The Problems of Women and Men

So far this has been a very depressing week as far as classes go. Our PBL case patient has genital warts and cervical cancer. The two seminars today, although interesting and well-done, were about breast cancer. This is going to go on for the rest of the week--tomorrow, we're covering male genitourinary problems, and Wednesday we're back to women. One interesting thing I noticed is that our pathology book has tons more coverage of women's health problems than men's. There are two separate chapters on women's health, one just on breast diseases and another huge one about diseases of the female reproductive tract. The sole men's health chapter is much shorter. I wonder if this is because there are that many more diseases of the female reproductive tract, or if we just know more about women's diseases?

Speaking of genitourinary tracts, this evening I did my GU exams at the Cleveland Free Clinic. It was quite an experience. Two of my classmates and I got there at 4:45, and we first got a pep talk of sorts by the woman who coordinates the medical student practice exams. She spent about half an hour telling us that we had to be professional, and giving us all kinds of ideas of how NOT to be professional that I would never have been clever enough to have come up with on my own if she hadn't described them in excruciating detail. Like, apparently in the past some med students have said they were going to the bathroom, but then bailed instead without telling anyone. She warned us not to sneak out of the clinic, or she'd have to report us to the school. I had to laugh, because as much as I was not looking forward to performing a digital rectal exam, I haven't come this far and worked this hard to let something like this stop me from getting my MD. So none of us bailed, and we managed to mostly stay awake during an incredibly boring video about Pap smears that, judging from the clothing the actors wore and the equipment being used, must have been made in the late 70s or early 80s.

After an hour of these torments, we were finally ready to do the female exam. Since there were three of us students, we were divided into one pair and one single person. I was the single person, and I had a sort of coach in the room to help me along with the patient herself. My standardized patient and the coach were super helpful, and once they started giving me instructions I got over the weirdness of the situation pretty quickly. First, we went through the breast exam, which I had done several times in longitudinal clinic already. No biggie. Then it was time for the pelvic exam. (We inserted the speculum, but didn't do the actual Pap smear.) I inserted the speculum and was able to visualize the os (opening) of her cervix on the first try. Then I tried to palpate her ovaries (I couldn't really feel them) and did the rectal exam. It wasn't too bad because I was so focused on what I was doing that I didn't even think about the grossness factor.

All that was left to do was the male exam. Since I was done first, I got to spend another 20 minutes one-on-one with the coordinator lady and hear about more blunders committed by previous medical students over the years. When the male standardized patients arrived, one of my classmates and I were paired together this time. That standardized patient was really awesome also. He started by explaining the exam, and then I went first. The male exam was a lot more uncomfortable for me than the female exam. The man was standing in front of me, and I was inspecting his penis and testes while seated, which felt pretty awkward. The weirdest part was when I was examining for an inguinal hernia. He didn't have a hernia, so I had to palpate pretty deeply into his inguinal canal to reach the inguinal ring. When he coughed I could actually feel his intestines move. After my classmate repeated the exam, we moved on to examining the prostate, which entailed yet another digital rectal exam. I was able to palpate the prostate, but it was hard to reach the far edges. Prostates are larger than I had realized.

We were finished at 9:00, and I was definitely glad to be done. Doing the GU exams wasn't as awful as some people make them out to be--you're so busy concentrating on the exam that you don't really have time to sit there and think about how gross it is. But at the same time, I am absolutely certain that I have zero desire to go into either gynecology or urology. Even though doing the GU exams wasn't all that big of a deal, I am definitely not looking to make a career out of it.