Pap Smears Save Lives

Kathy Griffin was so passionate about pap smears that she got hers done on live TV

Today’s guest post is by Sarah Cosgrove. Sarah is currently a graduate student in Boston, Massachusetts. When she gets a moment to pull herself away from work, she’s a avid baker and explorer of the greater Boston area. You can follow Sarah on Twitter.

About a week ago I retweeted a link for Feminists for Choice’s blog post regarding pap smears and birth control. Before I retweeted, with my comment encouraging women to ignore the post and to get yearly exams, I read the post entirely and intently. Upon retweeting the link I engaged Feminists for Choice’s Serena in a hearty debate on Twitter about the post and the standard U.S. practice of yearly gynecological exams and pap smears. While I have on numerous occasions been denied renewal of my birth control because I hadn’t had my yearly exam, I was appalled that a blog for women, by women, would discourage yearly exams.

If, as women, we think about our yearly exams as a means to an end, motions we have to go through to get a birth control prescription, then we’re doing ourselves a grave disservice. I agree with the last points of the post – that birth control needs to be more readily and cheaply available – but divorcing the acquisition of birth control from open, frank, yearly conversations with our doctors about our bodies, about our sexual and medical history, and about the need for screening, is dangerous. Blanket suggestions to skip mammograms or pap smears put women in danger. A study reported in the media often leads women to follow guidelines that may not be appropriate for them. How do you know you don’t need yearly mammograms if you do not have a discussion with your doctor about your medical needs? The same goes for pap smears or STD blood tests, etc. If, after that informed conversation, you two mutually decide on a different course of action then is common, fine. But the conversation is key. It is, and I cannot stress this enough, essential and lifesaving.

I fear that a post such as this will be read by women looking for a reason or an excuse to avoid the potential awkwardness of a gynecological exam and pap smear. A few brief moments of discomfort once a year is a small price to pay to ensure your health. A gynecological exam and pap smear can help screen for cervical cancer, uterine or ovarian abnormalities, all issues that can ultimately lead to problems with fertility or painful surgical procedures.

Also, there’s more to birth control than preventing pregnancy. Birth control medication is just that, medication. It alters your body’s chemistry. The hormones in birth control may pose a threat to your health if you have certain blood disorders or other risk factors. Your OB/GYN is trained to ask about these potential hazards during an exam.

As a breast cancer survivor, one with an extensive family history of breast and ovarian cancer, I have always taken my health seriously. My annual gynecological exam is sacrosanct, as is a yearly exam by a breast specialist. Does every woman have the same medical concerns and needs as I do? Of course not. But should every woman express the same level of interest in her body, her medical care, and her need for screenings and exams? Yes, most definitely. I agree with the author of the post and with several of the comments posted regarding it, that OB/GYNs shouldn’t be allowed to hold a birth control prescription “hostage” to get women into their office for an exam and a pap smear. We are grown women, we should be able to monitor our bodies, take notice of changes or abnormalities and address them with a health professional as needed. But do we? Do we always know what to look for?

A quick poll of the women in my Twitter stream about their feelings on pap smears and gynecological exams gave me the following answers:

  • I love that it gives me a chance to know my body better, to know what I need to be aware of.
  • I love that my gynecologist is sensitive to queer woman and our needs.
  • The exam isn’t painful, and I am comforted that it can save my life.
  • My annual exam gives me a chance to talk about my sexual activity with my doctor, to know that I am taking the best precautions against STDs.

This blog is called Feminists for Choice. We all have choices in life. Ideally, we always pick what is best. But passing up an opportunity to talk to your doctor about your body, your health, because you don’t want a pap smear? Silly. More women need access to birth control. But I don’t ever want our vigor for that access to deter vital tests, or prevent in office visits that save lives. As women we are used to taking a backseat, putting our needs behind the needs of our careers, spouses, children, families. But assuming we’re on the right track and making the best choices regarding our health is different than knowing. A yearly check up with your doctor will assure you that you are making the best choices possible. That is true empowerment.

Comments

  1. I think being a feminists has completely altered how I view pap smears. I think women are so accustomed to not speaking about their bodies, or even shamed by what we do, and pap smears might seems like a great discomfort. But now, for me, I am very comfortable with my body and choices, thanks to all the great feminists influence, and having a pap doesn’t bother me at all. On the contrary, we should speak about it more often.

  2. I wrote the original article and I am frustrated with your rebuttal for several reasons. I didn’t discourage the idea of having a yearly appointment with your doctor to discuss health–nothing of the sort. My argument is that a woman should not be coerced into having a pap and pelvic exam because she wants a renewal prescription for birth control, when there is no medical necessity for the exam in relation to the birth control prescription.

    You don’t address at all any of my research that shows that pap smears are unreliable tests, that other countries have vastly different recommendations for pap and pelvic exams and there are other ways to screen for cervical cancer than pap smears. Also, my article doesn’t mention anything at all about mammograms, so to lump mammograms into the argument is completely irrelevant.

    To make an informed decision and truly have a choice one must have all of the facts. I absolutely support the idea that women and men see their doctor at regular intervals and discuss their health openly and honestly, which includes doctors informing women of the high false positive rate of pap smears, letting women know that a pelvic exam is not necessarily required every year, and instead of having a blanket requirement that all women need yearly pap and pelvic exams, doctors should customize the yearly exam to fit the needs of each individual. How many more women would go see the gyno more often if they knew that they would only be subjected to testing that was necessary for them personally?

    What bothers me the most is the idea that women must be required to see the doctor because they cannot be trusted to take care of their health themselves. The attitude is condescending and disrespectful. While screening for disease is beneficial, it is a choice and women should be trusted to make the decision for themselves.

    • I’m on the same page as Kim. I think that if doctors really wanted to make sure that women seek preventative care on a regular basis, they would make the process less intimidating. Women shouldn’t have to disclose that they’ve been sexually assaulted in order to get a pap minus the speculum. They should be active participants in the pap process. The entire process of doing the exam – not just the circumstances – need to be revised.

    • Kim,

      Thanks for your reply. I think our respective posts are operating in dialogue while also addressing separate issues. Following my Twitter discussion with Serena, as well as other discussions with women on and off Twitter, I was interested not only in advocating for yearly pap smears but also advocating for a sense of comfort with reproductive care generally. I greatly respect the research you have done, and perhaps I could have done a better job of noting that there are an assortment of options for women regarding their care – how they receive it, how often they receive it, etc. – but I still stand by my argument, which is that yearly exams and conversations with an OB/GYN or just GYN are essential health care measures. This point, my primary point, is separate from your post in some ways.

      Every woman is different, as I note in the post. Every woman’s body, physical and emotional needs, medical history, family history, and sexual history are different. A health care plan that works for one woman won’t work for another. This is why an educated patient needs to have an educated conversation with her doctor. THAT conversation is the key point I was trying to get across. Perhaps, as women, we need to advocate for an environment in which that conversation can occur without an exam. Perhaps we need to advocate for an option in which a blood test or a recent physical on file can take the place of a full exam for a birth control prescription. I don’t know what the best option is. I am certainly open to any and all conversations that provide women with as much care and as much information as possible. This goes for pap smears, breast exams, mammograms, etc.

      I am fearful of “blanket” statements, which I mentioned in the post. I know that a gynecological exam can be scary to some women, and is scary to a lot of women. I have never been and never will be dismissive of those fears and concerns. But I have always hoped that some of those concerns can be assuaged through an informative exam that gives women more knowledge and power regarding their bodies and lends to greater comfort.

      I don’t want to discourage regular care just because I am frustrated about how birth control is dispensed. As I noted, I have been denied a prescription because I had not received an exam. I know the frustration that comes with that process. I was trying to show women that there’s more good that can come from a yearly exam than just a birth control prescription. I am a fierce advocate for good reproductive care. It literally saved my life. I tried to show women that by have an open communication with their doctor can lead to a health plan that is right for them. Maybe that means no pap smears. Maybe that means pap smears every few years. But that is for a patient and a doctor to decide, not for a blog, or a newspaper article, or a pundit on cable news to dictate.

      I did read your post, and I read it closely. I have in the last 9 days or so, read through a great many posts on this site. The accusation that I responded to your post flippantly or without appreciation of your work or the options out there for women to explore is, in my opinion, unfair. I want the best possible situation for every women. I really wish another woman didn’t have to go through what I went through. I hope that the women who read my post go into their appointment looking forward to harnessing their health care for themselves, seeing it as an empowering opportunity to become more comfortable with their bodies and more knowledgeable about their care. Period.

      • Sarah–I appreciate and support your point that regular communication with a doctor is beneficial for the heath and wellbeing of women. I was not trying to argue against that and I agree that on many levels we are talking about separate issues. I think what got me the most worked up was your intro where you encourage people to ignore my post. I presented information about yearly pap and pelvic exams not being medically necessary for birth control, which I think is important for women to know. I did not argue women should forgo a yearly appointment with their doctor, which I think is what we now both agree is where the miscommunication lies.

        I agree that communication is absolutely key and each individual needs to work out with their doctor what is best for their health. Part of that communication is information about the tests and procedures we endure, their benefits and risks. I think one of the roles of blogs and other media outlets is to provide information that is not commonly known. Women need to know exactly what a pap and pelvic exam is for, the possible benefits and possible risks. The standard practice of requiring a pap and pelvic exam to get a renewal bc prescription is so common that it is assumed that the two are medically intertwined, when in fact they are not. While this information should come from a doctor, often times the communication is lacking for a variety of reasons, which goes to the heart of your argument. An informed person has a better chance to ask the appurtenant questions of their doctor and work out a medical screening process that is best for them. There are many things wrong with the medical system in this country including doctors being overworked and rushing through appointments without asking questions or taking the time to be involved with each individual. I have been very fortunate to not really have any bad experiences at the OB/GYN but I have been yelled at, told that the exam is required for bc, and one doctor could not hide her absolute shock and appall when I shared that my husband and I were considering never having children. These are personal opinions that a doctor has no business casting judgment or commenting on whatsoever. Not to mention those who are traumatized or have much more complicated issues than I, who need a much better system of healthcare.

        I was not the one to accuse you of not reading my article closely, but I do admit that at first it did seem like that. I think we have resolved that I was not discouraging women to see their doctors regularly and that you are supporting the practice of yearly doctor’s appointments.

        I really do think that disenfranchising the two ideas, birth control and regular interactions with the OB/GYN would be much more beneficial for women. Women would be less reluctant to see the OB/GYN because it would no longer automatically equate to a pap and pelvic exam and women would actually have a discussion with their doctor about their health needs. Then, which ever medical tests are deemed necessary can be carried out on what ever time frame is best for the patient.

        In the end I think we’re mostly on the same page. For me, I think its really important to have the knowledge in order to have the ability to harness your own healthcare.

    • Stop sooking ! It doesn’t hurt 1 little bit.. Gosh this world has some MAJOR SOOKY BABIES !!!! There are millions of people that have problems far more important than you sooking about having a pap smear to get more birth control. Seriously get over it !!!!!

      • Elizabeth (Aust) says:

        What an insensitive and judgmental post…dismissing the way other women feel is unacceptable.
        For too long the system has encouraged women to judge other women’s feelings and to silence any honest discussion, thankfully, those days are over.

      • Elizabeth (Aust) says:

        I’d also suggest you do some reading, pap tests have nothing to do with birth control, denying women reliable birth control to force a test that legally and ethically requires our informed consent is coercion, this is about legal rights and our health. Very few women benefit from pap testing and no one benefits from testing before age thirty or too often and Australia and the States have always seriously over-screened, far too often and far too early, which does nothing more than produce huge numbers of false positives and lead to potentially harmful over-treatment.
        We now know that 95% of women aged thirty and older are not at risk from cc, they’re HPV negative, they cannot benefit from pap testing…take a look at the new Dutch program, which also includes a reliable self test HPV device.
        Beware, you may even start to feel angry yourself, that you have also been deceived….and others have taken risks with your health.
        HPV Today, Edition 24 sets out the new Dutch program that will save money, more lives and spare most women from unnecessary pap testing and over-treatment.

  3. wonderwoman says:

    Umm, I don’t think Sarah read Kim’s post very thoroughly. Kim said paps are good – but she advocated for a change in the procedure. Not sure why that’s a reason to belittle her arguments. Read the entire post, not just the headline, before jumping to conclusions!

  4. “a few brief moments of discomfort” does not adequately describe any pap smear that I have ever had. Best case scenario was serious pain during, worst case scenario was serious pain all day (though I have never had such problems with penetrative sex). “The exam isn’t painful” is a total lie for me. Forcing people to have pap smears to get unrelated health care is a symptom of a larger problem-a system where doctors rarely listen to and respect patients. If I could find a doctor that considered my being in pain every waking second of every day for a third of my life as fucking important as the fact that I am fat, maybe then I’ll take this crap about how doctors should be trusted more seriously.

    You know what I learned from my gynecological exams? 1) I am fat. As if I didn’t know that one already. 2) Doctors do not listen when you are clearly vocalizing that something is painful, 3) I know more about STD spread than her, 4) my terse description of sex acts in non-gendered terms (for example, “I only had oral sex with my last partner”) to avoid having to discuss my gender and sexuality with someone likely to have a poor reaction gets judgemental comments about the ‘weird’ lack of penetration.

    I actually have what my friends jokingly call ‘doctor’s appointment drag’ so I can get my thyroid problems dealt with without having to deal with ridiculous drama. My ability to access even disrespectful low quality health care is dependent on my ability to lie. Yeah, tell your doctor that you are kinky, genderqueer and bind your breasts, and that sometimes you think of killing yourself, not because you hate being queer, but because your daily level of physical pain is so bad. You’d be lucky to get out of there without being locked in a mental institution, let alone being able to get, say, an antibiotic for your sinus infection.

    • Cat, you bring up such an important aspect of this debate. Trans folks definitely have a worse time of it at the gyno that cis-gendered folks. Thanks for bringing that into the discussion.

      • I agree that the requirement for a pap smear to obtain a prescription for a drug is archaic and coercive. The results of a pap smear have no impact upon whether or not it is medically advisable to take the Pill. As was mentioned, high blood pressure is something to screen for, also whether or not the client smokes cigarettes, has a family history of heart disease or blood clots, or is at risk for stroke. The Pill is known to increase risk for those particular health problems. A pap smear does not test for any of those things and is an invasive procedure where screening for high blood pressure and family history is not.

        Kimberly did not attempt to dissuade anyone who chooses to have a pap smear from doing so, or advocate against pap smears in general, she was discussing divorcing an unnecessary and intrusive medical procedure from the process of obtaining the Pill for the very simple fact that results of a pap smear are unrelated to whether or not the Pill is a healthy choice for the client.

        I myself do have a yearly screening because I have a history of cervical dysplasia. My doctor explains every step of the procedure to me, is always respectful, as gentle as possible, answers all questions I might have. Because of the false/positive risk, if my initial results come back indicating a recurrence of dysplasia, I wait a few weeks and have another test done.

        I am very fortunate to be a client of a great community health care centre with largely female staff, who work within the community at harm reduction, consciousness raising, and are very inclusive and respectful of all clients and their choices. Cat, I wish you could go to my doctor, she wouldn’t raise an eyebrow and would treat you with the respect you deserve.

  5. As an Australian woman, I was totally shocked to hear what American women are put through just to get simple birth control. Getting a pap smear is, and should BE, a choice, not a demand or a law.

    When I was on the pill I got a blood pressure check, a discussion, and handed my script. No worries. In America, it’s a pap smear, a pelvic exam, and a rectal exam (if you’re really unlucky!), and then come back in a year to do it all again. You’ve got to be kidding!!

    Women should be able to decide for themselves that if pap smears are not in their best interests, they should be able to get birth control with just a blood pressure check. But does that really happen in America? From the stories I’ve been reading from women all over the net, from American friends, that’s a very big NO! It is shocking to hear of so many women being put through unnecessary pain and humiliation just to get the pill.

    For myself, cervical cancer is too rare (the death rate is less than 2 women per 100,000 – less than brain tumors!!) and the pap smear too unreliable (62% is the best you’ll get, but it is mostly rated at 50% – ask your Gyno about that! I am not joking), and I am a sexually low risk woman. I therefore decline optional cancer testing. IN fact, I’m 36 and I’ve never had a pap smear, and I will never have one, but try telling that to a doctor in America when you want the pill!

    It is a shocking and desperately sad situation for women in America. Very sad.

  6. As an Australian where yearly exams with a gyn are NOT routine, (just like most other parts of the world), I read with amusement when American women are convinced that their bodies are ticking time bombs that need this yearly surveillance. True empowerment is believing that womanhood is not a disease. The fact that Australians have a longer life expectancy and far lower hysterectomy rates than the U.S speaks volumes that these routine yearly tests are not of benefit to the female population but rather to the gyn’s bottom line.

  7. Elizabeth (Aust) says:

    I find it quite sad that American (and German) women think they need to see a gynaecologist every year of their life. (and frightening)
    As an Australian woman, I know these exams are unnecessary and more likely to harm you, and that’s a fact. 1 in 3 American women will have a hysterectomy by age 60 – a whopping 600,000 every year. You also have massive numbers of cervical and breast biopsies – 95% of you will be referred for colposcopy (and usually some sort of biopsy) to cover a risk of lifetime cervical cancer that is 0.65% (less than 1%) See: SEER statistics. Look at any health forum and there are very young American women who’ve had multiple aggressive cervical treatments for “dysplasia” or “pre-cancer” – these women wouldn’t even be tested in many countries and their health would be protected…given your doctors test these women, they should at least opt for conservative management of abnormal results. The facts are: cancer is VERY RARE in women under 30 (and rare in all age groups) while false positives are very high. Testing also usually misses the rare case that occurs in a woman under 30. (false negative)

    I’d say an informed woman would take the time to LOOK at the facts for herself…and ask lots of questions, who’d take charge of her health, not allow herself to be carried along by the system. (and I’m speaking generally there)
    The well-woman exam is not recommended here or in the UK (nor in many other countries) Why?
    It’s of poor/low clinical value in asymptomatic women and exposes your healthy body to risk – in the absence of symptoms, the bi-manual pelvic exam, rectal and recto-vaginal exam risk your health. The routine breast exam is not recommended either, because it doesn’t help, it doesn’t bring down the death rate from breast cancer, but leads to biopsies. The Nordic Cochrane Institute have done some research in that area and “Hands off my chest Dr” contains some commentary by an English Dr about the subject.

    The refusal to provide women with reliable birth control until they submit to unnecessary exams or optional cancer screening is appalling – an unplanned pregnancy or abortion carry far more risk to your life/body. This “requirement” says to me that control of women is the agenda, I suspect for profits.
    I know ACOG are now calling for girls as young as 13 to attend yearly for exams – there is, of course, no clinical need for these exams and naturally they didn’t feel the need to provide any….such is the level of disrespect and arrogance – those exams will damage young girls, mentally and physically. I cannot tell you the outrage that would occur here if such a thing were even suggested…but it seems American women are so conditioned to accept orders, that these things go by without a ripple….(and I’m not blaming American women, they are subjected to a barrage of devious “information” from birth to grave) Just watching some of your health shows, the dishonesty and manipulation is shocking….no wonder many American women need this reassurance every year, fearing their bodies will explode without this medical scrutiny, surveillance and control. It’s only when you haven’t been subjected continually to these messages that you can see straight through the speaker.
    My American colleagues all receive their health care in Hong Kong, they gave up on your doctors years ago and all have better health as a result – physically and emotionally. (while on business)
    Pap tests are exactly like colonoscopies, PSA testing, mammograms, FOT – all options, nothing more…cancer screening is always a gamble – there are risk and benefits so every man and woman should assess his/her level of risk and do as they see fit. Informed consent is a legal and ethical requirement for all cancer screening. As a low risk woman, I made an informed decision to pass on pap tests, my risk was near zero, while the risk of a false positive, sooner or later, was 77% with the Australian program and even 35%-55% with the Finnish program. IMO, far too high for a near zero risk.
    I don’t see a Dr every year unless I have a health problem – I believe I have better health “because” I’ve made informed decisions about preventative care. I also believe every man and woman is entitled to the truth about screening, men seem to get the truth, while women usually get half-truths with important risk information omitted – that must change. Even in this country, we need greater transparency in cancer screening and more respect for informed consent. Of course, our problems are tiny compared to your problems.
    I believe more and more American doctors will prescribe the Pill with a simple blood pressure test – while the doctors forcing unnecessary or optional exams will have fewer and fewer patients.
    More doctors WILL adopt evidence based medicine and respect a woman’s right to choose. Dr Robert Hatcher from the Managing Contraception site has had some strong words to say in this debate, also there was a news feature recently – “Women after birth control get unneeded pelvic exams”.
    Daniel Grossman and others are also campaigning for OTC access for the Pill – some say American women will have that option within 5 years. The Pill has been proven safe over decades and should be available OTC – as it is in many countries. Men can get Viagra everywhere….
    Hopefully, that will happen here as well, but the discussion is fairly low key here probably because women can access the Pill without medical barriers.
    The reality of the American system is less or no medical care for many women – having browsed the health forums, many American women have adopted my colleague’s actions and now get their health care overseas or use on line pharmacies. These barriers are forcing many women away from or excluding them from all health care. Women, like men, should be free to have a two-way respectful relationship with a health care provider – it should not be dictator and subject.
    Good luck to all of you….

  8. Alison (Aust) says:

    Unnecessary pap smears and coercive pelvic exams are a feminist issue. The pressure to screen for such a rare cancer is a human rights violation where the gendered abuse of bodily autonomy is focused directly on women.

    Cervical cancer is rare a woman’s lifetime risk is about 1% (0.68%), Pap screening only examines two types of the HP virus which is a common STI that usually clears up on it’s own without any medical intervention. There are more risks involved if a woman chooses to screen, such as the high possibility of a false positive Pap smear result, Angela Raffles’s evidence (check sources below) suggests that most abnormal tests are the result of lesions that do not advance on to cancer. An abnormal pap smear on a healthy women may require further intervention such as colposcopy and biopsy, tests that are humiliating and painful and produce anxiety about the possible findings. This may require further follow-up with Cone biopsy possibly leading to LEEP and surgery and the risk of damage to the cervix such as; cervical stenosis, hysterectomy and infertility.

    Women are under surveillance by our medical establishment and we have been taught from an early age to submit to the authority of our physicians. Most women don’t question that authority and trust that all exams and procedure’s are for our own good.

    So how is blindly allowing such a paternalistic practice to continue a feminist choice?

    Australian feminist Germaine Greer wrote a chapter on the dangers of cervical screening. (1999 ‘The Whole Woman’, Random House, pp. 135-147)

    “Men have the right to take care of themselves, or not, as they see fit, but women are to be taken care of whether they like it or not. Screening is many times more likely to destroy a woman’s peace of mind than it is to save her life. Women are driven through the health system like sheep through a dip. The disease they are being treated for is womanhood.” (p.147)

    I know very few men that are pressured to the same extent as women to have their ‘annual’ prostate check, and prostate cancer is far more common than the cervical cancer, testicular cancer is rare like cc and yet nothing is ever mentioned about men screening for that.
    Why is this do you think?
    Maybe institutionalised male privilege allows men to make an informed choice and actually provide them with the information to make that choice.

    Just because you like your doctor doesn’t mean they have your best interests at heart, they are in an industry that needs sick people to turn a profit, they are like any other business, especially specialists like OBN/GYN’s, a lot of income is derived from collecting pap smears added to that is an extra hidden incentive to screen more women, and the usual follow up procedures if you’re unlucky enough to get a positive result, it all helps keep their business profitable.

    Another issue that I find appalling is the number women that are suffering from PTSD after being coerced into a pelvic exam and Pap smear, especially teenage girls that don’t feel they have a choice. These women suffer from psychological symptoms simular to rape victims, such as; a sense of violation, humiliation, loss of dignity and powerlessness, and the similarity to rape is that they are being told if they don’t they submit to being penetrated by a metal object or the doctors fingers they might die, or have their reproductive rights withheld (obtaining bc in the US).
    We need be clear that rape is about power, not sex, and doctors’ use their established authority to control the way people think on the ethics of bodily integrity. Medical practitioners that believe their medical opinion must take primacy over our feelings and our decision-making, are abusers of the powerful position they are in over frightened and vulnerable people.

    I get really disappointed by the lack of compassion and bullying from women… Denying someone’s feelings of trauma and violation equates to further abuse. NO WOMAN should have to feel that she is not being heard or have her experience trivialised, and yet this happens a lot, when it comes to having a regular pap smear; you ‘must’ have your vagina looked at or else… I have heard women telling other women to ‘suck it up’, ‘get over it’, ‘stop being a baby it’s for your own good’, ‘I don’t have a problem with it so you shouldn’t either’ and so on…

    Is this ethical behaviour for women that identify as feminists?

    As feminists we should encourage all women to strengthen and support our right to make our own decisions, to research the facts for ourselves and make informed decisions about our bodies and about our healthcare. This, in my opinion is the foundation of feminism.

    Research to start with:

    Honesty about new screening programmes is best policy.
    A.E.Raffle,
    http://www.bmj.com/content/320/7238/872.1.full

    Women, Informed Consent and Cervical screening.
    Andrew Rouse
    http://www.bmj.com/content/320/7238/872.1/reply

    Outcomes of screening to prevent cancer: analysis of cumulative incidence of cervical abnormality and modelling of cases and deaths prevented, BMJ. 2003
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC153831/

    Joel Sherman, MD
    http://patientprivacy.blogspot.com/

    http://www.kevinmd.com/blog/2009/11/informed-consent-missing-pap-smears-cervical-cancer-screening.html

    Pelvic Exam Prerequisite To Hormonal Contraceptives: Unjustified Infringement On Constitutional Rights, Governmental Coercion, And Bad Public Policy.
    Heather S Dixon, 2004
    http://www.law.harvard.edu/students/orgs/jlg/vol27/dixon.php

    Top 20 Cancers Australia
    http://www.statistics.cancerinstitute.org.au/prodout/top20/top20_arhsres_incid_dstd_2004-2008_extall_NSW_P.htm

    Cervical Screening: Women’s Resistance to the Official Discourse
    http://etheses.nottingham.ac.uk/485/

    En-Gendered Surveillance: Women on the Edge of a Watched Cervix
    http://www.surveillance-and-society.org/ojs/index.php/journal/article/viewArticle/cervix

    Blogs/ Forums

    A forum of exceptionally informed women
    http://blogcritics.org/culture/article/unnecessary-pap-smears/comments-page-78/#comments

    Against All Evidence
    http://againstallevidence.wordpress.com/2010/12/30/cervical-screening-lies-part-1/#comment-189

    Women Against Stirrups
    http://womenagainststirrups.proboards.com/

    Why I’ll never have another smear test, Anna Sayburn
    The Guardian, Thursday 22 May 2003
    http://womenagainststirrups.proboards.com/index.cgi?board=gynmyths&action=display&thread=26

    Violet to Blue
    http://violet-to-blue.blogspot.com/2009/12/smear-testing-pros-cons-and.html

    Medical Autonomy Chronicles: The Virgin Pap Smear
    http://randombabble.com/2010/09/01/medical-autonomy-chronicles-the-virgin-pap-smear/

  9. Thanks for all the feedback about what the health guidelines are like in Australia, and for all the reading. This is great to have the resources to make an educated decision.

  10. Elizabeth (Aust) says:

    More support coming thick and fast – in the Wall Street Journal, “Questioning the value of the routine pelvic exam” – confirming what we’ve been saying all along – poor value, leads to unnecessary procedures and is not required for birth control. So, who was telling the truth?
    Hopefully more women will question the medical “advice” they’ve been following…
    I’m sure many women will also be angry – being put through these exams unnecessarily, being misled over the need for them and their value also, the women coerced into them to get BC – and the women denied BC because they refused the exam – sometimes with very serious consequences – unplanned pregnancy.
    This really is damning evidence against doctors – they knew the distress and fear these exams caused for many women, they knew they exposed the patient to risk, they knew they deterred women from obtaining reliable BC and the negative outcomes there…..any did NOTHING for decades. This honesty is only happening because more women are working it out – they now fear a loss of business/income, so the new angle will be, “come in for a chat every year”.

  11. I would like to echo some of the other women commenting here and ask you why you present this as if there was a medical consensus that yearly pelvic exams are generally necessary and a good thing? And telling women who don’t have yearly exams that they are “silly” is not advocating choice, it is belittling.

    The quality of information provided to women about breast and cervical screening is poor. There is a lot of emphasis on the benefits, and very little information about the risks, which are inevitable with any medical intervention. Indeed, the information about the benefit is often only partial, because the scale of benefit is not given- the screening leaflets in the UK do not say what the risk of getting cervical cancer is, so it is impossible to know how much potential benefit there is. Why is this important? Because without accurate and complete information, women cannot make an informed choice.

    What bothers me most about this issue, as a feminist, is that so few women are even able to tolerate debate on it- if you even suggest that perhaps the established practices are not working, that they are unfair or do not allow women a choice, the response is inevitably “don’t avoid your exams, you need them” and “we can’t give women an excuse to avoid the gyn” and the oh-so-common “don’t be silly”. I don’t think that women saying things like this realise how patronising and paternalistic they sound.

    It is never “well, I’ve read about the benefits and risks, and I know how likely it is that I could get that cancer and also how likely it is that I’ll have a false positive and be treated unnecessarily; and I’ve made a personal decision to have the tests.” Always, it is “don’t listen to her, she’s wrong, and make sure you get your yearly exam.”

    Until we can raise the issue without responses like these from other women we have no hope of doctors giving women the freedom to choose for themselves.

  12. This site is titled ‘feminists for choice’, yet it has allowed such a restricted view on a subject to which women are already misinformed, on a massive scale. Pap Smears themselves do NOT save lives, they merely present one very unreliable way to detect a rare cancer. Even if you were to find out you had the rare cancer from your pap, it might still NOT save your life.

    Women are made to think that each time ‘abnormal’ cells are found during a pap, and they undergo painful and damaging treatment like a LEEP procedure and/or a punch biopsy, that they have just been cured of cancer! This is very dangerous thinking, it is totaly untrue and doctors are not informing women of all the facts about paps. They’re not telling us that the huge majority of ‘positives’ are infact just irritation of the cervix caused by a tampon or a condom, and have nothing to do with cancer, then the woman undergoes unnecessary treatment, which she is lead to believe has saved her life, when there was NO CANCER and never ever would be any cancer!

    Pap smears are all about finding the one woman in so many thousands who might go on to develop cervical cancer, it is not about testing high risk women such as those with this rare cancer in their family, it is about making doctors a quick buck while not giving a toss about woman’s bodies.

    Pap smears carry risks that we’re just not told about, they can cause pain (which lasts after the test), bleeding, emotional distress and this can be compounded when the woman receives a coldly worded letter telling her her pap was ‘abnormal’ and she must attend colposcopy asap. The woman then thinks ‘OMG I HAVE CANCER’ and the word cancer for most people means DEATH.
    Can you imagine if a doctor told you you had a brain tumor based on shining a light up your nose? You’d be mortified until you found out it was a crock of bull, and then you’d be straight onto your lawyer with full intent of suing the doctor! Paps are the same thing, they’re unreliable, and they’ve lulled women into a false sense of safety.

    Many women are mislead as to what the pap is actualy for, they think it tests for a whole manner of things, such as STDs and other gynecological cancers like cancer of the womb or oaveries, when it does not, it doesn’t even do a good job at what it is supposed to be for! So, when that woman experiences symptoms that are not normal for her, such as irregular bleeding and pain, she might not seek medical advice because she was told ‘your pap was clear’ so she’ll think she’s safe!

    The pap is an outdated, invasive way to try and detect a rare cancer, the odds of you developing this cancer in your lifetime is miniscule. But the damage done by unnecessary treatment like LEEP after paps can be lasting and lifelong, such as your cervix being scarred shut, making it impossible for sperm to enter your womb if you wish to become pregnant, and meaning your menstrual blood is unable to escape, and backs up in your pelvis, which can lead to problems like endometriosis, pain and infections.

    So to all the women out there who honestly believe their lives have been saved because of a ‘positive’ pap, you should question your doctor as to wether cancer was actualy present. Don’t fall for the ‘precancer’ hogwash, there is no such thing as precancer, you either have cancer or you do not have cancer. Keep asking, ‘were there actual cancer cells found on my cervix’ and if the answer is no, then you underwent treatment you did not need, and your life was not saved by a damn pap test!

    Now ask yourselves just how many people YOU know who have had cervical cancer? for me it’s none, I know people who have had breast, liver and prostate cancer, but not cervical.

    You should be worrying about your hearts like doctors are trying to make you worry about paps & your cervix. Heart disease is the biggest killer of women in the UK, yet there is no national screening program for it, not unless you develop symptoms, and by then it’s often too late. Even if the pap saved one woman in so many thousands, there’s a good chance half that amount of women will die from heart disease, so in reality, paps are no more effective at preventing cancer than self awareness.

    If you go to a doctor saying ‘I think there’s something wrong with my heart’ and you’re only 20, they’ll probably take your blood pressure & pulse, tell you there’s nothing the matter and to go on your way, tell them you’re worried about your cervix and they’ll be crawling all over you, in more ways than one. They’ll not be able to get that speculum out fast enough!

    For doctors, paps and what some women call the ‘gyne merry-go-round’ of pap- biposy-LEEP-pap, over and over again, makes them a lot of money, either in payouts from insurance companies in the case of American women, or bonus payouts from the government for hitting pap smear screening targets in the case of women in the UK and Australia.

    Each time a GP gets a woman to come in for a pap in the UK, she’s another one on the way to hitting his screening targets for that year, he will receive a large cash payout from the government.

    Informed choice is not there with paps, it’s a DO OR DIE thing, we’re not informed of the risks, such as the thousands of false positives, the unreliability of the test or the pain and emotional upset it may cause. There is no infomation provided with the invitation letters saying anything to the effect that some women may find the test distressing, but many do.

    We’re told that paps save lives, when infact all paps do for 99.9% of people is scare them and cause them to undergo unnecessary treatments. They don’t test for any other illness where the actual risk of having it is so low, there’s more chance of a woman getting HIV than there is cervical cancer, but we’re not hard sold HIV tests are we!

  13. Elizabeth (Aust) says:

    Pap test guidelines have been scaled back to reduce negative outcomes in particular, the number of unnecessary procedures on women that can lead to premature birth, infertility and miscarriages. Young women carry a high risk of these bad outcomes, because they produce the highest number of false positives (1 in 3 pap tests) while cervical cancer is very rare in women under 30 AND we know screening doesn’t change the very small death rate in young women anyway.

    Most damning is the fact doctors went on testing, doing biopsies and over-treating for decades – urging (and coercing) women to have paps and in the States, ANNUAL paps from 18 or even younger. I believe it was only when they feared they couldn’t conceal this damage any longer and the threat of legal action loomed, that they changed the guidelines. It’s always something like, “we now know that annual testing is unnecessary and that women under 21 often receive treatment for changes and lesions that would resolve with no medical treatment at all”
    BUT, ask yourself: if this is “new” information – why are there other countries with LONG standing programs that test FAR less often that have LESS cervical cancer and far fewer procedures? (Finland, the Netherlands, the UK)
    Doctors know this cancer is rare and very rare before 30 – are you telling me no one noticed 1 in 3 young women were producing an “abnormal” pap test?
    No one noticed all of these young women having LEEP or cone biopsies etc?
    Sorry, I don’t buy it….
    There were ethical ways to offer this test to women who felt they might benefit from it and were prepared to accept the risks attached to testing – the reckless, unethical and negligent application of this test with no respect for informed consent is nothing short of scandalous. There are thousands of bad outcomes that could have been avoided….and the sad thing, many of these women still don’t know the facts – the REAL risks and benefits of this testing. Most don’t know their bad outcome was avoidable.

  14. Alison (Aust) says:

    Sarah and other pro annual pap screening people,
    I’d be interested to know if you’ve read any of our suggested reading and/or been inspired to do more research on cervical cancer yourselves? And if so, do you still feel you need to continue screening?

  15. Of course women have a right to say no to any exam. I don’t know why women feel the need to tell other women what to do -you screen I don’t so repect that! The author of this article is disgusting and I hope she can grow up and let women make their own choices despite her out dated opinions.

  16. And I just looked at the website name: Feminists for Choice. There is no choice in this article, no risks about this test, no respect, no dignity, nothing that would help women except for scaring them about a rare cancer (and always was). We’re not stupid and can decide for ourselves. Don’t call yourself a feminist and then coerce women into a dangerous test. You should truely be disgusted at yourself for taking away womens rights in the medical field. Once again, I refuse to screen respect it.

  17. http://www.slate.com/id/2298350/
    Above is a link with evidence that pelvic exams are of no benfit.

  18. Hi Niki thanks for that link. For more similar, go here: “Against all evidence” wordpress.

  19. Pap exams make me suicidal. I only put up with them to get my birth control in order to stop having my period and have clear skin.
    As a survivor of sexual assault, pap smears are traumatic for me. I have yet to find a sensitive provider. Talk up all the supposed benefits of pap smears all you want but I wish they weren’t required to renew a birth control prescription.
    I think eventually I’ll stop putting myself through it altogether and suffer through periods and acne.

    • Michelle, thank you for adding your voice to the discussion. I’m sorry the pap smears are so difficult for you. I can definitely relate. Some providers may allow you to insert the speculum yourself (not that it’s any less uncomfortable when it’s in), and some may be willing to do a blind swab. So speak up at your appointments. It’s your body, and it’s your voice.

  20. Elizabeth (Aust) says:

    Some of you may be interested to know that the self-sample device for HPV is already being used by Dutch women – the Delphi Screener. (they can get the Pill over the counter as well)
    Only 5% of women are HPV positive by age 40 – no hrHPV = no risk of cervical cancer.
    The Dutch have a 7 pap test program, 5 yearly from age 30 to 60, but will shortly move to 5 hrHPV primary triage tests offered at ages 30, 35, 40, 50 and 60 and only those positive will be offered the 7 pap test program. Those negative can follow the HPV program or if monogamous or no longer sexually active, might choose to stop all testing and revisit the subject if their risk profile changes in the future.
    This will greatly reduce the amount of testing and that means a lot less over-treatment.

    Women who’d like access should lobby their politicians or contact women’s groups or call into Amsterdam on your next holiday. The Italians, English and Finns are also looking at this device and hrHPV primary triage testing.
    The screening program for this rare cancer should never have been allowed to cause huge worry and vast damage to so many of the more than 99% of women who can never benefit from testing.
    In ethical and responsible hands, the damage, fear, pain, humiliation and distress could have been greatly reduced. Some respect for informed consent would have helped as well…
    http://www.sciencedaily.com/releases/2011/10/111020163909.htm

  21. Elizabeth says:

    I just noticed an error in my post, only 5% of women are HPV positive at age 30…not 40 as stated in my previous post. The Delphi Screener was launched in Singapore recently…

  22. Elizabeth (Aust) says:

    Michelle, they’re NOT required for birth control, the only clinical requirements for birth control are your medical history and a blood pressure test.
    American women need to challenge this unethical conduct and find a doctor who does not coerce women into elective cancer screening and completely unnecessary, unhelpful and risky routine pelvic and breast exams.
    Also, thought some might like to read this: a Scottish GP states she has chosen not to have pap tests. That sort of honesty is unheard of here in Australia, where doctors profit from seriously over-screening women, our program is excessive and harmful.
    http://www.managingcontraception.com/newsevents/dr-bob/pelvic-exam-necessary-for-contraception-rx/
    (helpful summary of the clinical requirements for birth control written by an American doctor)
    http://www.independent.co.uk/life-style/health-and-families/features/why-im-saying-no-to-a-smear-7577967.html
    This GP, Dr Margaret McCartney, has also written an excellent book called “Patient Paradox”.

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