ACOG Committee Agrees No Pelvic Examination Necessary for STD Testing

Women do not need to undergo humiliating examinations in order to test for sexually transmitted diseases.  Urine testing and/or self-collected vaginal swabs are acceptable alternatives to an internal exam.  The American College of Physicians and Surgeons (ACOG) Committee Opinion states the following:

“Nucleic acid amplification testing on urine samples or vaginal swab specimens is now an acceptable form of screening for gonorrhea and chlamydial infections, obviating the need for cervical sampling.  Other options that do not require an internal examination include self-collected vaginal swabs for diagnosing yeast infections, trichomoniasis, and bacterial vaginosis” ACOG Committee Opinion:

Sexually transmitted disease testing is each woman’s choice and there is no need to submit to an unwanted examination if a decision to undergo testing is made.  As one poster on this blog has stated:  “TAKE BACK YOUR BODY. THE MEDICAL COMMUNITY FEELS THAT IT IS THEIR RIGHT TO NUDE YOU AS A PERK, AND FOR GREED. DON’T BE NAIVE!”  (Alexis) Well put.



  1. Well it seems the majority of American doctors are still ignoring the reduced guidelines for pap testing and using HPV testing on those under 30 or using it too often, and they continue to do pap tests on huge numbers of women with no cervix (after a hysterectomy for benign conditions)…so I’m not hopeful. The profession needs to get tough with doctors and start a campaign to inform women – excess and inappropriate testing carries nothing but risk, then we might see things changing, for too long it’s been anything goes with the female body. Many doctors are simply not listening.
    Some say women ask for annual pap tests etc. well, surely as a medical professional it’s your ethical responsibility to properly inform the woman (or man) if they ask for something inappropriate, would you do a mammogram on a teenager if she asked for it (and this happens after scare campaigns or high profile case. My GP distressed quite a few young women because she refused to help them get a mammogram. Thankfully, they’d been knocked back by Breast Screen. (i.e. a bad time was after Kylie Minogue had breast cancer surgery) So often celebrities will advise young women to get screened, which causes no end of trouble in the consult room. My rule: never take medical advice from a celebrity.
    I heard an Australian GP say she hopes young women are never removed from the pap testing program, (that’s likely to happen at some stage) because it’s often the time when they ask for STI testing as well, so if they were not having the test, they wouldn’t ask for STI testing etc..

    They need to find another way of making STI testing available to those who want it without judgement or too much embarrassment. We don’t do prostate exams on young men to give them the opportunity to ask for or be pressured into STI testing, men get STIs as well.
    Using a test that carries risk for no benefit is unethical and I’d say, a lot more. There seems to be this attitude that the pap test is benign, when nothing could be further from the truth, damaging the cervix of a young woman (any woman) is not a trivial thing. There needs to be a lot more respect for the female body, we don’t have bits that can be casually cut out or removed.

    • Very cool. Hopefully they don’t blow it off like every other time they say something subtractive to the frequency of internal testing.

      As for doctors, let me see if I’ve got this straight:
      Their logic is that someone will take the opportunity to ask for something they DO want when someone forces them into something they DON’T want? The presumption is that they’ll ask for something of their own accord, but they’re going to corral someone into things because they wouldn’t ask on their own? AND that’s not an attack? AND they’re not untrustworthy because of that?

      Their background story doesn’t match the situation- pretty sure that’s Proof By Indication that they don’t actually feel the way that they say they do. Comes up a lot, I’ve noticed.

      Your right, Elizabeth- they shouldn’t be purveying things that are untrue or unsafe, anyway. Major reason to figure that they won’t be giving the highest quality of care- which, oddly enough, applies to infecting someone with these procedures. I’ll bet they don’t ask “How you had any tools inserted anywhere recently?” I really wouldn’t be half suprised if they do deliberately infect people so they can attack them & generate a repeat cost at the same time. If anything came up, they’d probably just say that these people picked it up before they came there.

  2. sTD testing is widely available by urine testing. HPV is not. Currently I believe that Trovagene has a urine based test for high risk HPV strains (result is either positive or negative, does not identify presence of individual strains). It is not not approved by FDA and I do not know if it is available outside of California.

    How does a citizen petition the FDA to approve these medical devices? I live in canada and there is mechanism in the Health Canada ministry to approve orphan drugs. Often petitions will go out from citizens to petition for certain issues including approving drugs or changing laws, making new ones. I do not want to personally contact my member of parliament about my outrage at pelvic exams and Pap tests. The ministry of Health Ontario is responsible for the Pap test incentive programme that pays doctors for meeting quotas for cancer screening. I was this programme disco tuned however I feel that if women had the choice of a urine HPV test that would be feasible. Currently there is a swab HPV test available in Ontario (patient pays) but it is always done with a Pap test and pelvic exam.

    I was thinking about making up information pamphlets and leaving them round public places. It would include information about pap testing and urging people to complain to the ministry of health. I find this rather difficult and overwhelming.

    Enough of bitching online. So where do I start? What can I do?

    • Didn’t know the FDA held any sway on Canada’s approval of these things (of course, since a lot of places follow America’s lead on things that might be a point).

      Honestly, I’d say to look up “public works” or something along those lines. Maybe just Google the exact question you just asked. To be really honest, I’d just say pay them off as an answer, but that might not work if it would actually help someone.

    • There tend to be trends in public policies also because of trade. So what FDA wants might affect other countries. 100% sure is FDA sends their inspectors to Canadian drug manufacturers for their own inspections (Health Canada also have inspectors). The FDA inspectors are more tough on Canadian manufacturers than in their own country. So how about $$$$ is spent. It is not about taking care of their own citizens health because it is about politics and markets. Some American food is make in horrendous conditions that would never happen in Canada or Europe.

  3. This web is unbelievable
    “Why Do I Need a Pap Smear to Get Birth Control Pills?”
    “Most doctors require you go get a Pap smear in order to get a prescription for birth control pills. Although it may seem arbitrary, and many people resist what feels like unnecessary intrusiveness, it’s actually for a very good reason”
    Really – Arbitrary – based on random choice or personal whim, rather than any reason or system / (of power or a ruling body) unrestrained and autocratic in the use of authority

    “Many women find Pap smears embarrassing, and they would avoid getting them if they could get away with it” ………..WHAT!
    “Is it paternalistic to require a Pap smear in order to get contraceptive pills? One could argue that. But it’s also effective. Sometimes doctor really does know best”………….ARGUE IT!

    These attitudes could explode my brain, sigh!!

    • I think off the bat that’s kind of subtlely refusing the situation isn’t it? The question is asked in order to deactivate this situation, plain & simple. I’d think that would be enough. It’s interesting that they don’t try to make people jump through all kinds of hurdles to get other prescriptions that are very dangerous & act like birth control is two steps from being cyanide.

      I just had a big argument with a guy (might still be ongoing, we’ll see today) that it’s not “best” because of doctor’s determination. It really is as if these people think that reality is forged by cognition! They DO realize when things aren’t going their way, however- so I guess it must just be a front. It’s confusing because it doesn’t make sense & maybe someone keeps trying to find a background reason that makes sense- which is chasing a carrot on a stick. Sneaky- to act crazy to try to hide malice.

    • There is this addendum at the end of the article: “Update 11/10: Since writing this article, I’ve read many women’s stories of their experiences getting Pap smears, and I’m no longer in favor of using birth control pills as a way to encourage Pap screening. I still think that regular, although not yearly, screening is important; however, I think that it would be better to recruit women through education than through mechanisms that are perceived as highly coercive. Your stories have changed my mind. Thank you.”

      However I do wonder how someone could write that article and not realize that they are basically saying that it’s okay for a Dr to act unethically and coerce you into an intimate exam and basically assault you and that assault is good for you as the Dr knows best. I cannot figure out how a rare cancer that was never a threat to women’s health became so feared with a screening test pushed onto women and informed consent taken away. The hoops women have to jump through in the UK to get off the recall system is coercive and just ridiculous. The pap smear became a test that women have to have and not an optional screening test that can be declined. It’s as if people have never really looked at the numbers and how rare CC is and always has been. I’ve read a few articles lately involving current events and women’s rights and it still comes down to that women and our bodies are viewed by society and portrayed in the media as things and as vaginas. World wide women are exploited and abused. I’m sure no one would think that the way women’s health care with the perpetuation of fearing our bodies and coercion and lack of informed consent contributes to that abuse. Many women do not even realize that they have never given informed consent. With the way our society portrays women it is not surprising that the medical system would view women as merely things to reach screening targets and make money.

      • Exactly…AND how often do you hear women say, “you can’t get the Pill without a pap and pelvic” it’s just accepted that’s the case, whereas neither is a clinical requirement for the Pill. These women are often trained to then fear getting the Pill without the probing and scrapping…it’s incredible that coercion is viewed by many women as normal (even helpful, “some women wouldn’t get screened otherwise”) and even more shocking that the profession has/had no problem treating women like objects with no rights.

        I contributed to that thread, I think the author was shocked to get a torrent of disagreement, fury, anger, tears and informed comments, it’s hard to tut-tut when a lot of women reject your comments. This is a positive sign, up until about 5 years ago that article would have been accepted (maybe privately cursed) and any negative comments would have been deleted or the poster howled down.

        Also, I don’t give a damn whether the author thinks women should have regular testing “perhaps through education”, the fact is women should receive all of the evidence and be left to make up their own minds. I decided LONG ago not to have pap tests, an informed decision. It’s not good enough to admit coercion is wrong, and then say that women should be “encouraged’ through education, that STILL denies us a basic right, CHOICE, the assumption being an educated woman WILL screen.

        So many have such a hard time with the concept of women making their own decisions or choosing not to screen.
        A breast screening charity in the UK made the offensive remark, “yes, we want women to make informed choices, but still attend for their regular screening”.
        That’s not respecting informed consent, not even close.

      • I think it’s also odd thatwomen don’t seem to consider altering that situation. I get that they HEAR that this is the situation, but what about realigning things? Men tend toward things like that a bit more, but I’d think there would be overlap? I suppose there actually is, even if some of it’s unsung.

        I remember hearing similar things about pharmacies deciding to not give teenage girls that Plan B pill (or whatever it’s called, it’s those emergency contraceptives). They would just tell them it’s illegal when it’s not or refuse to sell them those pills. These girls/women would just hear that & stop looking. Instead of finding out if they were lying or trying to force them to give them what they want. This is a time-sensitive situation & greatly influences someone’s life.

        I also don’t get why there wouldn’t be more of a taste for “bullying” these people? They go pushing someone around & claim it’s their independant right to do so. I, personally, find it very agreeable to just do something against their wishes (I know what that sounds like, but that’s exactly what you might be going against). They act like it’s self-defense, but self-defense doesn’t look the same for everybody.

      • I’ve wondered about that too, Alex, not sure why so many women just accept the situation, walk off accepting they can’t get the Pill without pap tests etc.
        I think it’s complex, but certainly women have been subjected to a systematic campaign over decades to brainwash us, corner us and force us into testing. I can’t think of anything like that in men’s cancer screening.
        I think women also, tend to be more accepting of authority, I’ve read some women want to please others, don’t want to make waves, be viewed as irresponsible, obstructive etc. Perhaps, we care more what people think of us.
        Of course, I’m generalizing, but I do wonder why so few stop and think, “what on earth is going on here?”…it’s now viewed as normal by many, when it’s an outrage.
        Over the years I was amazed how many intelligent women just submitted to whatever was demanded of them. Some seemed to think it was mature, sophisticated, responsible or modern to submit to pap tests. (especially when almost all doctors were male)
        I think everyone being on board helped, so women were locked out of real information and choice. Now we have a few whistleblowers and more women becoming informed, the tide is starting to turn and IMO, they’re losing control of the herd. Censorship – keeping all real information away from women, promoting the screening “story” and silencing, intimidating and ridiculing critics were vitally important to the success of this program – women had to feel like they had no other choice, there was only one reasonable option: to screen as directed.
        It would be interesting to hear what others think…why do so many women just accept medical mandates and have done so for decades?

      • Trust is another factor, more women tend to trust these programs and doctors, I’ve heard women scoff at the suggestion these programs are not in our interests, “we didn’t go to medical school, did we?”…etc.
        So many can’t accept that doctors would do anything other than put our interests first.
        Personally, I believe self-interest and politics goes right to the top, some of the statements that come from the AMA, IMO, makes clear their major concern is protecting their power and commercial base. (against the Pill being taken off script, two senior male members recently linked the Pill with pap testing, one seemed to be endorsing medical coercion, against pharmacists dispensing the Pill and other medication etc.)

      • You know, I just thought of something else: guilt for thinking badly of the people that “want to help.” It’s the theme of not attacking an innocent- which is a good alignment to have, but it doesn’t always apply. The whole “you’re hurting your family” angle is present, too. It doesn’t have to be true for someone to say it, but maybe there’s a little bit of a presumption of honesty & accuracy.

        An action has to be engaged in order to occur, so I still don’t get how someone thinks this is something that just happens. It’s an intejected action. It’s not just “part of the situation.” I don’t think women would figure a punch in the face is just a part of marriage.

    • From the article you posted:

      “The bad news is that the problem of unintentional harm is far bigger than many people suspect. The Office of the Inspector General for Health and Human Services reports that among Medicare patients alone, it contributes to 180,000 deaths annually. On a national level, unintentionally harming patients in the process of trying to improve their health now ranks as the number three cause of death in the U.S. — ironically just after cancer.”

      Just for a comparsion- cervical cancer kills about 4000-something people in the U.S., yet people are brainwashed to fear cervical cancer, and not preventive medicine.

      • So it’s 18000, 000 with more on top of it vs. 4000 or so, over all? Isn’t that interesting? I don’t remember ever seeing that mentioned in a textbook in school. I’m willing to bet no one else has, either.

        Altruism doesn’t produce ownership, anyway (so “being worried about someone” doesn’t make their actions innocent, even IF it were true)- but when one sees those kinds of figures, they’ve got to figure there’s other things besides ailment concerns going on.

        I go with organizational pervyness & malice mixed with potential monetary gains (also present in the ground-floor level). Masters & minions being the same thing as each other in a variety of ways. I’m really suprised that people think that everything from thieves to marine biologists will tend toward associating with people similar to themselves, but don’t think that that happens with anything educated & certified. What’s the deal with that? Also, it’s like they have no concept of upper-level corruption or regulatory capture one an individual or organizational level. No, someone can’t be twisted & cruel at the same time as being highly placed. Of course not, they’re just in a better position do to things like that & do it potentially without risk of retaliation. No motivation for getting to that level to do that, either.

        You know what I just thought of? That someone can go buy a bottle of aspirin (or a rope, or a set of steak knives, or rubbing alcohol) that they could harm or kill themselves with & no one acts like that is something to instantly presume those will be the end results of using them. Yet, with birth control pills they act like this is some kind of dangerous thing & they’re being considerate by generating coercive hurdles to getting them.

      • According to stats I read medical mistakes cause 210,000 in the US every year from over testing and over treating. When hospitals are included the estimation rises to 440,000 deaths each year. There were 37,485 people deaths in the US in 2009 from using prescription drugs. As was stated 4000 women died from CC and that’s what I’m supposed to worry about.

  4. My grandmother was watching the Dr. Phil show this moring. He was counceling a young woman who was prostituting her self for money and other things. Doctor phill had a woman who used to be a prostitute come on the show and talk to the girl. She said she had ” erly cervical cancer” like it came from her sleeping around. It bothers me all these woman saying they “had” cervical cancer and having sex causes it. How are they healthy now if they had the cancer. And why are doctors telling woman they have erly cc . Its as tho doctors are not explaning anything to woman and purposly misleading them. Then they go on nathtional TV to scare other woman about “erly cc” and send a message that woman having sex equals female cancer. It just annoyes me. And I see this more and more on tv.

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