Patient Information

Self Examination of Private Parts" (SEPP)
Delay in its popularity and Publicity and the Present day Stage Presentation of the "Commonest Indian Female Cancer."


By Dr. Manoj Sharma,
Associate Professor Department of Radiotherapy,
Maulana Azad Medical College, New Delhi
Advisor, Cancer Control Program Govt. of NCT of Delhi.

Introduction:

The "Self Examination" in both educated and uneducated population has been one of the prime methods of cancer prevention both in India and abroad. According to one study 40 % of the breast cancers were detected due to husband's awareness. The self-examination of oral cavity has started yielding its result as gutka and pan masalas are taking its toll. Unfortunately the "Self Examination of Private Parts" (SEPP) designed and aimed at prevention of commonest Indian female cancer & known Hindu male cancer has not been taken up by the public as a daily routine due to apathy and shyness of those who are involved in cancer treatment and prevention.
The arguments for feasibility study and field trials have only delayed the flow of though and awareness of such a method of prevention for a commonest Indian female cancer. Since Ca.Cervix and buccal mucosal cancers were not the problems of developed countries the self-examinations related to these killer cancers remained either unexplored or largely unknown to public. In a country like India the problem is of lack of "Grass-root level awareness". The problem of cancer cervix is maximum in those states where literacy levels are lowest hence awareness on cancer cervix is an immediate requirement.

History:
The first ever "Self-Examination of Private Parts" was designed and popularized by the author way back in 1980. This document was the out come of series of interview with the husbands of Ca. Cx. patients. The natural history of male cancers heard from the patients was carefully transformed. While the talk related to it received a cold response in the oncological community in India, in Europe and North America the Self-Administered Cervical Screening was on its way for public utilization. The Result: No difference in stage presentation of cervix in majority of Cancer cervix dominant states in India and cancer on verge of extinction in the areas where "self-administered cervical screening" was promoted.

The Present Knowledge of those in Profession

Advising Vaginal Douches to all the females visiting the Gynec. OPD for various Obstretics and Gynecological problems as a single most effective simple method of cancer prevention was unknown to most and was not advised by any.
WHO Recommendation for Pap Smear as routine investigation along with CBC, X-ray chest and urine/stool tests for other ailments too for the "Vulnerable Population" of females was unknown to most of the practitioners, specialists and even gynecologists.
That there is an entity called "Self Examination of Private Parts" was unknown to most of the medical professionals including several oncologists.
That the popularization of visual inspection of the cervix atleast once in a year is must for the vulnerable population of females atleast in "Cancer Cervix Population Dense Zones". That the popularization of chemoprevention of cancer is the demand of the day for Indian population
.

The Steps in Drafting the Self Examination of Private Parts
1-Understanding of the
a) Etiological factors,
b) Human sexual habits and
c) Natural Progression of genital cancers (Biological behavior).

Interviewing the cancer cervix patients- Their experience of subtle changes "inside." The unusual"-feelings/bleeding/discharge/pain. Obstruction in free passage of stools or urine. Dysurea or dyschesia.

Interviewing the husbands of the cancer cervix patients- His feeling during the intercourse for preceding six months prior to final diagnosis of ca.cx. in his wife viz sense of obstruction, narrowing / shortening of vagina vis-a-vis feeling during the last trimester of pregnancy-any similarity in both? Wife avoiding sex or having painful sexual experience (dypairunea)

Husbands Attitude-towards his wife, sex, and personal hygiene.

Elaborating the Details of Symptomatology of the cancer of Uterine Cervix, Uterine Corpus, Penile, Testicular and Prostate cancers in easy laymen's language with illustrations and diagrammatic presentations.

Explaining the Methodology of Hygienic Procedures :1) Vaginal Douching,2) Prepuce retraction 3) Glans Penis cleaning. Detail descriptions of the condition called phymosis and para-phymosis and consequent dangers involved by not getting it corrected through surgery.

Understanding the psychology of those who often have unsafe sex, both marital (without condom) or extramarital (either with infected partner or with the partner whose status of infection is unknown) .

The Fundamentals of Genital Cancer Prevention
To be explained in the Pamphlet & in the articles in regional languages ,radio-talk and TV shows albeit done by the specialists in their own regional television and radio channels.

Improving the Literacy and socioeconomic levels of populations. With hard core statistical data based information of states/ countries where low ca. Cervix incidence is associated high literacy levels.
Promotion of concept of virginity till marriage.(British example).
Creation of awareness in general public on etiological factors of genital cancers.
Practice of cleanliness of genitals for both males and females.
Practice of Vaginal douches especially after intercourse.
Usage of Condom and getting habituated to it in order to provide physical barrier to sperm head proties, smegma & other genital infections. Promotion & popularization of pinhole vasectomy than tube ligation.
Six monthly Pap Smear. Or pap smear at least once in a year. Per speculum gynecological examination including visual inspection atleast once in a year and
Colposcopic acetic acid examination and its awareness in the vulnerable population of females.
Treatment of any undue and persistent vaginal discharge. Atleast once test for venereal diseases viz. STS or HPV DNA dot hybridization in those cases of persistent vaginal discharge and
An attempt to take detail sex habit history of both: female and her husband lest he or she had extramarital sex affair.
LASER/CRYO/Diathermy if Chronic Cervicitis is diagnosed.
Counseling against free / Unsafe and Polysex-both polygendri and polygamy- a recently emerging trend in metropolis and adolescent Indian school children. Advice of HPV DNA dot hybridization test in those who are at risk and who can afford it.
Identification and Notification of Post Coital Bleeding/ spotting of blood on male undergarments after intercourse.
Limited Celibacy in hypersexuals & frequent P/S examination. of their spouse.
Screening against all the STDs including HPV in case of exposure and if finances permit.
Chemo Prevention by Promotion of diets with anti oxidants and Micronutrients and
Promotion of anticancer agroforestry " One Family with at least one Fruit Bearing Plant norm"
Seeking a medical practitioners opinion if cancer can be declared as a notifiable disease as has been done in many other countries so that exact quantum of genital cancers. So far "Notifiable Disease " status is given to infectious diseases only in our country.
Improving undergraduate and post graduate teaching in gynecological oncology and urology.

Method of Popularization of Self Examination of Private Parts pamphlets.

Convincing the State Govt. "Directorate of Health" about the recent advances in preventive oncology. Orientation and education of the officer deputed for cancer control program.
Example: Govt. of NCT of Delhi Networking of Cancer Clinics in Nine District Center Hospital & Referrals.
Attaching the pamphlets to hospital OPD Slips.
Through Medical representatives to GPs for onward transmission in the periphery and small towns.
To the attendants of the cancer patients visiting cancer treatment centers. ("Hit when the iron is hot")
Through publication in the news paper/ magazines.
Through pharmaceutical firms who have done self examinations pamphlets for Breast and Oral cavity.
Thorough TV/Radio Programs-Can be presented in Pictorial Form or realistic(as has been done in case of Breast Self Examn.) or in descriptive form for Radio.
Linking with literature of Self Examination of Breast and or Oral Cavity pamphlets. It will be less vulgar than many of the ongoing live programs of some notorious channels.

The Results:
Chenglepattu ( Tamil Nadu ) Experience
First methodical cancer survey carried out in mid 1950s has created awareness hence early detection of cancer of uterine cervix and penile cancers.
Details: Caninst@md2.vsnl.net.in
The Varanasi Experience:
Down-staging of Cancer Cervix Presentation. Please see for details in the following articles published in national and international journals.
1) Asian Medical Journal, Vol. 25(11), 795-808,1982.
2) International Journal of Cancer Education. vol.3no.2,pp117-119.1988.
3) Journal of Medical and Paediatric Oncology1997Vol. 18, 54-58,1998
4) Obstretics and Gynaecology Today Vol. IV No. 6 pp 378- 385.1999.
5) Details: dr_manoj_sharma@hotmail.com


Barshi (Maharashtra ) Experience:
Descriptive epidemiological and control trials were well reported with strong positive results.
Details at bmnene@pn3.vsnl.net.in.

Tripoli (Libya)Experience
1. Opening of six Pap smear and gynecological counseling centers in Tripoli Town. Radio Telephone Talks on Gynec Cancer was a great hit
2. Publication of Self Examination of Private Parts in Arabic and its repeated review on Libyan Television.
3. Orientation of Undergraduate Students about the WHO recommendations on Pap smear and "Self-Examination Culture" in Libyan contemporary ultra conservative ways of life.

Delhi Experience:

1. Orientation and Oncological education of the Officer in-charge Cancer Control Cell Directorate of Health Govt. of NCT of Delhi and his participation in conferences of oncology related scientific societies.
2. SEPP on Hoarding & Busback Panels-for the First time in India.
3. Setting Up of 9 District Level Friday Cancer Clinics with trained Nodal Officer who teaches the SEPP & Self Examination of Breast & Oral cavity.
4. This has resulted in large telephonic inquiries from the public to the directorate of health about the method of SEPP and way to obtain the literature on it.
5. For the First time the referral Hospital of Directorate of Health i.e. LNJP has seen in shift toward more early stages of cancer of uterine cervix, there were more hysterectomies for early Ca.Cx. ever than before. This was possible due to referral by aware practitioner and by aware patient.
6. The Gynecologist at last agreed in principle to the proposal for SEPP for which they were vehemently oppose to.

Conclusions:

1. Ironically the over all incidence rates of cancer cervix after 50 years of independence has not shown much of change in India .The exceptions are few metropolitan cities & Kerala state.The Role of Literacy & Prosperity confirmed
2. SEPP teaches early recognition & prevention of genital cancers other infectious diseases often precursor to genital cancers.
3. SEPP teaches Etiological factors and early detection of the genital cancers and
4. Creates consciousness about newer detection methods such as colposcopy, serological tests for cancers
5. SEPP is in conformation to the WHO recommendation of Pap Smear in Indian child bearing female.
6. SEPP teaches the basic of genital hygiene, why is it necessary and how to practice it
7. SEPP teaches Indian males the much required respect & concern for Indian female (and her cervix) who, most often is subjected to neglect & insult.
8. SEPP literature could be helpful in population control as it links excessive child birth ,early age of marriage and "Freelance Sex" (? resulting in unwanted pregnancies and hence abortions)with cancer of uterine cervix. . It recommends usage of condom for cancer and other precursor infectious disease.
9. SEPP teaches for the first time the chemo prevention of cancer through diets and micronutrients/ antioxidants.
10. SEPP ,for the first time sends message of generating anticancer food reservoir through anticancer agro-forestry as it is the lack of these fruits and vegetables in the daily menu of the socio economic class which is affected the most by cancer of uterine cervix.

A sample of "Self Examination of Private Parts" pamphlets can be obtained from Dr. Manoj Sharma, Associate Professor, Department of Radiotherapy, Maulana Azad Medical College, New Delhi. Or by sending 10cmX 25cm self addressed envelope with postal stamp or Rs. 3/- to the following address:
Dr. Manoj Sharma
502, Kanchanjungha, Kowshambi
Ghaziabad-201010
E-Mail: dr_manoj_sharma@hotmail.com

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This leaflet , for the benefit general public through general practitioners and gynecologist is inspired by the article written by Dr. Manoj Sharma, Associate Professor Department of Radiotherapy, Maulana Azad Medical College, New Delhi and Advisor, Cancer Control Program Govt. of NCT of Delhi.
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The material and information in this article is based on personal experiences, research, and various studies conducted by the author.