Many women are uncovering the facts regarding pelvic exams and are discovering that cervical cancer is rare, that a pap smear is an unreliable testing method, and that they face a very real risk of harm from followup procedures. Some women understand that all cancer screening is optional and are saying “No” to pelvic exams and pap smears, but some Doctors are not respecting informed decisions. What follows are excerpts written by women who have said “No” to cervical cancer screening:
Sarah, from Australia: A few days ago I’ve got this severe pain in my chest, I felt it somewhere deep and it wouldn’t let me move or breath normally. I waited for a couple of days – no improvement. Knowing that many people in my family died of heart attacks, I convinced myself to be a “responsible person, proactive about own health” and went to the medical center I was such an infrequent visitor of. That’s where the “fun” began. Here is the script.
Doctor: Hello Sarah, take a seat. What’s happened?
Me: Hi. I’ve got this chest pain and it wouldn’t let me sleep, move or breath properly.
Doctor: Ok, let’s have a look what’s in your records.
Me: I have a kind of family history…
Doctor: When was your pap last smear?
Me: ?????
Doctor: There’s no info about your pap smears in your records.
Me: That’s about right. I’ve never provided such info.
Doctor: Why not?
Me: Because the only outcome would be that I’ll be told to have the next one.
Doctor: Are you saying you aren’t doing pap smears at all?
Me: Sorry, I came here today because…
Doctor: Don’t you know that pap smears are the most important tool for preventing cervical cancer?
Me: I heard that, but today I’d like to do something about my chest pain…
Doctor: I’m talking about cancer here; it is a very serious thing!
Me: Yep. *Cervical* carver, which I maybe possibly have a tiny-puny risk of, or maybe no risk at all!
Doctor: Have you been vaccinated against cervical cancer?
Me: No I’m not vaccinated against *HPV*? They said I’m too old for that when the vaccine was rolled out.
Doctor: Then why you think you have such a small risk?
Me: Usually I don’t discuss my private life, but to finish with this question – I’m a long-term absolutely monogamous relationship with a man who has never been in short-term relationships. And I tested HPV-negative before meeting this man.
Doctor: So what?
Me: Don’t 97% of women and 100% of men clear the virus within 2 years and become immune to it?
Doctor: The virus may not be cleared, it may just lie dormant for ages and then activate and cause cancer.
Me: If our bodies did not develop immunity against HPV, the vaccines wouldn’t work.
Doctor: It’s more complicated than that!
Me: Could you please explain then?
Doctor: It’s complicated, you won’t understand.
Me: How do you know I won’t understand?
Doctor: It will take too long and we’ll waste your consult time for an irrelevant lecture. And we’ll make the other patients wait!
Me: Well, so far you’ve been happy to waste my consult and the other patients’ time on talking about irrelevant pap smears.
Doctor: You should watch your language! Cancer prevention is not a waste of time! It’s important!!
Me: Today, for me, my current pain is important, not a chase after a rare cancer that I have 99% chance of never getting in my whole life. And since you told me to watch your language, I will tell you that I know about unreliability of pap smears, about the misinformation around this screening, about incentive payments doctors get, about reaching screening targets and I know the real statistics of this cancer. And that’s why I don’t want to discuss pap smears anymore.
Doctor: In thins case you can’t be a patient in this centre. We are committed to providing high quality comprehensive heath care. And if you resist that, we can’t help you here.
Me: Fine. In this case I want all my info to be deleted from your system, because I don’t want to a patient here anymore, and I’m not coming back ever again. Thanks for bloody nothing, you greatly helped with my chest pain.
Slam the door.
F%cking conventional medicine with its ” high quality comprehensive heath care”! http://blogcritics.org/culture/article/unnecessary-pap-smears/comments-page-174/#comments
Here is another woman’s story:
Sia: I’ve just had an unbelievable experience at the doctors today, I went in to see a random doc for a medical certificate, and he asked me when my last pap smear was, I said that I’d declined to participate in that programme, I actually really wasn’t in the mood for a debate, anyway he actually told me I was a “silly girl”, and asked “why not?”… So I told him. That should have been the end of the discussion, but he felt it was his duty to lay on the usual cc is in decline because of screening, precancerous cells are detected a lot, and save lives yadda yadda.. So I counter argued him, you all know the arguments.. Well, he started to raise is voice and talk over me, by this stage I’d figured out it was time to get the hell out of there, he wasn’t listening to me, so I said “I’m going now”. He then had the nerve to say, “No I haven’t finished talking to you yet”!! I got up and left, and got the forms to make a formal complaint with the practice manager on my way out. http://blogcritics.org/culture/article/unnecessary-pap-smears/comments-page-173/#comments
Not all Doctors would react this way. Here is one female Doctor’s views on pressuring women into pelvic exams and pap smears:
I do think it’s bad practice to cajole and occasionally frighten women into smear tests . . .
Currently, women are encouraged to have a smear. GPs are incentivised to do so. This means that when a woman comes in with a symptom that needs sorted, there is a detraction from the woman’s agenda. This presents a conflict. I can’t quote research because it, shamefully, hasn’t been done – but there are women who do not wish to have a smear and who are asked, time and again, why they are not ‘complying’ with the medical screening targets. This can cause distress and can even prevent women from coming to see the doctor about symptoms. Many doctors have seen this pattern.
I don’t expect people in general to realize this, but it cannot be ignored. There are many discussion forums on the internet where women discuss the issues they have faced when they have wished to decline a smear. Women have felt humiliated, bullied, harried. It’s not fair and it’s not right.
To me the problem is that we advertise smears as the usual. We don’t individually consent and explain screening in the same way as we would other interventions – like a prescription or an operation. We do not recognize that it is a completely valid choice not to have screening. Doctors cannot and should not force their own value judgements onto anyone else – either to have or not to have a cervical screening.
I’m happy to explain my rationale because I am concerned that a great many women are being directed into cervical screening without knowing that it’s a choice and without giving fully informed consent. I want to see better discussions of the pros and cons. This isn’t recognized well – here’s a response to some research on the uptake of cervical screening written by myself and Professor Susan Bewley. It didn’t occur to these researchers that some women may have wanted not to be screened.
via Why I don’t have smears | Margaret McCartney’s blog.
Sue,
I think male doctors have a problem with a no answer from women all the time. That has been my experience. For example, the last time I asked my male doctor for the pill, he tried to sell me all these other forms of contraception which all required a foreign object in my body one way or the other. When he came to the IUD I shuddered and said “no way, not with their history”. What was his reply? “I’m beginning to warm to them” !!!.WTF? Anyway I repeatedly told him “no, I want the pill”. He finally gave me a prescription, 3 months supply only mind you and threatened me with a breast exam the next time I was coming in! How dare he get angry with me becasue I object to having a foreign object in my body.
Another male doctor, another incident of doctors not liking to be told no by their female patients.
When I was pregnant I had a dangerous condtition which could be treated conservatively or with a hysterectomy. I, of course chose the conservative treatment and I made it clear at every appointment that I did not want a hysterectomy. He appeared to respect my wishes. However, at the last appointment before my baby was to be born he recommended a hysterectomy even though he knew how vehemently opposed to it I was. I so angry that I told him I was not turning up for the birth. Well he changed his tune and started grovelling to me to come back. Point is, why do I as a woman, have to make threats to get my way?
Mary that is dreadful. Here you were, vulnerable and pregnant, made to fight for your right to keep a valuable organ. Good for you to stand your ground and to threaten to go elsewhere for the birth. Same with the IUD, and what indeed did he mean he was “beginning to warm to them”?! You were treated very badly and put through so much unnecessary stress at a time when you most needed comfort and a sense of safety. I just don’t understand why men are the main “caregivers” when it comes to women’s health.
The next time I meet a male gynecologist which probably will be never, I am going to ask them what makes them think that they as men have anything to contribute to the specialty, except an obviously enormous ego.
Here is what Elizabeth had to say in response to the patient experiencing chest pain and whose dr was attempting to force a pap smear:
8674 – Elizabeth (Aust)
“Doctors have always used coercion to force women into testing and some still persist even though they know it’s unethical and also, if you’d ended up in hospital after leaving the surgery, his conduct in the consult room could land him in court and before the Medical Board. Doctors need to understand they do not have the right to treat women in this manner and that it can lead to serious consequences for the doctor and the patient.” http://blogcritics.org/culture/article/unnecessary-pap-smears/comments-page-177/#comments
Accounts like these make me wonder why after 2 years I still have no Likes on my post that claims a pelvic exam is basically rape (http://agalltyr.wordpress.com/2010/11/28/a-pelvic-exam-is-rape/). I mean, what the hell else do you call it when someone in a position of power is actually arguing with you and trying to scare you into letting him/her stick things inside you?
I’m not trying to play down conventional rape. I’m sure that’s even more traumatic, but I’m trying to point out that pelvic exams are a very psychotic and disturbing practice in our society. Coercion should never have anything to do with access to the private areas of someone’s body.
I’ve had 2 years to think about it. Rape is still the first thing I think of when I think of a pelvic exam, and it’s not like I’m just imagining it in my head. I’ve seen those videos that various medical organizations posts on their own web sites and YouTube. It’s just disturbing.
Matthew, your post that claims a pelvic exam is basically rape was like a revelation for me at a time when I most needed it. I think when something traumatic happens to a person it can take a while to make sense of it, especially when you are not certain even what to call it. A pelvic exam can feel exactly like rape when you are coerced and frightened into it, and when the physician is unethical. But because a pelvic exam is called something else and because it happens under the guise of health “care”, the word “rape” doesn’t seem appropriate. I found an interesting site that discusses sexual assault when the assault doesn’t fit a typical stereotype:
“This (not fitting into a stereotype) makes sexual assault a very lonely issue for some survivors. It’s a lot harder to recover from something when you don’t even have a name for it.
The farther someone’s experience is from the stereotype, the more difficult it can be for them to identify what happened as sexual assault and access supports. The impact is the same, but the context in which it happens can be a barrier.”
http://www.consented.ca/rape-prone/its-misrepresented/
I agree that the further a sexual assault is from the stereotype, the harder it can be to make sense of it, to recover, and to move on from it. Your post Matthew helps victims of bad medical practices by unethical physicians to make sense of a traumatic experience, to sort through it, and to begin to recover and move past a bad experience. I certainly like your post Matthew! And I’m willing to bet I’m not the only who does.
Matthew, I agree with you! When you posted over at blogcritics a long time ago, there was something of a backlash from a few of the posters, calling your views too extreme. They argued that a pelvic was perfectly ok as long as the woman WANTED the exam. Which I found kind of disturbing. Maybe there are a few kinky women out there who really do enjoy the experience, but aside from them, what self-respecting woman actually WANTS to have someone who is not the man/woman/rampant rabbit you love rummaging around in the the most intimate part of your body? It’s one thing if you’re suffering from symptoms and you endure an exam because you’re hoping they might find the cause of your problems, although for all the good that does you might as well go to the local garage and ask one of the grease monkeys to have a poke around… but if a woman actually accepts or, worse, demands routine pelvics, that’s still rape in my eyes. Women like that have been brainwashed to believe that pelvics are essential to their health, and that she’s digging her own grave by not having them. These fears are instilled in her by the very people providing the *service*. So in a twisted way, the medics have become rapists, by convincing her that she’ll die if she doesn’t let them do what they want. Rape isn’t about sex, it’s about power – and being able to stand over a half-naked woman who is frightened and vulnerable (better still, immobilised by the stirrups) must be a huge power trip. Only difference here is this rape is LEGAL, and the rapist is wielding a speculum instead of a knife.
Of course doctors will react like this when a woman says NO to pap smears. And not only male doctors. Incentive payments offered by the government are too lucrative. And to get them, the doctors are required to coerce every “under-screened” woman into having a pap smear and keep coercing at least 70% of their 20-69 yo patients into having “regular” pap smears. Therefore, every new “non-complaint” female patient can jeopardise their chance to get the 30 pieces of silver. That’s why it is more profitable to kick the free-thinking woman out and keep the percentage of the pap-smearing sheep hight.
Anonymous that is very interesting about the money/ratio incentive and certainly explains why women doctors are just as dedicated to smearing as males are.
Katrina, your comments about rampant rabbits and grease monkeys rummaging around had me laughing! And I’m in complete agreement about the grease monkey being just as effective. Having a peek into a vagina via a speculum exam to see what’s up in the uterus or ovaries is like looking in through the window of a house to see the entire floor plan.
It’s not just male doctors and it’s not just on this topic. In general I find that doctors do not like being told no. Many seem to have have somewhat of an “expert” complex, expecting you to do what they say without question because they’re the experts. How could you possibly know as much as they do?! Then there is also the issue of quotas and/or kickbacks for compliance. Ask parents who have declined or delayed vaccines for their children how they have been treated and you’ll find a lot of the same techniques – bullying, coercion and dismissal from the practice. In general, my belief is that ALL medical decisions should lie with the patient.