DEAR DR. DONOHUE: A patient brought me your column on stopping Pap smears after a hysterectomy. You cited the recommendations of the American College of Obstetrics and Gynecology. However, these directives are only recommendations. A woman’s sexual practices are a most important consideration. I have women in my practice who are widowed or divorced, some in their 70s and 80s, and they participate in sex with one or more older men without the benefit of condoms. They are at risk of human papillomavirus transmission, which causes cancer of the cervix, vagina and anus.

Currently there is no test for human papillomavirus in males, and most men have never heard of it. They may be transmitting it to their partners. The Pap smear is one test for HPV in women. The men of today are no more enthusiastic about condom use than our grandfathers were. The burden for disease prevention is on women.

I would appreciate it if you would address this issue in your column. Men and women need to know that human papilloma virus is ubiquitous.

If people could see the fear and pain caused by testing for and treating HPV in 12- and 13-year-olds, and if they realized the lack of responsibility and accountability of males in refusing to use condoms, the new vaccines for this virus would be enthusiastically used for their children. Currently, they are not.

Until that time, every woman of every age needs to make an individual decision with her gynecologist about the time to discontinue Pap smears.

In conclusion, I want to share a story about Ann, 84, and John, 87 (not their real names). They met in an assisted-living facility where John had been very popular with the ladies. They were married two years ago. Last year Ann came in for her annual exam. Her Pap smear demonstrated early changes of infection with the virus, and her DNA test was positive for the high-risk type of papillomavirus. — C.R., MD

ANSWER: Doctor, you make a strong case that the decision to continue Pap smears ought to be something decided by a woman and her doctor. The recommendations for stopping Pap smears were for women who had had a hysterectomy with removal of the cervix. As you say, recommendations are only recommendations. They are not federal laws.

The booklet on Pap smears and cervical cancer delves into these topics more deeply. To obtain a copy, write: Dr. Donohue — No. 1102, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: My eye doctor, a glaucoma specialist, recommends a procedure done with a laser to reduce pressure in my eyes. My father was blind, and I am a bit nervous about anything having to do with my eyes. Can you expand on this procedure for me? — J.K.

ANSWER: Glaucoma is a rise of fluid pressure in the eyes (not blood pressure). The increased pressure compresses the optic nerve, the vision nerve. Unless it’s relieved, blindness results. Eyedrops often can do the job. However, lasers are now frequently used as first-line treatment. The laser beam opens the channel for fluid drainage, somewhat like unplugging a clogged drain. That fixes the problem without having to turn to medicines. It’s a very safe procedure.

DEAR DR. DONOHUE: Seven or eight years ago, I was told I had a right bundle branch block, but not to worry about it. I never understood what it is all about or how it affects me. Please explain. — B.S.

ANSWER: The right and left heart bundles are cables of tissue, like the cables that bring electricity into your home. The heart cables bring the electric impulse generated by the heart’s pacemaker to the lower heart chambers, the ones that contract and pump blood out of the heart. Your right cable has a short-circuit. The impulse still reaches the right ventricle, but it is delayed a tiny bit. It takes a detour. When there is no obvious heart disease, a right bundle branch block is not a threat to health or a long life.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.


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