became due I dutifully went along to the clinic. The sample was found to be "technically unusable". After three unsuccessful attempts to get the speculum into me, the nurse concluded that we should leave it until after my summer holiday. I have never returned, despite several reminders from my GP. When I get as far as booking the appointment I find an excuse to cancel it. Aged 49 and menopausal, I have reached a time in my life where I no longer want the intrusion of intimate examinations.

I am educated, sensible, and aware of all that medical science has to offer. Three times I have been investigated for breast lumps - thankfully all benign - because I examined my breasts regularly, and visited my GP on finding a lump. The last time, the mammograms and needle aspirations had become less shocking because I knew what was coming. But the anxiety was appalling, especially with a prolonged wait for results the third time. The consultant's advice when I was discharged was to take advantage of NHS mammograms when I reach 50.

Reason tells me to have the smears and the mammograms. But no amount of rationalisation gets me through the psychological barrier. I no longer want anyone prodding around my body, even in order to discover whether I have a cancerous tumour which, if diagnosed early, can be successfully eradicated.

A friend, Jennifer, also has a profound aversion to well-woman check- ups. Twice since she turned 50 she has been called for mammograms, and twice she has consciously rejected the offer. She knows the indefensibility of her position, but she just can't cope with the screening process. Another friend, Megan, has not had a smear for many years and has become fatalistic. Both find their everyday lives quite stressful enough without the added pressure of screening.

How many women are struggling to survive day by day with family problems, ill health or exhausting jobs and find the prospect of screening "one stress too many"? A straw poll among my female acquaintances shows that most loathe the screening process, although most are sensible enough to accept it.

Jennifer, Megan and I know that many lives are saved by mass screening. We pray that we will not pay the price for our passive resistance. We feel silly and guilty. Yet we also believe we cannot be exceptional, and that the price of the lives saved is heightened stress levels in women across the population.

Why are men not subject to the same pressure to be screened? Testicular cancer is eminently curable if discovered early. I suspect that few men check their testicles regularly, and that there would be resistance to mass screening - even though it could save lives. And, despite the certainty that screening is a good thing, I have a suspicion that many women feel objectified by the pressure to undergo it. It does not help that women are not warned when procedures can be painful. Mammograms can be at best uncomfortable, at worst agony.

The wait for results is another turn-off. If results were available on the day of screening it would eradicate the prospect of weeks or months of low-grade anxiety. But this is unlikely to happen except for women rich enough to seek private testing. Meantime, women are faced with yet another choice in a world saturated with choices, while many men appear blissfully ignorant of the responsibility for their own health.