Is Embarrassment Hurting Your Health?
|In the summer of 1987, after enduring six months of vaginal bleeding, my mother, Rebecca Gallant, then 82, finally went to see her doctor. She was diagnosed with uterine cancer, which, during those six months, had grown dangerously widespread. Why didnt you come in sooner? the doctor scolded Mom, a favorite patient. I was too embarrassed to talk about it, she answered, blushing. My mother underwent surgery and chemotherapy. Fortunately, she survivedagainst the oddsand lived another 12 years.
Such deep reluctance to discuss intimate medical problems may be more common among women of my mothers generation, but all women can understand it. Most of us have found it difficult at one point or other to talk to a physician about some delicate matter. There are many reasons for our reticence. Understanding them can help us overcome this reserve and take better care of our health.
Much of our discomfort is rooted in how we learned to view our bodies in childhood. For example, were taught early on not to soil ourselves, so incontinence is extremely embarrassing, says Diana Dell, M.D., assistant professor of obstetrics/gynecology and psychiatry at Duke University. Similarly, we grow up believing that sexual issues must be kept secret.
Women may also keep quiet about health concerns out of fear that their doctors wont take them seriously, as indeed some doctors dont. In a national survey published in 1993 by the Commonwealth Fund Commission on Womens H9ealth, based in New York City, twice as many women as men reported being talked down to by physicians and more than twice as many women reported being told a condition was all in their heads. Jerome Groopman, M.D., a professor of medicine at Harvard Medical School, has seen this happen in his own family. When his Aunt Dorothy, 88, told her doctor she was experiencing nausea and loss of appetite, her doctor told her it was nerves. Luckily, her family didnt accept that diagnosis and pressed the doctor to look for a medical cause. It turned out that the medication she was taking for a heart condition was too strong, says Dr. Groopman. When the prescription was adjusted, Aunt Dorothy was fine.
Women worry, too, about looking foolish for being concerned over something that may be nothing. Humiliation, however, isnt life threatening. But keeping quiet about worries can be. Fay Fulton, 37, of Washington, D.C., learned this during a regular checkup eight years ago when she asked her doctor to examine a freckle on her chest that looked funny. It was asymmetrical and had doubled in size. I knew the signs of skin cancer, but the spot didnt seem that odd, she says, and I was embarrassed to take my doctors time just to ask about a freckle. She asked as an afterthought: By the way, is this something to be concerned about? It was melanoma. Fortunately, we caught it in time.
Communication also breaks down when doctors fail to ask about issues that women are reluctant to raise and when theyre uncomfortable discussing delicate subjects that do come up. In a 1998 Commonwealth Fund survey, less than half the women interviewed said their doctors had counseled them about basic health issues such as exercise, diet, smoking and alcohol use in the past year. The survey also found that the topics doctors discussed least often were sexually transmitted diseases (STDs) and violence in the home. Doctors worry that they may be insulting a patient by asking about these problems, says Owen Montgomery. M.D., assistant professor of obstetrics and gynecology at the University of Pennsylvania School of Medicine. Dr. Montgomery has found, to the contrary, that patients who want to discuss these and other sensitive issues are often grateful to doctors who raise them. But bringing them up isnt easy, especially when the issue is sex.
Women are often embarrassed to talk about sexual problems because theyre afraid something is wrong with them or theyre reluctant to share pillow talk, says Miriam Greene, M.D., an assistant professor of Obstetrics and Gynecology at NYU Medical Center in New York City and a member of FAMILY CIRCLES Health and Medical Advisory Board. Patients will talk with me for 4 minutes and then, when my hands on the door, theyll say, By the way Thats when we get to whats really troubling them.
Whats bothering women in many cases, she finds, is loss of desiretheir own or a partners. Ill want to know the reason for that, says Dr. Greene. Are they not interested in sex? Is it painful? Dr. Greene finds that no matter what the problemwhether its inability to achieve orgasm or uterine prolapse (a condition in which the uterus drops into the vaginal canal due to the weakening of supporting ligaments)once she says, Thats not unusual and I can help you with that, the patient relaxes. Then we can discuss what to do about it, she says. Sexual problems affect quality of life, and if your quality of life is not great, you ought to do something about it.
If the problem is a known or suspected STD, most women realize they must do something about it, but that doesnt make doing it any easier. When Gayle*, (names followed by an asterisk have been changed) 28, learned that a former sexual partner had gonorrhea, she made an emergency appointment with her doctor and walked nervously into his office later that day. Even thought I was single and this was the 90s, I worried about what he would think of me, she says. She helped dispel her own anxieties by telling him, Im really embarrassed to be here. He was reassuring. Well, lets see if theres anything for you to be worried about, he said. He asked about symptomsshe hadnt had anythen took a specimen to test. He didnt look at me disapprovingly or lecture me, says Gayle. He was very businesslike. I found that comforting. Later, after the tests came back negative, he talked to me about practicing safe sex, and I was ready to listen.
If a doctor is going to work with patients, he or she needs to be comfortable talking about sexuality, says Dr. Montgomery. It is not the doctors job to moralize. Physicians need to know enough and ask enough questions to help a patient help herself.
A woman may also keep mum about a problem because she thinks shes the only one ever to have it and doesnt know its common and may be treatable. Urinary incontinence is one such problem. The National Association for Continence (NAFC) reports that as many as 25 million Americans, 80 percent of them women, suffer from bladder-control problems and those who seek treatment wait about seven years to do so.
Celeste Gaspari, 48, of Burlington, Vermont, waited 10 years. Some time after the birth of her second child in 1986, she began experiencing leakage, a frequent consequence of pregnancy, which can weaken the muscles of the pelvic floor. She did Kegel exercises to strengthen these muscles, but the condition worsened, making it hard for her to run and exercise. I was embarrassed, she says. I was too young to have to deal with this. Then, in my aerobics class, I noticed that other women were skipping the jumping-jack exercises just as I was. I thought, I bet they have this problem, too. Thats when I decided to get help.
She consulted her obstetrician, who suggested a medication that might inhibit sweating as a side effect. As a runner, I didnt think that sounded right for me, says Celeste. Rather than acquiesce, she asked her primary-care physician to refer her to a specialist. Of the three suggested, she chose to see Lindsey Kerr, M.D., a female urologist in Burlington who is also spokeswoman for the NAFC. It was easier to talk to a woman, says Celeste, and Dr. Kerrs manner put her at ease. She asked when I had leakage, didnt repeat questions, sized up the situation quickly, named the tests I needed and told me my options, including risks and consequences. We tried a couple of things that didnt help, and then I opted for surgery to raise the bladder back into the pelvic cavity. It worked.
An estimated 1 million Americans are affected by some form of the even more embarrassing problem of fecal incontinence. This condition is eight times more common among women than men aged 25 to 45, largely as a consequence of difficult childbirth. (It can also be caused by birth defects, neurological disorders, autoimmune conditions, colorectal disease and accidents and other trauma.) Sadly, many cases go untreated because sufferers are too embarrassed to discuss the problem even with their doctors.
Most physicians dont query patients about incontinence, and people with severe problems are often hesitant to bring them up because they fear their only option is a colostomy, says Michael P. Spencer, M.D., a colorectal surgeon in Minneapolis, Minnesota. When women do raise the subject, they are often told its something they will have to live with.
Thats what Maxine,* 42, was told when she finally went to her doctor for help with a problem that had begun with a badly performed episiotomy during the birth of her first child in 1986. Her doctor initially prescribed exercises to strengthen the muscles around the anus. When that didnt work, we tried biofeedback, she says. When that proved ineffective, her doctor said shed just have to live with it. But I wasnt living. I had become a virtual recluse. One day after a particularly embarrassing accident, I phoned him and cried, I cannot live like this! I think that got his attention. He said he had recently learned about an implantable prosthesis designed to simulate the function of the sphincter muscle in severe cases of incontinence. I said, Lets do it. The operation took place in June 1998. I cannot tell you how much everything has changed since, says Maxine. It saved my life.
The bottom line: Patients and physicians need to be candid with each other, even if it makes them uncomfortable. There are lots of health issues women dont discuss unless doctors ask, says Cindy Pearson, executive director of the National Womens Health Network in Washington, D.C. Women have to break that cycle. You usually dont want to talk about your sexual organs or bathroom habits, but sometimes you have to. Women need to realize that doctors are trained and have confronted all kinds of things. They deal with excrement. They put their hands in live people and touch their organs. However intimate the issue, keep in mind that the doctor has heard it before, many a time, and that whatever you say is confidential. So if a doctor doesnt raise an issue, its imperative that you bring it up.
Women need to know that any concern is appropriate to discuss. I really believe the relationship between doctor and patient is a partnership that must be honored by both parties, says Saralyn Mark, M.D., senior medical adviser to the Department of Health and Human Services Office on Womens Health and an assistant professor of medicine at Yale. Doctors cant treat problems they dont know about. Says Dr. Montgomery, You need to be your own best advocate.
You can beat embarrassment. Try these 12 expert tips.