Preventive Medicine




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Preventive Medicine:

Screening Physical Exams


Everyone seems to be talking about it. Recently there has been a shift in American medicine to focus more on screening and prevention. What needs to be done and when? That’s difficult to answer. There is controversy about which screening and prevention programs actually work, and how often they should be done. Gays, lesbians, and bisexuals clearly have different risks than the larger American public, but how this affects the types of screening and prevention we need is not well known. I will try to address many of the most common screening and prevention practices utilized by doctors and how they pertain to our community, so that you can be better educated about what you might need.

Many patients think of a screening exam as a "full physical", but many things do not need to be checked if they are not bothering you. The basics to have checked are blood pressure, height, and weight. Most experts recommend checking cholesterol every 5 years after the age of 35 for men and 45 for women, and sometimes at least once before then. Colon cancer screening should begin at age 50. However, the most important part of the visit is discussion of risk factors and prevention. For example, discussing substance abuse, domestic violence, diet and exercise, heart disease risk, seat belts, and signs of depression save many more lives than examining ears or taking chest x-rays.

For women, Pap smears and breast exams are important. There is much more controversy than I can address here over what this entails for lesbians. Cervical cancer is less common in lesbians, but does occur, so Pap smears are needed. The most common recommendation is to have annual Pap smears for 2 to 3 years, then if those are negative and you are at low risk, they may be done every 3 years. Breast cancer may be more common in lesbians. There is controversy about the usefulness of breast exams and the age at which they should began, but many doctors do them yearly. Most authorities recommend yearly mammograms after the age of 50, and some recommend it after 40.

For men, prostate cancer screening begins about age 50. Testicular cancer screening is frequently done beginning at age 15 to 20, but it’s benefits are controversial. Gay and bisexual men probably have no different risks of these than straight men.

For people who are sexually active, STD screening should be considered. This is most effectively done if you can openly discuss with your doctor what behaviors you practice with whom and what your risks are. Periodic HIV testing should be considered for all persons with risky sex practices or sharing needles. Syphilis testing should be considered in all persons with multiple sexual partners, persons having unprotected sex, and persons with other STD’s. Men having sex with men are at particularly high risk for syphilis. For these same groups, Hepatitis A and B testing should be done, and if negative, the respective vaccine should be given. Hepatitis C testing should also be considered. Although there is no vaccine, but treatments do exist. For sexually active women, gonorrhea and chlamydia screening should be considered, but there is not good evidence on screening in lesbians. While routine testing for gonorrhea and chlamydia in men is not currently recommended, symptoms such as penile or rectal discharge or chronic sore throat should be inquired about. Routine testing for men at high risk may be appropriate.

If you haven’t had a screening physical or health maintenance visit recently, you should schedule one. Because of the controversies, every doctor does things a little differently. Optimally your doctor will know you well and will know what risks you have, whether related to your sexual orientation, habits, work exposures, family history, etc., and can advise what is right for you. Your sexual orientation is often medically relevant. If you do not have a doctor you feel comfortable discussing it with, you should try to find one.


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