Every time I go to a walk in clinic the doctor asks me “When was your last pap test?”. I went to a clinic for a sprained ankle and the doctor glanced briefly at my ankle, and then continued to pressure me into a pap test. The same thing happened when I went to a clinic about a suspicious looking mole on my back.
The scenario always goes something like this:
Me: I’m worried about a mole on my back.
Dr.: Uh huh, when was your last pap test?
Me: I can’t remember, not too long ago.
Dr.: Well, we will have to do one then. Get undressed and hop up on the examining table.
Then the Dr. leaves before I have a chance to say anything. I worry if I don’t comply and be a good girl that he won’t help me with my health concerns. I would like to be given information and a choice!
Doctor’s view on informed consent for pap smears: http://www.kevinmd.com/blog/2009/11/informed-consent-missing-pap-smears-cervical-cancer-screening.html
Summarized doctors’ article about unnecessary pap tests/pelvic exams: http://forwomenseyesonly.wordpress.com/2012/09/30/battle-brewing-over-pointless-pelvic-exams/
forwomenseyesonly 
Pap and mammogram happy hours. Nice link. Maybe the informed part of consent will be more regular.
Pap and mammogram happy hours 🙂 – it is always about boobs and vaginas at the dr’s office. We do have other parts! It is hard to say “no” to a stern dr’s gaze asking about paps, but I have started wriggling out of it. Now I always say “I had my last pap 3 months ago, but thanks for asking”! I find it easier to lie than to explain I have chosen to not be screened for cervical cancer since it is very rare in developed countries. In Canada the incident rate is .0007%. It is about the same incident rate found with mouth cancer but you don’t see dr’s bugging us to open our mouths for them. Thanks for the comments Katie.
Here, in the US the situation with Dr’s is similar. Though they do not demand a pap test each time I go in, I have been in for a sore back, or throat and they ALWAYS ask. If my vagina hurt I would tell you! I am here
for my ankle. Ugh.
Exactly! I would like to say to drs if there was a problem with my vagina I would let you know but otherwise could you please focus on the reason I’m here! I think I’ll get a t-shirt that says “VAGINA” printed on it to wear if something comes up, because that is all the drs here in Canada seem to care about. I think in the US the drs might be further ahead than they are here in terms of following the recommended guidelines to screen once every 3 years. Here they want to play with their speculums every chance they get. They have been causing harm to women both mentally and physically.
Doctors in the US are very very focused on “bikini medicine” – looking at a woman only in terms of her breasts, vagina, and rectum, and ignoring any other health concern that brings her in to see the doctor. They’re probably more interested in performing pelvic exams and other such “follow-on” exams because it’s extremely lucrative.
More than half the time spent in an “ordinary’ doctor visit is spent arguing with them about refusing a pelvic exam, regardless of the complaint that brought me in. After they’ve spent 5-10 minutes pressuring me to show them my vagina, I’ve started asking, “Do you think my (shoulder pain, mole, breathing difficulty, etc) is in my vagina? Could I have that in writing?” By then, the appointment time is exceeded, and I never did get medical care for why I went in.
I’ve stopped going for fairly-minor problems. I don’t get health care anyway – just pressure to look up my skirt and grope my breasts. In high school, I at least got dinner and a movie for such pressure.
Beth, you have done a great job of summing up the problem here. Women don’t get health care, period. All they get is traumatized, coerced, humiliated, exploited, dehumanized, and sometimes molested . . . or worse. On its own a pap test feels worse than being molested, and sometimes there is the added bonus of a dr taking it up a notch. Sometimes women are further terrorized when a smear comes back positive (fairly common), and then they get re traumatized, humiliated and dehumanized when they get even more pressure to go for follow up tests and “treatments”, which are even creepier. I loved the part about how in high school you at least got dinner and a movie – exactly, going to the dr is just like a bad date, a very very bad nightmarish date.
I also like the term “bikini medicine”, I hadn’t heard that before but it does describe all focus points of interest very nicely. Interesting how they have very carefully de-sexualized the term for such an exam by calling it a “pelvic” exam, when in fact what is involved is far more intimate than most women would allow a close lover or spouse do to them.
I am very thankful to have stumbled on this article. I had a PAP smear come back “positive” for abnormal cells in November and got the call on my way to the store. I was terrified until I was able to get to a computer and do research, and even after that I was still afraid. This makes me feel much better about my choice to wait until my next (required to get BCPs) PAP before doing anything.
Kate, pap tests are not required for birth control, the only clinical requirement is a blood pressure test and your medical history.
Here is a summary put together by Dr Robert Hatcher.
http://www.managingcontraception.com/newsevents/dr-bob/pelvic-exam-necessary-for-contraception-rx/
The more often you test, the more likely you’ll get a false positive for no additional benefit over 5 yearly testing from 30 to 60, annual and 2 yearly pap testing carries high risk – 77% is the lifetime risk of referral for colposcopy/biopsy with 2 yearly testing, almost all amounts to over-detection. Annual pap testing would be even higher. So over-screening risks your health for no additional benefit.
We now know only HPV+ women aged 30-60 can benefit from pap testing. No country in the world has shown a benefit pap testing those under 30, but young women produce the most false positives. (1 in 3 for those under 25)
Not sure of your age or whether you’re having annual or two yearly testing, but I think you’re wise to be cautious…the cervix is there for a reason. Unnecessary “treatments” can cause damage and lead to some serious health and obstetric issues.
http://www.motherjones.com/politics/2012/04/doctors-holding-birth-control-hostage
(an interesting article written by a journalist on the subject of medical coercion ie. holding birth control hostage until you agree to unnecessary exams and ELECTIVE cancer screening)
I was just reading about the SoloPap test that might be marketed here by an American company, Medical Systems International (MSI), their office addresses are in Nevada, USA and Tasmania. I don’t think you can order it yet, they’re waiting for final FDA approval. (not far away, apparently) It seems to be both a pap and HPV test. I don’t like that idea, the Americans are doing both tests on women and it’s not a good idea, it generates the most over-investigation for no additional benefit. It just sends more women into endless re-testing and day procedure.
MSI say there is only one other self-test kit, and seem to be talking about Tampap, (available in the UK) but what about the Delphi Screener?
Also, they recommend their product over HPV self-testing, as some cervical cancers are not linked to HPV, you can be HPV- and still get cervical cancer. We therefore need (I hate that word) pap testing to be covered. (or both HPV and pap tests)
Not sure I agree with that…the new Dutch program will not even offer pap tests to those women who are HPV-. I know small cell neuroendocrine carcinoma of the cervix, which is VERY rare, and accounts for only 100 of the 11,000 cases of cc diagnosed in the States every year, “might” not be linked to HPV, but them again, it might be linked to HPV.
It seems many accept if you’re HPV-…you’re not at risk of cc and cannot benefit from a pap test. Even if it’s true that small cell is not linked to HPV, the risk is so small compared to the much higher risk with pap testing. Some women might feel HPV primary testing gives them enough protection. It’s up to us how much risk we’re prepared to accept to cover a very rare/tiny risk.
For those interested in cervical screening, IMO, knowing your HPV status is an important first step. I think the Delphi Screener would be preferable, if you’re HPV+…then you’re at risk (a small risk) and might consider having a pap test or you could use the Solopap at that stage. (if you check it out and you’re satisfied it’s a good idea) It’s great that more self-test options are on the way, (hopefully, they don’t put too many unnecessary barriers in front of them) but we need to be careful they don’t just land us in the same ugly place…being over-screened and over-treated. IMO, women under 30 should be very careful with both pap and HPV tests…there is no evidence of benefit, but lots of risk. For me: the risk of cc was so small, I was not prepared to accept the fairly high risk with pap testing, so no pap tests for me.
So, approach with caution.
http://medsysint.com.au/
The other point I forgot to mention, the even rarer types of cc are usually missed by pap testing anyway, and a false negative can falsely reassure and lead to a later diagnosis. Adenocarcinoma is usually missed by pap tests, yet it’s linked to HPV.
HPV primary testing and HPV self-testing IMO, would prevent/catch more of these rare cancers and offer much better protection from over-treatment.
Over-screening with pap testing or combining HPV and pap testing in an attempt to catch these very rare cancers is bad medicine IMO, because you’d worry and harm large numbers and probably miss the very rare cancer anyway.
This is a post from a high profile happy papping website.
“Hi Everyone
We’re looking for someone in England who developed cervical cancer between the ages of 25-29 after delaying their cervical screening test.
This is for a TV interview on Monday 10th June. The TV company will cover travel and an overnight stay if you’re outside of London.
This is a great way to help us raise awareness of cervical cancer and prevention so we’d love to hear from you.”
Shocking.
Are they interested in hearing from all of the young women over-treated after early pap tests, they’d be thousands of them? No….
What about someone from The Netherlands or Finland who can confirm they’ve never screened women under 30? The evidence does not support testing them, it’s high risk for no benefit.
What about someone who got cc after one or more normal pap tests? Young women tend to get an even rarer form of adenocarcinoma, usually missed by pap testing. False negatives may falsely reassure.
What about mentioning the number of cases in those under 30 is the same whether you screen or not? But screen these women, and fill up day procedure.
No, they just want someone who fits their agenda, someone unscreened who was unlucky enough to get cc.
So, so dishonest, the evidence says pap tests are unhelpful (and risk their health) for young women, those under 30. This is misleading, manipulating and scaring women to protect non-evidence based screening.