Women with disabilities need health exams
Many people think a disabled woman’s only health concern is her disability and that she needs no other health examinations. But this is not true. Checkups with a health worker every 2 to 3 years, even if you feel 鐹ne, are an important way for a woman to 鐹nd health problems early, when they can best be treated.
Women with disabilities often have a hard time getting exams. You may not want to get exams because you have grown up feeling ashamed of your body. Or you may not want anyone to touch your body. Or you may already have had so many exams and operations that you do not want to see another health worker.
But because regular exams are just as important for women with disabilities as they are for all women, learn as much as possible about them from this book and other resources. Then you can ask local health workers—and demand of hospital directors and ministers of health—to make these services available to you and other women with disabilities.
This chapter has information about breast exams and pelvic exams. Getting these 2 exams is important for any woman to stay healthy. For more information about other health tests.
What regular health exams can tell you
Sometimes a person can be sick and not realize it until the problem has become very serious and difcult to treat or cure. But many health problems can be found by having regular health checkups. Some of the health problems that can be helped if they are found early are: anemia (weak blood), tuberculosis (TB), HIV/AIDS and other sexually transmitted infections, malaria, some cancers, high blood pressure, worms and other intestinal parasites, and diabetes. Any woman, whether or not she has a disability, can have these problems.
Two of the most important regular exams a woman should get are breast exams and pelvic exams. Two common cancers women develop are in their breasts and cervix, and these tests can help identify and treat them early.
How to prepare for breast and pelvic exams
You can prepare for a breast or pelvic exam by knowing ahead of time what is going to happen. Ask the health worker to talk about each step of the exam and to explain anything you do not understand. It may help to think in advance of questions to ask her.
As a woman with a disability, you may have different needs during the exams. If possible, take a friend or family member who can stay with you the whole time. Talk with the health worker about your specific needs before the exam so she can do them in a way that is safer and easier for you.
If you are deaf or cannot hear well, bring a friend with you who can use sign language to help you communicate with the health worker.
If you are blind or cannot see well, bring a friend to explain and describe the exams. Ask the health worker to carefully explain what she is doing and what you cannot see.
If you have a mobility-related disability or cannot walk well, bring a friend, or plan ahead how to enter the clinic or health center.
If you have trouble understanding or learning, and the breast or pelvic exam makes you frightened, nervous, or uncomfortable, ask for someone you trust to stay with you during the exam.
Family members and caregivers can help women who have disabilities that affect learning or understanding:
• Talk about the exams in advance. A family member or friend can explain the exams to a woman who has trouble learning. Help her understand that these exams are important for her to be healthy. Describe what will happen during the exams and answer her questions. If you can, tell her who will do the exams.
• Visit the clinic before the exams, if possible. The day before the exams, try to go with her to the place where the exams will be done.
• Have someone she trusts go with her. If she wants, a friend or family member can stay with her during the exams. If the health worker who does the exams is a man, make sure a woman she trusts stays with her the whole time.
the breast exam
A regular breast exam is a good way to make sure you do not have any signs of breast cancer. Most women have some small lumps in their
breasts. These lumps often change in size and shape during her monthly cycle. They can become very tender just before monthly bleeding.
Sometimes—but not very often—a breast lump that does not go away can be a sign of breast cancer. Many women get breast cancer which, if
not treated, can kill you. Regular breast exams ensure that cancer can be found and treated early, when it can still be cured.
A trained health worker should examine your breasts every time you have a regular check-up or pelvic exam. She will use the exam method described in this chapter.
Even though a health worker may examine your breasts every year or two, you can examine your own breasts more often.
If you cannot do it yourself, someone you trust can do it for you. It is best to get the same person to help each time. That way, the person who helps will know if something changes.
Try to examine your breasts once a month on the same day during your menstrual cycle . If possible, always do it 7 days after
your monthly bleeding starts each month. If you can do it regularly, you will learn how your breasts usually feel, and you will be more likely to
know when something is wrong. Also, try to examine your breasts when you have enough time to relax and do the exam well.
To help you remember how your breasts feel each month, make a simple drawing. Draw a large circle for the breast, and a smaller circle for the nipple. When you examine your breasts, if you feel any lumps, mark the place on the drawing. When you check again the next month, it will be easier to remember where any lumps were and if they are getting larger.
The pelvic exam can help you know if:
•you have any lumps, swelling, or sores, around your genitals. Some of these could be dangerous and may need treatment.
•you are pregnant.
•you have an infection in your womb, tubes, ovaries or vagina.
Untreated infections are dangerous.
•you have cancer of the cervix, ovaries, or womb.
•you have other problems in the womb or the ovaries, such as 洹broid tumors, endometriosis, or cysts that are not caused by cancer .
If you limp when you walk, or use a cane, crutch, or a wheelchair
If you have dif洹culty moving your body, you will know best how to move from one
position to another. Ask your friend or the health worker to help. Before the pelvic exam begins, make sure you are well-balanced and feel safe and comfortable. Before the exam, try to pass as much urine and stool as you can. The pelvic exam can easily make the muscles relax and cause urine and stool to come out. If you wear a catheter all the time, you do not need to remove it. It will not affect the exam. If you have a urine bag tied to your leg, remove it and place it either beside you or across your belly. Make sure the tube does not bend, and that it continues to drain properly.
Steps of the pelvic exam:
.1The health worker will look at your outer genitals for any
swelling, bumps, sores, or changes in color.
.2Usually, the health worker will put a speculum into your
vagina. A speculum is a small metal or plastic tool that holds
the inside of the vagina open.
She can then examine the walls of the vagina and the cervix for swelling, bumps, sores, or discharge. You may feel slight pressure or discomfort with the speculum inside, but it should not hurt. The exam is more comfortable if
your muscles are relaxed and your bladder is empty.
.3If the clinic has laboratory services, the health worker should do a Pap test
for cancer and, if needed, tests for STIs. To do a Pap test, the health worker uses a small, rounded stick to scrape a bit of tissue off the cervix. This is not
painful. You should feel only a little pressure. The sample of tissue is sent to a laboratory where it is checked for signs of cancer. If cancer of the cervix is
found and treated early, it can almost always be cured.
.4After the health worker removes the speculum, she will put on a clean plastic glove and put two fingers of one hand into your vagina. She will
press her other hand on your lower belly. In this way she can feel the size, shape, and location of your womb, tubes, and ovaries. This part of the exam
should not be painful. If it is, tell her. It may mean something is wrong.
.5For some problems, the health worker may need to do a rectal exam. She will put one finger into your anus and one finger into your vagina. This
exam can give the health worker more information about possible problems of the vagina, and of the womb, tubes, and ovaries. The rectal exam will be
easier if you push against the health worker’s finger when it first touches your anus—as if you are passing stool. This will relax the muscles around
your rectum so the exam is less uncomfortable.
If you have stiff or tight muscles Muscles can suddenly get tight and stiff during an exam. This happens mainly to women with a spinal cord injury or cerebral palsy. Sudden muscle spasms can happen when:
•you move onto an exam table.
•you are in an uncomfortable position.
•an instrument such as a speculum is put into the vagina.
•a health worker puts her fingers in the vagina or anus, as with a ‘bimanual’ or rectal exam.
If you have tight muscles, ask the health worker to go slowly so you have more time to relax. If a spasm happens during the exam, ask the health worker to stop and wait until your muscles are relaxed or soft again. Do not pull or push directly against the tight muscles. This will make the spasm worse. A friend can gently hold or support the affected place until the muscle is soft again.
The exam will be easier if you can find a comfortable position where you can relax and do not have to make your muscles tight to hold yourself in place. Or ask a friend or family member to help hold your body during the exam. If this is not possible, you can roll up blankets and put them underneath your knees.
IMPORTANT :Do not massage or rub spastic muscles. Massage will make the muscles tighter.
When you examine a woman who is blind or cannot see well
For a blind woman, going to an unfamiliar place like a clinic can be
confusing. She does not know where things are or where to go. Sometimes people treat blind women roughly or move
them around. This is not very respectful. When you guide a blind woman, do not take hold of her arm or hand. Many blind women rely on their hands to “see,” by touching. Instead, offer her your arm and let her hold your arm or rest her hand on yours. Tell her
where things are and where you are going. Then she will learn how to get around the space better on her own and will feel more comfortable during the exam.
When you examine a woman who has trouble learning or understanding
Women who have trouble learning or understanding should still get information about their health and should help make decisions about their bodies. You may need to take more time to explain things to a woman who has trouble learning. Instead of just asking her if she understands, ask her to tell you in her own words what she has learned.