There is a lack of research on the harmful psychological effects of pelvic exams. The lack of research highlights how the harmful effects from pelvic exams have largely been ignored, or have been considered not important enough to warrant investigation. The small amount of research that exists has mainly been conducted with the goal of addressing women’s “anxieties” with the exam, and has been done for the sole purpose of learning how to harness women’s compliance.
In spite of the lack of recognition given to the psychological harms of pelvic exams by the medical community, many of us do experience harm. Many of the comments from women on this blog and on other sites have revealed that the psychological effects are often significant and can have a detrimental impact on our lives. In addition, the psychological effects can be difficult to understand, clarify, and articulate. This post is a compilation of my own and other women’s experiences of pelvic exams presented in a way that attempts to clarify an issue that warrants more attention.
Psychological Harm #1: Trauma
A woman’s first pelvic exam can be traumatizing, especially if she is unaware of the exam’s invasive nature and/or is coerced into the exam while seeing her doctor for a different reason. In these cases the woman is unprepared and is not expecting an invasive exam to take place. In addition, many doctors do not fully explain what the exam involves, explain the reasons for the exam, or offer the woman a choice prior to proceeding.
Here is what one woman has to say about her first pelvic exam: It’s humiliating, degrading, and painful. The first time I had a pap smear done, I was so traumatized, I now have to take prescription Xanax to avoid having panic attacks when I get pap smears done now. And I’m only 24. How many more am I going to have to have for the rest of my life? What am I going to do when I want to have children and every doctor wants to shove his/her fingers and tools inside me? (Scared Guest) via Women Against Stirrups – What’s your opinion on the pelvic exam/gynecology?.
Psychological Harm #2: Loss of Control
I can think of no position more vulnerable and undignified than naked with legs wide apart, feet up in stirrups, and a fully clothed doctor standing over me. Feelings of vulnerability and a loss of control in this position are intensified when I am asymptomatic and do not wish to have a pap test/pelvic exam – but have been aggressively pressured and coerced to the point where I feel I have no choice.
Here is another woman’s thoughts on loss of control and vulnerability: I am 21 and today i went for my first smear..UGHH i freaked out, cried and had to leave with a vicodin prescription…which is pretty straaaaight. but, the point of my frustration is that I, like you, feel as though i am being violated, and sexually assaulted. I feel overly anxious due to the vulnerability of the situation . . . Its not even like ive never had sex. it is just that i have trouble being prodded and fingered by a metal prong. (Anonymous) via Awkward Things My Mother Never Taught Me: Just How Violating a Pap Smear Really Is….
Psychological Harm #3: Dissociation
Women have been led to believe that a pelvic exam is a vital part of their health for so long that many no longer question it, or feel they have a choice. When a woman feels she has no choice but to undergo a violently invasive exam she will often develop a sense of detachment, or numbness, in an effort to distance herself from what is happening to her own body.
Here is what Claire T. Porter has to say: ”Closely connected with the absence of self is the dispensing of existence experienced by women… Women undergoing these procedures report a sense of nonbeing” (Raymond 1993, xv). I cannot help feeling that my body, especially the most private areas of it, has been taken away from me. This surgeon and the horny resident both assess my pubic area. Now the vision of my genitals is held in their brains. I feel I possess my sex less and less and feel them both smug in the fact that they own it. What a power trip for them. Bastards. via Women Against Stirrups – I’m Taking Back My Pussy!.
Psychological Harm #4: Invalidation
The value women place on the privacy of their vagina is in no way reflected by many practitioners’ attitudes. There is an expectation that we are supposed to be fine with this type of exam. Yet have we not always been taught to keep our legs together, sit with our legs crossed, and to not let strangers touch us? The role we are expected to assume during day to day life versus the role we are expected to adopt during a pelvic exam are vastly different. How a pelvic exam feels and how we are told it is supposed to feel presents a gap of huge proportions. The lack of acknowledgment for how we feel confuses us, belittles us, and invalidates us. We lose a sense of stability, trust, and safety.
Chrissy (UK) says: This all goes with the ‘get used to it, you’re a woman’ attitude, or ‘I’m a doctor and therefore entitled to see and touch your body’. I don’t know what they are taught when they are medical students, but there is no way they understand what it is like for a woman to be exposed and spreadeagled on an examination table whist they rummage around in the most intimate part of our body. I still remember my first pelvic examination. I was 17 and the (male) doctor forced my knees apart, as I wouldn’t comply with his verbal instructions to spread my legs. I felt violated – I WAS violated . . . October 2, 2012 at 12:43 pm
Psychological Harm #5: Dehumanization
All women have a right to privacy and dignity, except of course when they are in the presence of a doctor. The name assigned to the “pelvic” exam is carefully nonsexual and yet what takes place during the exam is something more intimate than most women would allow a spouse or lover to do. It is cruel to expect women to ever become used to this type of extreme exposure, and it is inaccurate to assume women will become desensitized over time. To expect women to get used to the exam is cruel and dehumanizing.
Yazzmyne says: . . . I also believe that these gyn exams are rape even when a woman consents to it. She may verbally and rationally agree to it, but her body screams NO and most women do not listen or respect their own bodily feelings in this context. With all the fear mongering about cancer and the fear for the exam itself, she can’t even make a rational decision (and not that it has to be a rational one, because rationality is used to justify the whole ordeal and rationalize her feelings of violation away) because the mind is locked in fear and can’t think clear anymore and this is exactly what doctors want. There are so many benefits for them to keep using the medieval pelvic exam:
to satisfy their sexual lusts
for the powertrip
for the money
and the fear this exam generates in women also keeps them traumatized, in fear, unable to think CRITICAL about the so called need for them October 10, 2012 at 5:04 pm
Psychological Harm #6: Distrust
A lasting, pervasive sense of distrust is likely to form when one is violated by someone in a position of trust. The distrust that results from negative experiences during pelvic exams can present a lasting barrier to a woman’s access to health services. Women who are traumatized by their physician’s practices related to pelvic exams are far less likely to trust the medical system as a whole.
FerretGirl01 says: I have a terrible fear of the OB/GYN mainly because my very first pelvic exam was so traumatic. I was a virgin and it hurt so much that I cried. And even after I told the doctor to stop, she kept trying to collect the sample after telling me she would stop any time. I felt violated…scared…and I hurt so bad I had to take pain relievers. I was bleeding when I got home and discovered my “cherry” had been popped because the doctor was too rough and rushed with the exam. That made me terrified of ever getting one again . . . via Fear of Gynecological Exam – Women’s Health – MedHelp.
Psychological Harm #7: Fear
There are all kinds of fears that go along with this exam. There is fear of the consequences of refusing, fear of the consequences of complying, and fear of the consequences of speaking out.
Anonymous says: I’m 22 and I haven’t been to the gyno! Every time I even think about it I get so freaked out and sick. I’m not scared of being in pain – I’m scared of personal intrusion, of being on my back and not having control. Every time I think about it, it makes me feel like it would be some kind of assault, because I really **don’t want** it to happen, and going would just be me trying to get over my fears and knowing that it’s something I need to do. I’m terrified of anyone touching me when I know that I’m forcing myself to let them and that I feel so insecure and invaded. I haven’t been sexually abused . . . But I’m just SO.TERRIFIED. via extreme exam anxiety.
AVEN Member says: Doctors are always pressuring their patients to get it done, and instilling fear of cancer to those who refuse. I think they insist more on a pelvic exam than they do on quitting smoking. Yes, I am doing the ‘unspeakable’ and questioning doctors . . . I think the procedure is inhumane. If you think I just need to suck it up, please listen. This is ranting towards people like that. People that think women just need to “suck it up” or “get over it”. Rant on Pelvic Exams – Asexual Visibility and Education Network.
Psychological Harm #8: Despair
When women repeatedly have their way of understanding the world ignored it can lead to feelings of despair. When their understanding of what is occurring is discounted and invalidated; when their fears, trauma, and other experiences are ignored, then their place in the world and sense of self can shift. Women are often left with pervasive feelings of hopelessness and despair.
Anonymous says: I got my first pap smear yesterday. I’m not a big crying type, but I cried like a baby. It was the most traumatizing experience of my life. I’m 18 and I’ve only had one partner for the year I’ve been sexually active . . . The metal “spectrum” upset me and that was bad enough. But the worst part for me, that has left me horrified and with nightmares, is what came next. Nobody told me going into this that the doctor was going to shove her hand all the way up to basically my stomach. EXCUSE ME?! Why does nobody see this as completely violating!! I cried so hard. Today being the day after, I keep reliving it and I don’t want anyone to touch me and I just feel disgusted . . . I should not be subjected to this, especially at my age I don’t think. Not to mention that I was pretty much forced to get one if I wanted birth control. That just seems wrong to me. I try to be save and prevent a child at this time and my life and what am I forced to do? Be humiliated, violated, and traumatized. via Awkward Things My Mother Never Taught Me: Just How Violating a Pap Smear Really Is….
Elizabeth says: On one blog a young woman was so stressed about pap tests she wanted to be knocked out…it’s shocking, she should be told to forget about it and enjoy her life – this testing has robbed so many women from the pleasure of being healthy, young and female and often takes our peace of mind, bodily privacy and dignity, damages our health and lives, destroys relationships and takes the shine off sex, especially after traumatic “treatments” and when women are unable to access the Pill without forced testing…and at age 30 if she’s worried about cc, she could test herself for HPV, but that would be too easy and make too much sense…actually doing what’s best for her, she’ll probably end up being sedated for a pap test…so depressing. http://blogcritics.org/culture/article/unnecessary-pap-smears/comments-page-175/#comments
In conclusion I would like to say that if you find you have “anxieties” regarding pelvic exams you can take heart because, as you can see, your concerns are valid. On a brighter note, there is a great deal of new research available that supports far less frequent pap tests and pelvic exams. In addition there are now alternative ways to test for cervical cancer, such as the Delphi self-screener, which is available in some countries. See Singapore – Dutch Collaboration: http://www.delphi-bioscience.com/SiteCollectionDocuments/Media%20Release_March%2026,%202012.pdf
Thank you for writing this. Thank you for acknowledging the trauma.
Yet there is article after article pointing out the futility of the routine pelvic exam AND it’s harmful, it carries risk to your health, you may even face unnecessary surgery. I posted a link on another thread – yet another study and the reasons given why these exams are still being performed or “required” are disgraceful…profits, because women now expect a pelvic exam, (whose fault is that?) for false reassurance and because so many in the medical world STILL believe it’s a screening test for ovarian cancer – WRONG! So, incompetent medical practitioners, NPs etc…and I’d include perverse reasons in that list.
One of the most repulsive and confronting exams in the book…of poor clinical value with lots of risk, study after study confirms those facts, yet nothing is done to actually stop these exams. The harm and distress continues and what exactly are they doing to address/stop the coercion that has always existed to force this exam onto women…that is still going on. The profession is not doing enough to change the system, to get rid of the routine pelvic exam. Can you imagine the same cavalier attitudes if we were doing the same thing to the healthy penis?
IMO, when a doctor coerces a woman into an exam that is unnecessary, unhelpful, irrelevant and harmful, it amounts to an assault and should see the doctor in serious trouble. Time to stop the studies and chatting…and take some real action to stop this medical abuse.
Add to that: simply recommending this exam (no coercion) or performing it because the woman expects it is not good enough, by miles. Our doctor has a higher responsibility and should be putting our interests first. If a teenager asks for a mammogram, the doctor has an ethical obligation to properly advise her, it’s not a good idea, it would just risk her health. The pelvic exam falls into the same category as far as I can see…the benefits are not there and the risks are real and serious.
A woman brainwashed by the system needs to be helped to understand the exam is unnecessary and carries risk. The medical profession created this mess and they have a responsibility to clean it up.
Can you imagine being a pregnant girl illegally incarcerated in one of the thousands of maternity “homes” which operated in Canada and the US post WWII until 1985? These pregnant girls were systematically rounded up by government and Children’s Aid social workers, all because they were unmarried and pregnant and had a commodity. While confined to these institutions they were subjected to frequent and repeated forced pelvic exams where there was NO CONSENT of either the patient or her guardians. Then their newborns were literally abducted from their legal mothers on the delivery table to be trafficked for adoption purposes.
That dissociation point is what concerns me the most, because I believe that’s the brainwashing that the medical community actually encourages in women who have a crippling fear of pelvic exams to begin with. Women are encouraged to suppress their feelings because the procedure is supposedly “nothing to be afraid of”.
While it’s true that with enough effort you can suppress your feelings about just about any unpleasant circumstance in life. The question is whether a person should do this, since it kind of turns a person into an empty shell, a sort of robot.
I’ve heard that people who are sexually abused as children exhibit a similar phenomenon. They suffer a lifelong detachment from their own bodies, a defense mechanism to protect their minds because the abusive situation was so shocking and overwhelming.
So do prostitutes, Matthew. I read several accounts of brave women who were able to exit the industry and they speak of dissociation primarily, even more so than the rape, beatings, etc., and how they can never have a normal sex life again.
I should rephrase that. What really concerns me the most is a woman leaving a gynecologist’s office with tears running down her face because she was suckered into this inhumane treatment that society thinks is normal. Or maybe it happens in her car on the drive home. Or maybe it’s not until she gets home and the trauma sets in.
Women have “put up and shut up” with things for decades. Cultured to feel soft, vulnerable and even helpless, many of us go right along with that suggestion. It keeps women oppressed and without a voice. Thanks for those women who now take up the right to think and process and speak out about their feelings related to this awful practice.
Great article Sue, I’m glad you’ve summed up the psychological harm this screening causes, it’s so true that much of the research questioning the validity of cervical screening primarily looks at the physical damage to women and not the emotional trauma women suffer. It’s appalling and ironic that we as feminists do so much great work to raise awareness and work to protect women from rape, sexual harassment and abuse, yet medically endorsed pelvic exams are not questioned and in fact encouraged by many of these feminist collectives because they’ve bought into the fear mongering.
It’s hard to believe ethical intelligent people with strong humanitarian values can sanction this practice, it’s like there’s an unconscious partition that separates reason from the spooked herd mentality. If a women is traumatised by rape she is validated and cared for, but if a woman is coerced into medical rape and is traumatised and not coping, there’s no support for her, her feelings are questioned and invalidated and she is told she has to allow it to happen again.
Vaginal exams are still part of the way we do gender, there’s a lot of unhealthy aspects to doing femininity, unrealistic beauty standards and body image, routine body modification (hair removal, makeup), high heals and the hypersexualisation of feminine identity we’re all greeted with, every time we look at a magazine, tv or in the mirror. Adhering to the gynaecology directives is as many have said, part of being a woman, just as compulsory marriage and pregnancy is in other parts of the world.
The message I keep hearing is women don’t really own their bodies, they’re just caretaking them until someone else needs them, the medical profession has institutionalised bad mother shaming by reminding pregnant women that without this or that intervention and screening their child is at risk. Women without children are pre pregnant and therefore need to make sure their reproductive organs are properly supervised, and menopausal women pre and post are a great source of revenue for gynaecologists to manage and then claim their hysterectomy trophy.
It’s really frustrating to try and change sexist deep-rooted beliefs instigated by medical hegemony and fear mongering, I can’t help but look at most women and feel horrible for what they’re put through with these exams and worry that they will groom their daughters to submit to them as well. I really appreciate your blog and the small number of others like it, we need to keep this dialogue going.
I think there needs to be a law put into place to protect woman from being forced to have a pap smear or pelvic exams. Hear in the US most woman are told that they can not get the pill with out a pap smear and sometimes breast exam. also some doctors deny all health care or drop the woman as a patient if she refuses to have screenings. I think the first problem with doctors is they have been taught to not see genetal exams as sexuall so they cant see what they are doing is RAPE when they prevent woman from giving concent. they dont seem to understand that they can not force or make a woman feel like she has no choise but to let them put hands and tools inside her vagina. the message has alway been you HAVE to have pap smears. when doctors are forced to take no for an answer this treatmant will get better. also the woman have a right to know about false positves negatevs and what the follow ups intell ie leep and bios. hiding this from woman is a crime.
i whould also like to add that this testing is sexist men are not told they must have prostate exams and refused all health care untill they comply. I do think this is used to control woman. i know fiminists pushed for all woman to have acces to this test but i think its almost became a law in doctors eyes.
“Doctor standing above me”… every OBGYN I’ve EVER seen (26 in my 23 years) has SAT on a stool between my legs.
I remember I went to the ER after falling out of a truck. I ended up needing surgery 6 years later because they “missed” the break. I kept being pressured into a breast/vaginal/rectal exams and pap smear…at 16. Needless to say, I asked the “doctor” what my reproductive system had to do with my foot and that was it.
My midwife says I suffer from PTSD (post traumatic stress disorder) due to 25 OBGYNs doing FULL GYN exams (breast, vaginal, rectal and cultures) and, after 18 months, I finally got what I was told was a pelvic CT scan (it ended up being full body) to find out why my periods were so painful. Never did find out why they were so painful. Since I’m breastfeeding the very baby these OBGYNs said I’d never have, I have yet to have a period.
Great site. One suggestion: Don’t call them “pap tests” since “test” implies it’s reliable. Great site!!
OverItAll, that was a good question to ask! What does a woman’s reproductive system have to do with her foot? And at 16 your odds of having cervical cancer were practically nonexistent. I was horrified to hear that 25 obgyns did full exams on you and not surprised it would lead to PTSD. I’m sorry that happened to you. I like your suggestion regarding calling the pap test a pap smear instead, and for exactly the reason you state!
Great site, and very poignant posts.
I just have a response to one of your commenters who said “Can you imagine the same cavalier attitudes if we were doing the same thing to the healthy penis?”
We already do, and worse. It’s called circumcision. Infant or child boys in the US routinely have their healthy foreskin (which contains the 5 most sensitive parts of the penis, and is attached to the glans at birth like a fingernail) amputated, usually without pain control, or with pain control that is completely inadequate, like a lollipop. This surgery removes what has been shown to be a very important part of the penis for reasons that are either unsupported by scientific evidence, or actually *disproved* by scientific studies. Although a similar procedure was practiced on female children was discontinued in the 1970′s and outlawed in 1997, it is still legal to cut up a male child’s healthy genitals.
If the child escapes circumcision as an infant, he will likely face forced retraction of his foreskin before it is naturally separated. This happens because the prevailing medical “wisdom” is that the foreskin should be retractible by age 2, when scientific evidence shows that only 50% of boys are retractible by age 10, with the rest becoming retractible by the end of puberty. This forced retraction can create scar tissue, which then causes the foreskin to become non-retractible (because scar tissue doesn’t stretch very well) and thus gives the healthcare professionals a reason to tell the parents that circumcision is now necessary.
This whole process is, of course, very profitable to the medical establishment, so it won’t stop soon either.
Also, those circumcised men are about 4 times more likely to take Viagra than the intact men, so there is even more profit motive…
In summary: yes, I can imagine the same cavalier attitudes toward male patients’ bodies, but I think it all needs to change. Medicine should not ever be synonymous with hurting.
Yes, but circumcision doesn’t happen to men over and over again, every year from the time they reach puberty. Men are not asked to be circumcised in order to fulfill a work physical, get a medical card. Men don’t get letters from the NHS every year asking them to go in to be circumcised, It’s also now seen as an option, and doctors and hospitals WILL fully respect parents’ wishes not to circumcise. It’s traumatic, it’s wrong and it causes lasting harm but it is not the same at all as what we are discussing here.
Also, men/boys are at least given creams/shots to prevent some of the circumcision pain, women are not given anything. Just an FYI: I fought my husband when it came to the circ topic. After 4 months of me constantly sending him links, it simply took him holding his still-bloody baby boy and me saying “he’s absolutely perfect” to convince him NOT to circ. And blame the doctors on the high circ rate. I fought so hard because I believe if you’re born with it, it must be important. Oh and boys only go through it ONCE in their lifetime, not every year from 15 till they’re dead.
Oh and they use the foreskin in anti-aging face creams…EW!
One more: PTSD, flashbacks and triggers for survivors of sexual abuse.
Rape and sexual abuse survivors already deal with issues of body disassociation, and a feeling of lack of control over what happens or has happened to their bodies. Vaginal exams are a trauma because they put the survivor into a situation where, once again, things are being inserted into their bodies and they are being touched against their consent. I can’t even begin to wonder at the number of survivors who are horribly triggered, experience flashbacks or have setbacks in their healing due to paps and pelvic exams.
And yet…this is a group that is especially pressured…women survivors are told that they might have STDs from their abuse so they especially need paps. Never mind that every single STD can be detected by blood test, including cervical cancer.
Diane, there is no compassion for any woman, we’re all mere numbers on the way to the target….they don’t give a damn how many lives they destroy along the way. Papscreen are targeting victims of sexuall assault…will they offer them a HPV self-test device? Of course not, they’ll be pressured to have serious over-screening which greatly increases the risk of these already traumatized women facing unnecessary biopsies and over-treatment. As the number of women being screened continues to fall, we’ll see even more desperate measures to shore up numbers.
Some interesting articles are appearing at the Kevin MD site.
http://www.kevinmd.com/blog/2013/03/obgyn-perspective-choosing-wisely.html
This doctor closed a thread on her blog when women started discussing the value, need and risks with pap tests. One of my posts was deleted a few months back, I mentioned the Delphi Screener and she was concerned I was marketing the Screener. (I wish…) It felt like censorship to me, my entire post was deleted, not just the bit that related to self-testing.
Doctors need to understand they can’t keep the facts and better options from women forever…that’s worked for decades, but more real information is now circulating.
There is also an article…”Ob-gyns are not primary physicians”…exactly, it’s a huge mistake to see a gynecologist for general care, no wonder the reproductive organs are the focus and 1 in 3 American women will end up having a hysterectomy by age 60…gynecologists are surgeons after all.
Hello, good site – some very interesting points raised. They’re particularly interesting to me as I’m now in my mid forties, have had smears regularly all my life, and have had no problems with them. I admit I wouldn’t choose to do it for fun, but I definitely haven’t experienced any of the issues listed above. Every doctors that have examined me have been courteous, respectful and informative. I genuinely think that the vast majority of women out there have had experiences similar to mine – at least that’s the case for my friends. Obviously, judging from this site, there are women out there who have had bad experiences, which is terrible. I think this is potentially more of an indictment of the way the procedure was performed rather than the procedure itself, if that makes sense. From my experience its certainly possible to have a smear test performed respectfully and without any sort of lasting damage. Its a shame that there aren’t more women like me who have seen this site, as its clearly a topic of great importance, yet it should be be expressed that there are plenty of women out there who haven’t had bad experiences and I don’t think screening program’s should be written off because of this, as they do save many lives. Perhaps those doctors who perform badly could be encorouged to see it from the woman’s perspective and treat the process with more sensitivity. I hope we can have a good discussion on this, and that more of us can have experiences like mine.
hi Tess,
on this blog the pap smear screening programs are in the first place written off because there is a lack of informed consent as the moderator already pointed out and the many harms (both physical and psychological) of frequent pap smearing from a young age on are not being communicated to women plus the way women are being harassed and coerced into this testing is unethical and disrespectful, but also sexist as men aren’t treated the same way when it comes to ‘male exams’. Maybe you haven’t experienced harassment as such, because you willingly go along with what the program wants you to do, but that doesn’t mean there is no problem as those who choose otherwise will get to see the true nature of the intentions behind this program, because they will be made to feel they have no choice other than to submit.
Also, for me and many other women, a good bedside manner isn’t going to do it. I find this exam to be unnecessarily invasive and demeaning no matter who conducts it and even if you would want to test for cervical cancer, I am sure there has always been a better way (non-invasive) to test for the same thing, but that is obviously not in the interest of those who are behind the pap smear programs.
So despite your good intentions to convince women to see the good in this test and hoping for more women to have experiences similar like yours, I as a woman don’t want your experience. I am happy to say NO to this medieval exam no matter how nice the doctor is, in fact I don’t even want to be asked about it.
I also wonder how women such as yourself who never had a negative experience from a pap smear would feel about these exams if they would come to know the truth about the rarity of cervical cancer and the inaccuracy and harmful physical risks this test exposes them to. Many women have been conditioned to have blind trust in doctors and put great value in this so called ‘life saving’ test, so I think they are also taught to minimize the vulnerability and the invasiveness this exam requires from them and are trained in allowing strangers to cross their personal boundaries and privacy and be ok with it when they are not even at a health risk.
This sort of turning-a-blind-eye-to-the-strange-sexual-and-invasive-nature-of-the-exam attitude is also necessary I feel to prevent the age old pap smear from being criticized. Because more criticism and complaints (instead of ridiculing women for being ‘such a baby’ if they see it as worse than ‘just a little uncomfortable’ or giving women the advice to ‘just find a doctor they can trust’) about the test could lead to a more innovative, non-invasive and more accurate test (or the acceptance and widespread use of those that are already invented) which would bring more empowerment to women and at the same time, more info would be leaking out about the current test and the truth about the low prevalency of cervical cancer, making testing alltogether for this disease a lot less important.
But the exposure of these facts are not in the interest of the system who loves the pap smear’s inaccuracy as it requires women to come back more often (=more money) and the powerlessness required from the patient gives doctors great control over women, so I can’t blame them for keeping up with the lies, who would want to lose out on such a huge powertrip anyway?
Tess, thank you for your comments. I am happy that you have had nothing but good experiences. As for your comment “they do save many lives”, I can see you believe that pap smears are unquestionably positive. I feel otherwise. Cervical cancer is rare, pap smears are inaccurate, and the high rate of false “positives” leads to further invasive and often harmful “treatments”. However, I feel each woman has a right to decide for herself as I am all for freedom of choice and informed consent for each and every woman.
What I take issue with is the lack of informed consent being offered to women regarding pap tests. I have had four very negative experiences with doctors which include sexual misconduct and other forms of aggression. I have had a former family doctor refuse to keep me on as a patient when I made an informed decision to decline a pap test. There is much harm being caused by the aggression, coercion, and misconduct in regards to pap tests – all in the chase after this rare cancer. Women are often unable to access health care/medications when they decline pap tests.
As for your comment “I hope we can have a good discussion on this”, I do hope by “discussion” you did not mean “debate”. Because unless you are against pro choice and informed consent for each woman, and feel each woman should be permitted to make up her own mind – without being denied health care – then there really is no debate here.
Tess,
I am pleased that you are happy with the level of screening you are receiving and with the respect shown to you by health professionals.
However, I am confused by some of your statements. Primarily that you believe the majority of women in general have had the same positive experiences as yourself with regard to cervical screening. This is unquantifiable.
You also wish that more women with positive experiences could see this site – for what reason? I am aware that there are women such as yourself who are happy with their doctor and with screening. You could produce 100 women such as yourself, but that would neither negate my experiences nor encourage me to go for screening.
My issue with cervical screening is not just with the invasive, uncomfortable and embarrassing nature of the test, or whether the smear taker is respectful or not, I also have an issue with the lack of information regarding the risks and benefits of the test.
You obviously believe there are only benefits to screening, but you will find if you read some of the links to medical papers on this site, that this is not the whole story.
Tess… Have you never heard the expression ‘if something seems too good to be true, it usually is’?
Personally, I think the medicalisation of the female body has stripped us of our dignity, particular the medical standards in childbirth. I’m not a mother myself but I can’t see how lying on your back like a stranded beetle during labour can possibly be beneficial to mother or baby. Equally, I think many women dismiss the negative feelings they have about intimate exams under the guise of ‘it’s for my own good.’ When the truth of the matter is that many of the things we’re *supposed* to do *for the good of our health* can do us a lot of harm.
I refused pap smears throughout my twenties – and believe me, I was put under A LOT of pressure to ‘comply’ – simply because the idea repulsed me. I wasn’t raised by nuns, nor have I ever been sexually assaulted – I was just raised to believe that my private parts were exactly that – private – and NO-ONE had the right to demand I spread ‘em under ANY circumstances. Oh yes, I WAS bullied into a pap eventually. Even though the nurse was lovely and did her best to put me at ease, It was painful, it left me bleeding and sore, and I walked out of the clinic feeling violated.
I have also been with a group of friends talking about smears – the general consensus was ‘it’s not nice but it has to be done.’ One girl admitted that she had never had one and the others laid into her. I did try to provide them with some genuine statistics but I might as well have been talking to a herd of sheep. So, Tess, when you say your friends feel the same way you do, is that true? Or are they just agreeing with you because they’re afraid to be ridiculed and bullied if they reveal their true feelings?
After all, whenever there’s a survey or study which looks at the reasons for non-attendance, the reasons are always given as; Embarrassment; Can’t find the time; Not really bothered.
So all of us naughty girls who don’t do as we’re told are lazy, stupid and reckless.
There’s never any acknowledgement that some women may have psychosexual (or even physical) issues which make smears a no-no. There may be cultural issues which make a penetrative exam unacceptable. Or – perish the thought! – that some women may have researched the subject and decided that the risks outweigh the benefits for them.
Here in the UK, when the screening program first began the participation rate was around 45%. But the disease isn’t as common as most people think, nor is the test as reliable as we’ve been told. So, in order to make any impact on the disease, the screening program was aiming for 80% participation. (Just like breast screening, funnily enough.) This isn’t just about saving lives. The screening program is very expensive – £130 million per annum was the last estimate, and I’m not sure if that’s just the screening or takes into account all the follow-ups, *treatments* and interventions (during pregnancy, for instance) which this ‘harmless’ test often leads to. Anyway… the program gobbles up a huge amount of funds for very little benefit, and the screening chiefs have to justify it’s existance and the use of such funding (and keep themselves in their cushy jobs, of course) by *proving* to their lords & masters that it’s working.
Obviously, many women objected to such an invasive exam, so the program wasn’t the roaring success they’d hoped. What then? They whine that they can’t get enough women up on the couch. What does nanny state do? Get scientists working on a test that women would find more acceptable? After all, men can now have a simple blood test if they don’t want an ‘invasive’ rectal exam, right? And the pap smear was already 40 years old when the program started, so time to look for alternatives, right? Wrong. The government decided to award GP’s for hitting targets. That’s right, GP’s get incentive payments – get enough women to agree to a smear test, you get a nice fat bonus!
And, miracle of miracles, within a very short time the participation rate was above 80%. Now, how did those nice GP’s get all those reluctant women to expose themselves? Bullying, coercion, and blackmail, that’s how.
It’s true Kate
Kate, spot-on, I couldn’t agree more.
I assume you’re still being harassed by the pap police.
I don’t get letters etc, I’ve never screened so the pap test register don’t have my details. If a UK-style call and recall system is introduced here, (read harass and keep harassing) to counter our falling screening rates, I’ll make sure I’m permanently removed from the program.
The pap test program here is more than a decade behind the evidence and has always horribly over-screened women, so we have very high over-treatment/excess biopsy rates…so as the screening rate falls, what does our Govt do?
Do they Immediately wind back the program, finally following the long established evidence? Do they finally exclude young women from the program?
No, they increase the target our GPs must achieve before they get their fat bonuses.
It’s disgusting, they know many women find this test unacceptable for all sorts of reasons, they know we’re seriously over-screening and over-treating women…so what do we do? We carry on regardless…how can this be about women’s health? IMO, it’s about protecting the lucrative industry that feeds off over-screening and over-treating. The healthy cervix is targeted and sacrificed to satisfy vested interests. It also shows how little they care about our rights, health, well-being, bodily privacy and dignity.
Great discription of the situation Kate! I wish this your post was printed out and distributed instead of that pro-pap propaganda junk we get in doctors’ waiting rooms.
At least, it should be copied to other web sites for everyone to see. It could really save many women’s cervixes from unnecessary butchery.
That last post is mine, I can’t connect to WordPress for some reason, so I’ve used another provider.
Elizabeth (Aust)
Elizabeth there are glitches with WP sometimes, recently there were some complaints about emails not working properly. I hope it’s been fixed. BTW if you are still following the comments on the NY article the most recent one from “CountMeAmused” is a good one: http://well.blogs.nytimes.com/2013/04/29/an-exam-with-poor-results/