“It’s like they think we don’t have sex at all,” I complained down the phone to my friend, as I boarded the bus to go home from a sexual health checkup in which I’d been reminded, many times, that the service didn’t cater to the needs of people such as me.
Ready to give my mate the full account of what had happened, I realised that maybe my fellow passengers didn’t want to be subjected to this story. So I reluctantly said my goodbyes, sat down and gathered my thoughts.
From the moment I called to make the appointment to the second I left the building, I was reminded, drip by drip, how sexual healthcare in this country is at best unwelcoming to disabled people, and at worst completely inaccessible. I just wanted the usual MOT – which we should all be getting routinely if we are sexually active – but even that proved troublesome.
When I walked into the clinic for my appointment, I stood in front of a reception desk so high I couldn’t see the three people behind it (and, as I’m 4ft tall, they certainly couldn’t see me). We had a brief and very awkward exchange, before I was ushered into a waiting room where the chairs were too high for me to mount, so I had to stand. I was given a form with tiny printed text that asked me all manner of personal questions, excluding a very important one: whether I had access needs. In fact, at no point, from the initial phone call to the appointment itself, was I asked about my access needs.
In the patient room, I was asked to lie down on a bed that was too high for me; the stirrups didn’t fit my legs so I couldn’t use them; and clinicians couldn’t find my cervix (lots of people with dwarfism, and many without, have tilted cervixes – it’s a thing).
Some of those things are inconvenient and uncomfortable; some are major access barriers. All together, they can make you feel like giving up and going home. Speaking up and pushing for better access, which places the onus on disabled people and not the people in charge of the inaccessible environment around us, can feel overwhelming and awkward – particularly in the context of sexual health.
Mine is not an isolated story, and it’s not the worst-case scenario, either. I was able to get what I needed, albeit in an undignified fashion. Others aren’t so lucky. I asked other disabled people to share their experiences, and this is what they told me.
One person told me that the sexual health clinic at their local hospital runs a walk-in service that’s located up three flights of stairs with no easily accessible lift.
Imogen Fox, a queer disabled femme, told me that when they visited a sexual health clinic, the tests they needed couldn’t be carried out because there was no hoist to move them from their wheelchair to the bed.
Someone else said they had to phone up to ask accessibility questions before booking their appointment, but phoning being the only option is an access issue in itself for those who are deaf or have neurological disabilities. Another talked about having to wait months for a home visit appointment because they couldn’t leave the house; a lengthy waiting time like this is risky if you have an infection that needs treatment.
“It took three years from receiving my cervical screening invitation to actually being able to have it,” says Lorraine Stanley, CEO of Sex With a Difference (SWAD), an organisation dedicated to improving access to sexual healthcare for disabled people in the UK. The delay was caused due to a lack of examination tables with appropriate leg supports and handles. “Luckily, my results were clear, but if there had been cancerous cells present, the delay could have resulted in my having to have a more invasive treatment.”
Disabled people are painfully aware of the accessibility barriers we face in healthcare at large. In the context of sexual health, these barriers feel somehow heavier to me; society often treats us as though we’re not deserving of sexual experiences, and/or that we simply can’t have them. Inaccessibility to sexual health only reinforces these stereotypes.
Hannah Barham-Brown, who is a GP registrar and wheelchair user, agrees. She told me that due to services being under huge strain, “it is inevitable that as human beings, staff will fall back on assumptions to speed up care provision – but this is liable to disproportionately impact disabled people, who may be assumed not to be sexually active at all.”
Later that day, I called my friend back and shared what had happened. They replied with sympathy, then added: “But the NHS is on its knees.” They’re right, of course. Nevertheless, it’s unfair, and oftentimes dangerous, that disabled people should yet again have to bear the brunt of the Tory government’s chronic NHS underfunding. We deserve opportunities to explore sex – and we deserve access to sexual healthcare, too.
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Cervical cancer is a type of cancer that occurs in the cells of the cervix, the lower part of the uterus that connects to the vagina
Cervical cancer-
Cervical cancer is a type of cancer that occurs in the cells of the cervix, the lower part of the uterus that connects to the vagina. Most cases of cervical cancer are caused by the human papillomavirus (HPV), a sexually transmitted infection. Here are various details about cervical cancer:
Risk Factors:
1. HPV Infection: Persistent infection with high-risk types of HPV is the primary cause of cervical cancer. Not all HPV infections lead to cancer, but certain strains increase the risk.
2. Smoking: Women who smoke are at a higher risk of developing cervical cancer.
3. Weak Immune System: A weakened immune system, often due to conditions such as HIV/AIDS or immunosuppressive medications, may increase the risk.
4. Birth Control Pills: Long-term use of oral contraceptives has been associated with a slightly increased risk.
5. Many Pregnancies: Having many full-term pregnancies, especially if they occurred at a young age, may increase the risk.
6. Family History: A history of cervical cancer in the family may contribute to an increased risk.
Cervical Cancer Awareness Month-
Cervical Cancer Awareness Month is recognized in January each year. The month serves as an opportunity to raise awareness about cervical cancer, its risk factors, prevention strategies, and the importance of early detection. The goal is to educate the public, healthcare professionals, and policymakers about the impact of cervical cancer and encourage actions that can reduce the incidence of this cancer and improve outcomes for those affected.
During Cervical Cancer Awareness Month, various organizations, healthcare providers, and advocacy groups may conduct educational campaigns, host events, and share information through various channels such as social media, articles, and community outreach programs. The awareness efforts often focus on the following key messages:
1. **Prevention through Vaccination:** Highlighting the importance of HPV vaccination, especially for adolescents, to prevent infection with high-risk types of human papillomavirus (HPV) that can lead to cervical cancer.
2. **Regular Screenings:** Emphasizing the significance of regular Pap smears and HPV tests for early detection of precancerous changes or cervical cancer.
3. **Risk Reduction Strategies:** Providing information on lifestyle factors that can reduce the risk of cervical cancer, such as safe sex practices, quitting smoking, and limiting the number of sexual partners.
4. **Access to Healthcare:** Encouraging individuals to prioritize routine gynecological check-ups and screenings, and advocating for increased access to healthcare services for all.
5. **Support for Those Affected:** Acknowledging the challenges faced by individuals diagnosed with cervical cancer and promoting support networks, resources, and information for patients and their families.
By promoting awareness and education, Cervical Cancer Awareness Month aims to empower individuals to take proactive steps in preventing cervical cancer and ensure that those diagnosed receive timely and effective treatment. It also serves as a platform to advocate for policies and initiatives that improve cervical cancer prevention, screening, and treatment on a broader scale.
Symptoms:
Cervical cancer may not always cause noticeable symptoms in its early stages, which is why regular screenings, such as Pap smears and HPV tests, are crucial for early detection. As the cancer progresses, symptoms may become more apparent. It's important for women to be aware of potential signs and seek medical attention if they experience any of the following:
1. **Abnormal Vaginal Bleeding:**
- **Between Periods:** Bleeding or spotting between regular menstrual cycles.
- **After Menopause:** Any bleeding or spotting after menopause, which is defined as 12 consecutive months without a menstrual period.
2. **Unusual Discharge:**
- An increase in vaginal discharge that may be watery, bloody, or have a foul odor.
3. **Pelvic Pain or Discomfort:**
- Persistent pain or discomfort in the pelvic region, especially during sexual intercourse.
4. **Pain During Urination:**
- Pain or discomfort during urination can be a symptom, though it is less common.
5. **Pain in the Lower Back or Leg:**
- Advanced stages of cervical cancer may cause pain in the lower back or leg due to the spread of cancer to nearby tissues.
6. **Weight Loss:**
- Unexplained weight loss not attributed to diet or lifestyle changes.
7. **Fatigue:**
- Ongoing fatigue that is not alleviated by rest or improved sleep.
8. **Swelling of the Legs:**
- Swelling in the legs may occur if the cancer has spread to nearby lymph nodes, causing blockages in the lymphatic system.
It's important to note that these symptoms can be caused by various conditions, and having one or more of these symptoms does not necessarily mean a person has cervical cancer. However, if any of these symptoms persist or are unusual for an individual, it is crucial to consult with a healthcare professional for further evaluation and appropriate testing.
Regular screenings, including Pap smears and HPV tests, are effective in detecting precancerous changes or early-stage cervical cancer before symptoms appear. This emphasizes the importance of routine gynecological check-ups and discussions with healthcare providers about individual risk factors and screening schedules. Early detection greatly increases the chances of successful treatment and recovery.
Diagnosis:
The diagnosis of cervical cancer involves a series of steps, including screening tests, diagnostic procedures, and imaging studies. Early detection is crucial for successful treatment. Here's a detailed overview of the diagnostic process for cervical cancer:
1. Screening Tests:
Pap Smear (Pap Test):
Description: Cells are collected from the cervix and examined under a microscope for any abnormalities.
Purpose: Detects precancerous changes or early-stage cervical cancer.
Frequency: Regular screenings are recommended for sexually active women starting at age 21, with the frequency determined by individual risk factors.
HPV Test:
Description: Checks for the presence of high-risk types of human papillomavirus (HPV).
Purpose: Identifies women at higher risk for cervical cancer.
Frequency: Often done in conjunction with Pap smears, typically starting at age 30.
2. Diagnostic Procedures:
Colposcopy:
Description: A colposcope (a lighted magnifying instrument) is used to examine the cervix for abnormal areas.
Indications: Follow-up for abnormal Pap smears or HPV tests.
Biopsy:
Description: Removal of a small tissue sample from the cervix for laboratory examination.
Types:
Cervical Biopsy: Removes a small piece of cervical tissue.
Endocervical Curettage: Scrapes cells from the cervical canal.
Conization (Cone Biopsy): Removal of a cone-shaped piece of tissue.
Purpose: Confirms the presence of cancer and determines the extent of abnormal cells.
3. Imaging Studies:
- CT Scan (Computed Tomography):
- Description: X-ray images are taken from different angles to create detailed cross-sectional images.
Purpose: Determines if cancer has spread to nearby lymph nodes or other organs.
MRI (Magnetic Resonance Imaging):
Description: Uses magnetic fields and radio waves to create detailed images.
Purpose: Helps assess the extent of cancer and identify spread to nearby structures.
PET-CT Scan (Positron Emission Tomography-Computed Tomography):
Description: Combines PET and CT scans to detect areas of increased metabolic activity.
Purpose: Assesses whether cancer has spread to other parts of the body.
4. Staging:
Description: Determines the extent and severity of cancer, guiding treatment decisions.
Staging System: International Federation of Gynecology and Obstetrics (FIGO) staging system is commonly used for cervical cancer.
5. Other Tests:
Blood Tests: Certain blood markers may be measured to assess overall health and response to treatment.
6. Genetic Testing-
Description: Identifies specific genetic mutations that may affect treatment decisions.
Indications: Considered in some cases, particularly for advanced or recurrent cervical cancer.
7. Multidisciplinary Consultation:
Description: A team of specialists, including gynecologic oncologists, radiation oncologists, and medical oncologists, reviews the diagnostic findings to develop a comprehensive treatment plan.
The diagnostic process for cervical cancer involves collaboration between the patient and healthcare providers. If cervical cancer is confirmed, the information obtained from diagnostic tests helps determine the stage of cancer and guides the development of an individualized treatment plan. Early detection and accurate diagnosis play a crucial role in improving outcomes for individuals with cervical cancer.
Stages of Cervical Cancer:
Cervical cancer is staged from 0 to IV, with higher stages indicating more extensive disease.
Cervical cancer is typically staged based on the extent of its spread, and the staging helps guide the treatment plan. The staging system commonly used for cervical cancer is the International Federation of Gynecology and Obstetrics (FIGO) staging system. The stages range from 0 to IV, with higher stages indicating more advanced disease. Here's an overview of the stages:
Stage 0 (Carcinoma in Situ):
Description: Also known as carcinoma in situ (CIS) or pre-cancerous lesions. At this stage, abnormal cells are found only on the surface of the cervix and have not invaded deeper tissues.
Treatment: Often treated with procedures like cryotherapy, laser therapy, or cone biopsy to remove the abnormal cells.
Stage I:
Description: Cancer is confined to the cervix.
Sub-stages:
IA: Invasive cancer that can only be seen under a microscope and is limited to a measured depth of invasion.
IB: Clinically visible invasive cancer confined to the cervix.
Treatment: Options may include surgery (hysterectomy), radiation therapy, or a combination of both.
Stage II:
Description: Cancer has spread beyond the cervix but not to the pelvic sidewall or lower third of the vagina.
Sub-stages:
IIA: Involvement of the upper two-thirds of the vagina but not extending to the tissues around the uterus.
IIB: Cancer has invaded the parametrial tissues (tissues around the uterus) but not the pelvic sidewall.
Treatment: Typically involves a combination of surgery and radiation therapy.
Stage III:
Description:
Cancer has spread to the lower third of the vagina or the pelvic sidewall and may block the ureters (tubes that carry urine from the kidneys to the bladder).
Sub-stages:
IIIA: Cancer has spread to the lower third of the vagina but not to the pelvic sidewall.
IIIB: Cancer has spread to the pelvic sidewall and/or may block the ureters.
Treatment: Combination of surgery, radiation therapy, and possibly chemotherapy.
Stage IV:
Description: Cancer has spread to nearby organs, such as the bladder or rectum, or has spread to distant organs.
Sub-stages:
IVA: Cancer has invaded adjacent organs, such as the bladder or rectum.
IVB: Cancer has spread to distant organs, such as the lungs, liver, or bones.
Treatment: Treatment may involve a combination of surgery, radiation therapy, and chemotherapy, depending on the extent of the spread.
Recurrent Cervical Cancer:
Description: Cancer has come back after initial treatment.
Treatment: Treatment options depend on the location and extent of recurrence and may include surgery, radiation therapy, and/or chemotherapy.
It's important to note that the specific treatment plan for cervical cancer is highly individualized and depends on factors such as the patient's overall health, the stage of cancer, and the presence of specific risk factors. Patients should discuss their treatment options and prognosis with their healthcare team. Early detection and appropriate treatment play a crucial role in improving outcomes for women with cervical cancer.
Treatment Options:
The treatment of cervical cancer depends on several factors, including the stage of the cancer, the patient's overall health, and individual preferences. Treatment options often involve a combination of surgery, radiation therapy, and chemotherapy. Here's a detailed overview of the main treatment modalities:
1. Surgery:
a. Hysterectomy:
Description: Surgical removal of the uterus, and sometimes, nearby tissues.
Types:
Simple Hysterectomy: Removal of the uterus and cervix.
Radical Hysterectomy: Removal of the uterus, cervix, part of the vagina, and surrounding tissues.
Indications: Common for early-stage cervical cancer.
b. Lymph Node Dissection:
Description: Removal of lymph nodes to check for the spread of cancer.
Indications: Often done during a radical hysterectomy.
2. Radiation Therapy:
a. External Beam Radiation:
Description: High-energy rays target cancer cells from outside the body.
Indications: Used to treat the cervix and surrounding tissues.
b. Brachytherapy (Internal Radiation):
Description: Radioactive sources placed directly into or near the tumor.
Indications: Commonly used after external beam radiation to target residual cancer cells.
3. Chemotherapy:
Description: Medications that kill rapidly dividing cells, including cancer cells.
Indications:
As Primary Treatment: Before or after surgery to shrink tumors.
As Adjuvant Therapy: After primary treatment to kill remaining cancer cells.
For Advanced Stages: To control the spread of cancer.
4. Targeted Therapy:
Description: Drugs that specifically target cancer cells or the processes that support their growth.
Indications: Used in some cases of advanced or recurrent cervical cancer.
5. Immunotherapy:
Description: Boosts the body's immune system to target and destroy cancer cells.
Indications: Investigational, with ongoing research for its use in cervical cancer.
6. Clinical Trials:
Description: Participation in research studies to test new treatments or combinations.
Indications: Offered to some patients as an option, especially in advanced or recurrent cases.
7. Palliative Care:
Description: Focuses on relieving symptoms and improving quality of life.
Indications: May be integrated at any stage, even alongside curative treatments.
Follow-Up Care:
After completing treatment, regular follow-up appointments are crucial to monitor for recurrence or any long-term effects of treatment. This may include physical exams, imaging studies, and other tests.
It's essential for individuals with cervical cancer to have open and ongoing discussions with their healthcare team to understand the recommended treatment plan, potential side effects, and the overall prognosis. The choice of treatment is personalized, taking into account the specific characteristics of the cancer and the individual's health status.
Preventions:
Preventing cervical cancer involves a combination of vaccination, regular screenings, and adopting healthy lifestyle practices. Here's a detailed overview of cervical cancer prevention strategies:
1. HPV Vaccination:
Description: HPV (human papillomavirus) vaccines are highly effective in preventing infection with the most common high-risk types of HPV.
Vaccines:
Gardasil 9: Protects against HPV types 16, 18, 31, 33, 45, 52, and 58, as well as types 6 and 11, which cause genital warts.
Cervarix: Protects against HPV types 16 and 18.
Target Population: Recommended for both males and females, ideally before sexual activity begins.
Age Recommendations: Vaccination is typically recommended for adolescents around the age of 11 or 12, but it can be administered up to age 26 for females and age 21 for males who were not vaccinated earlier.
2. Regular Screenings:
Pap Smear:
Description: Cells from the cervix are collected and examined for abnormalities.
Frequency: Guidelines may vary, but generally, starting at age 21, with the frequency determined by individual risk factors.
HPV Test:
Description: Checks for the presence of high-risk HPV types.
Frequency: Often done in conjunction with Pap smears, typically starting at age 30.
Combination of Pap Smear and HPV Test:
Description: In some cases, both tests are used together (co-testing) for enhanced screening.
Frequency: Recommendations vary; typically done every 3-5 years for women aged 30 and older.
Screening Guidelines: Follow the recommendations of healthcare providers or relevant health organizations, taking into account individual risk factors.
3. Safe Sex Practices:
Condom Use:
Description: Consistent and correct use of condoms during sexual activity can reduce the risk of HPV transmission.
Precaution: While condoms offer some protection, they do not eliminate the risk entirely.
4. Quit Smoking:
Description: Smoking is a risk factor for cervical cancer. Quitting smoking reduces this risk.
Benefits: Smoking cessation has overall health benefits and can improve the effectiveness of cervical cancer treatment.
5. Limiting the Number of Sexual Partners:
Description: Having a smaller number of sexual partners reduces the risk of HPV exposure.
6. Early Vaccination for Boys:
Description: Since HPV can also cause cancers in males and can be transmitted through sexual activity, early vaccination in boys is recommended.
7. Health Education and Awareness:
Description: Educate individuals about the risks of cervical cancer, the importance of vaccination, and the need for regular screenings.
Encourage Early Detection: Emphasize the importance of seeking medical attention for any abnormal symptoms.
8. Follow-Up Care:
Description: Women with abnormal Pap smears or positive HPV tests should follow up promptly with their healthcare providers for further evaluation and management.
9. Pregnancy Planning:
Description: Women planning to become pregnant should discuss their cervical health with their healthcare provider.
Preventive measures work best when combined, and it's essential for individuals to work closely with healthcare providers to develop a personalized prevention plan based on individual risk factors and health history. Early detection and prevention are key to reducing the incidence and impact of cervical cancer. Early detection and prevention are crucial for managing cervical cancer effectively. Regular screenings, vaccination, and adopting healthy lifestyle choices can significantly reduce the risk of developing this type of cancer. It's important for women to discuss their individual risk factors and screening schedules with their healthcare providers.
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