Saying “No” to a Pap Test

Every time I go to a walk in clinic the doctor asks me “When was your last pap test?” Even though my reasons for visiting have nothing to do with my reproductive organs — once I went because of a sprained ankle, another time because of a flu — it doesn’t seem to matter to the doctors. They are always more interested in finding out the date of my last pap test than in finding out about my actual problem.

And because I’ve never once had a doctor explain anything about pap tests to me, I never even knew what they were for until one day I did my own research, and only then did I learn they were used to screen for cervical cancer. I was shocked when I also learned that cervical cancer is RARE, that pap tests are rampantly inaccurate, and that doctors are supposed to be offering us a choice about whether or not to screen.

So, the last time I needed to see a doctor, I decided to turn down the inevitable offer of a pap test.  This post is for all you women who need to see a doctor but who, like me, have decided not to have a pap test or pelvic exam.

After years of compliance, this is how the experience of saying “no” played out:

I’m up for this and I arrive feeling in control – I can do this no problem . .

Trying to stay limber in the waiting room

And trying not to think about some doctor’s attitudes

Finally shown into the exam room and soon after the doctor walks in

Here’s hoping the doctor will focus on the reason for my visit, but one of the first questions the doctor asks is “when was your last pap test?”

And I’m like

But then I gather courage, and explain that I’m not there for a pap test because I’ve chosen to not participate in cervical cancer screening

And the doctor’s like

The doctor says things like “but it’s for your own good, pap tests save lives, it only takes a minute and since you’re here anyway . . .”. I’m tempted to give in

But no, I actually feel like doing this

And this

But I take the high road and instead do something like this

Explaining the reasons why I have decided to opt out of cervical cancer screening (for example, because cervical cancer is rare and pap tests are rampantly inaccurate, etc.) did not go over too well with the doctor. Doctors make extra money from pap tests, and some doctors also don’t like to have their opinions questioned. Bringing up the reasons why I’m opting out of screening (no matter how valid and well researched those reasons are) led to a long argument, and I end up in this type of situation:

After much verbal sparring, I end up getting my way. But another idea occurs to me in the process: in the future if I don’t want to go through a lot of arguing, I could always say I’m currently having a heavy period. Or, if I don’t want to lie, I could schedule my appointment for that time of the month.

Or, if the doctor’s a male, I could act surprised and then say I only allow women to perform pap tests, never men

Or, I can bring a really big guy with me into the exam room

But, how ever you decide to approach it, if you manage to get what you need without being coerced into an unwanted exam, then congratulations  – well done!

More on this topic:
Other ways to combat pap test coercion: https://forwomenseyesonly.com/2012/12/06/three-ways-to-combat-doctors-bullying-you-into-unwanted-pap-tests-and-pelvic-exams/
Female doctor who does not have pap tests: http://www.goodreads.com/author_blog_posts/2234123-why-i-don-t-have-smears
Informed consent missing: http://www.kevinmd.com/blog/2009/11/informed-consent-missing-pap-smears-cervical-cancer-screening.html
What some male doctors do when women say “no”: https://forwomenseyesonly.com/2012/10/17/what-some-male-doctors-do-when-women-say-no/

257 comments

  1. I’m done with general GP’s.

    I know they mean well, but I don’t want doctors prodding around up inside my vagina with cold hard metal instruments.
    I was taken advantage of by a male doctor this way at 18 or 19 years of age, as well as given a breast exam that I did not need nor consent to.

    The risk of cervical cancer is quite small, and in my opinion doesn’t warrant the constant badgering women receive to undertake regular screenings when many of us simply don’t want them. I do not owe anyone any explanation as to why we wish to decline this particular medical procedure.

    I don’t care if its a woman doctor, a male doctor, or anyone. My body is my own. If that cannot be respected then I’ll take my business elsewhere.

    • I agree, I went in with my husband for a simple check up and we were separated so I had my 14 month old daughter with me. The nurse walked in, checked my weight, then asked me if I wanted to undress to prep for a pap smear. I just stared at her like, are you serious? I asked her, ” am I to hold my child as you fiddle around down there?” She laughed nervously and told me to reschedule. I have not.

  2. Reading this four years after you wrote it and so glad you did! I went for a simple skin check today and was asked by two different staff about pap smears. I feel so violated just being asked, and have been upset ever since. At best, it’s psychologically damaging and ineffective as a screening test, and at worst, the unnecessary biopsies afterwards can damage the cervix and cause problems in pregnancy. I feel so angry and lose faith in the doctors who recommend it. When will they get rid of this appalling practice, and stop trying to coerce every female who walks in the door? I don’t think I will ever find, “Hi, what’s your name? When was your last pap smear?” an appropriate conversation, and especially not with multiple strangers every time I walk into a medical centre.

    • Tell them office time is too short to discuss other health care issue than what you scheduled the appoint for and refuse to answer the question. Tell them to place on your chart that you want this issue permanently resolved and they are to never bring the subject again. Patients have the right to refuse any pill, treatment, exam, without receiving harassment or coercion and you do not need to provide them with a reason. Tell them your choice is no and the issue is closed and to get back to the reason you came to the doctors.

  3. About a year ago, when I was 22, I went into my first appointment with an adult doctor. It was so stupid since I was about to graduate college and move out of the state in a year and could have just held out with my pediatrician until then, since I would have to get a new doctor once I left anyway. My dad kept badgering me to go to an adult doctor and would get mad about my lack of trust for doctors, so he picked one out for me, and I decided to go. I’m not typically super trustworthy of doctors, but I decided this time I would try this trusting thing. The doctor asked me if I was a virgin and we talked a bit about it, and then she said that women over 21 are recommended to get pap smears, even if they’re virgins, but as a virgin I didn’t necessarily need one. I had only heard about pap smears and I guess I was stupid enough to assume they were external exams, which I was fine with, so I said if they were recommended I’d do it. Doc starts getting really weird, goes out, brings some nurse in or something. I kept thinking “maybe she’s going to go inside me but she wouldn’t do that without telling me, knowing that I’m a virgin, right?” I decide to ask her to tell me exactly what she’s going to do and she’s like “I’m just going to check down there and take a swab.” Stupid trusting thing. The speculum she used what like 4 inches wide (probably less than that, but it looked huge and definitely wasn’t the tampon-sized ones that are typically used for virgins) and the pain was excruciating. Every time I told the doctor I was in pain she was just like “it shouldn’t hurt,” like that meant anything. Ended up getting super traumatized, dropped out of college, felt like my body had changed (had these weird cramps that just went away a few months ago after going to an actual gynecologist and having a much better experience, so I think the cramps were psychosomatic), and I’m still dealing with it a year later. Felt like rape, but everyone keeps telling me that it wasn’t and I should just “get over it” so I’m super confused. Been warned about rape since I was 11 (told that’s why I couldn’t do all the things my brother could) so now that I’ve had this incredibly painful experience with some unwelcome thing going inside my vagina and it’s not rape… I just don’t get it.

    • Hi. This stupid doctor took unfair advantage of you. You went to her in all innocence not knowing what she had planned for you.

      You are a virgin and she had no right to do that to you. She knows you dont do this to virgins. Complain to the medical authorities.

      Now you need to move on with your life. Read the comments and articles on this site and get strong. Learn from other women. Smears are not necessary or mandatory. Learn to stand up to doctors. Dont be afraid to be ‘very’ firm with them.

      X

      • I did complain to the medical authorities. Nothing’s happening. So I’m taking matters into my own hands. In my mind, if she doesn’t accept responsibility for what happened, it’s my responsibility, which means it’s my responsibility to make sure this never happens again. I take my responsibilities very seriously.

  4. I made my doctor permately resolve the issue and I am never to be asked about them again. I once had an asshole male Dr when I refused a pap asked what my husband would want me to do. I went bat shit crazy on him.

    • Oh my Monica – you made me laugh so loud in the office everyone wanted to know why – Thank you for making my day with your comment “I went bat shit crazy on him”. I seriously am PMSL at the moment! Brilliant!
      Just goes to show how paternalistic they all are….like a husband has any right to that decision about ones body…..I dam well think not!

  5. I haven’t posted here in like 4 years. So I’ve been seeing a nurse practitioner since my old doctor didn’t work out. She was obsessed with pap smears. Granted, she mostly left me alone because I’m a very good liar and would reassure her that my midwife was doing them (not) and flat out told her, “You really don’t need to bother yourself with my girly stuff. Ever. If I have an issue I’ll let you know.” However, she always had the stuff set up in every exam room and it was really weird. CREEPY. I left her because she literally blamed every health problem I had on my weight. Ear infection? It’s because you’re fat. Sprained ankle? Fat. Inherited thyroid problems? Fat. I lost it after the sprained ankle (slipped on the stairs and rolled it) and fired her.

    I’ve been with this NP for a year and she’s really great. She’s very sweet I have a good rapport with her and instead of blaming everything on my weight, she is trying to help me understand the underlying causes of why I struggle to lose weight and celebrates when I’ve lost even a little amount instead of telling me it’s not good enough. Paps have never come up because she never asked, but she did this past week when she suggested a physical later this year with all the bells and whistles. I took a deep breath and looked her right in the eyes and said, “I understand I am overdue for a physical and I do need to keep an eye on some things, but know that I will not consent to any GYN exams or pap smears or breast exams. I never will. They are invasive and I cannot abide them without panic attacks for months afterwards. I understand the risks. I am low risk for HPV and breast cancer, anyway, and I choose not to be screened.”

    She shrugged and said, “That’s fine. When you book your appointment online, just write in the notes section that you don’t want any GYN or breast stuff and we won’t worry about it.” She then grinned and said, “Makes the appointment shorter anyway.”

    I was floored. Never have I met a practitioner who was so accepting of my choices and didn’t argue with me. Maybe it’s because I’m over 40 or maybe because I was proactive. I almost hugged her, I was so happy. She’s definitely got me as a lifelong patient now!

  6. I’ve gone on here anonymously before and I’ll comment again. So I talked to my husband about my choice not to screen, and several reasons why I won’t and why it’s pointless and extremely invasive, he was sweet about it and supportive in my decision. I’m going to my doctor today to get my hip checked out because it’s been hurting on and off every day since about the middle of October, so I want to see if they could refer me to someone who can check it out properly like a physical therapist or to get an x ray and so on. My husband agreed to go with me to my appointment but then he had something going on which he might not be able to come, so I, not being dominant in my personality AT ALL, am pretty nervous about going and hearing basically the FIRST QUESTION being “when was your last pap smear” and then trying to coerce me into doing it as if it has ANYTHING to do with my hip??!!! I’m more concerned about my hip than my reproductive system. I think my reproductive organs are healthy and well! It’s my hip flexor and hip socket that’s bothering me! I’m a ballet dancer just a couple years away from being a professional, and I NEED my hip to do well for my performing career, especially being 24 and wanting to continue after 25. How can I stick up for myself if by chances my husband won’t be there with me at my appointment? Any pointers or suggestions? I’d love to hear from some of you soon, thank you. And thank you for making this page a reality because now I know I’m not alone 🙂

    • “I don’t participate in screening and I’m well-informed about the consequences. I am not discussing this any further. I am here to be seen about my hip.” Grey-rock, don’t JADE (justify – argue – defend – explain). If you try that, you’ll only sit there discussing your choice 95% of the time if the doctor is a pressuring one, and won’t have your hip looked at properly. I hope it goes smoother than you imagine and that you don’t have to say anything at all or just a mild “No thank you”.

    • Quite simply just say “NO THANK YOU, I have made an informed decision not to screen, now please can we use the consult time for the problem I am here for”.
      You are in charge of your body and there is no need to justify your refusal. Always remember “No decision about you without you”

    • It’s pretty bad when this pap crap becomes a barrier for women who seek medical care for things which are actually wrong. It’s almost like an “admission fee”. Grrrr. You’re not alone, and I think women are starting to wake up and notice that our health is not contained exclusively in our reproductive system.

      As I had an appointment for an actual medical condition derailed into pap coercion, and where I kept my clothes on, I can sympathize. Yes, you’re a ballet dancer, and good enough that you’re looking forward to having a performing career in it (wooo hooo! WTG!), the functionality of your hips is VERY important to you. You’re not fearing a rare cancer, which is nearly unheard of in women under 25.

      My suggestion is to bring the conversation back to the issue with your hip when they try to bring up your genitalia. “Let’s get back to the reason I’m here. My hip (describe again).” Or, you could embarrass them, with a question, “So, you think the issue in my hip is actually in my vagina or cervix?” If they say it does, GET IT IN WRITING! Then, take that to everyone from the medical board to the media.

      It’ll make you feel better to have a backup plan. Could you see about getting to a different doctor, perhaps an orthopedist, whose interest and practice is the bones and connective tissue?

    • You’ve received excellent advice from everyone. At medical appointments I always keep in mind that by asserting myself I’m not only standing up for my right to bodily autonomy and full informed consent, but also helping other women who may have the same concerns. We’re all part of the same movement striving for respectful healthcare where we receive the same balanced information and informed consent that men do, and when one of us speaks up we are strengthening all of us.

  7. Constantly repeating “I opted out and signed a disclaimer ” then remaining silent worked for me. After asking about 4 times why I didn’t want a smear test and my repeating the above he finally got the message ..NO ? you STILL don’t want to have a smear test? You can guess my reply…one defeated doc hung up the phone

  8. I found being calm and firm worked a treat, don’t engage in debate, that’s what they want, try not to be defensive…I know that’s hard because the pressure we face works in their favour, we’re in their consult room. Of course, this strategy is easier as we get older, at your age I simply avoided doctors. Of course, that’s unacceptable, we’re entitled to medical care without pressure to have screening tests or exams we don’t want…
    I know young women who were seriously over-treated as a result of early screening, the risk of a false positive is very high below 30 and especially under 25, we know screening does not benefit young women. Now it’s even easier…women can self test for hpv from age 30, 95% will be hpv- and can forget about cc. Women might choose to re-test for hpv every 5 or 10 years…or if confidently monogamous or no longer sexually active, might forget about screening full stop.

    I’d gauge your doctor’s attitude, you’ll soon know…if you face pressure, coercion, I’d leave and find another doctor. At only 24, a pap test is a bad idea, even here in Australia they’ve finally raised the screening age to 25: still too young, but too many vested interests want to do pointless colposcopies and biopsies on young women.
    You’ll find the strategy that works for you but my advice is to calmly say you’d just like to focus on your hip issue…and start talking about your hip and dance career.
    Very exciting, the ballet is so beautiful…

    • Thank you all for your amazing comments! So I went in and luckily there was no discussion on my reproductive system and pap smears. The focus was on my hip, just like I hoped! I told my husband about it and he was like “oh good, I was worrying for a while and felt really bad I couldn’t be there and hoped you were doing okay. Glad they focused on your hip.” Also, my husband is and has been my only sexual partner, so like… what’s going to happen? Is monogamous sex going to, give me… cancer??? How? I’m pretty sure a healthy sex life is GOOD for the vagina, not cancerous. Pretty sure my husband’s semen is not gonna poison my insides! Anyway, so I’ll be going into physical therapy here soon and then might have an MRI done as well to see exactly what’s going on and how they could fix it. Thank you all for your wonderful support! I am hoping I can get my hip fixed soon because I love ballet so much with a huge passion, and I MUST keep doing it!! ❤

      • I’m SO GLAD that you found a doctor who could focus on, and treat, the problem at hand rather than run you around with your reproductive system first.

        They don’t have any problems sewing the seeds of doubt in one another if they come up with the woman having HPV…. even though it’s more likely that HPV were put into her in the clinic than her husband having an affair, the affair notion will be brought up. Or, if that doesn’t work, put in a the notion of a “forgotten” sexual attack when you were very young.

        It’s great to see you being faithful, and sticking by and helping each other in anticipation for this being brought up in lieu of medical care.

  9. Hi.
    Not posted for a while as busy sorting out this deregistering debaticle. They in fact in a fashion admitted defeat about the finger prick tests and all sorted now and re registered.

    Back in November I emailed a complaint to healthwatch and last night I finally got a reply (new record LOL) I was astounded at the content surrounding cervical screening and apparently I need councelling with a sample taker. I let you read it for yourself.

    I’m emailing to pass on some guidance from NHS England about cervical screening in case you are still having trouble with your GP practice

    ‘Women can opt out of the programme at any time but we would rather the woman deferred

    The GP under no circumstances can refuse to opt them out of the programme.

    In the East Midlands there is a policy in place that if a woman requests via her practice to be ceased from the programme, she should have a face to face discussion with her sample taker to ensure she is fully informed of the risks of not attending and importantly she can opt into the programme at any time in the future as long as she is in the eligible age range (25 – 64)

    PCSE are notified by the sample taker to send the woman a copy of the national disclaimer form and thje woman chooses to sign the form and return it for action by PCSE, or chooses not to sign herself out of the programme’

  10. Rose they’re chancing their luck. I informed my GP and the screening centre in writing I was opting out. I was sent the disclaimer and signed and returned it. There’s no requirement to get counselling

  11. Hi I’ve been reading this site for over four years now. I can’t even go to my docs any more I’ve not been to well lately but I won’t go and get any help! I’ve not had a smear test for 8years now and I don’t won’t one so when I go to my docs i always get the you need to have a smear test! I go home feeling like I wish I was not a female. I live in the u.k

    • I’m sorry this pap crap is acting as a barrier to your seeking medical care. I hope your issue goes away,but if it doesn’t, I would encourage you to see a doctor – and stand your ground about refusing the pap, and actually get diagnosed and treated for your actual medical problem(s), rather than some rare cancer.

  12. Hi Hayley
    I’m sorry you’re not feeling well. Hopefully it’s nothing to worry about and you’ll get better without having to seek medical care. If you do need to see a doctor, this site has loads of advice and tips to help you assert yourself in the face of any pressure to have a smear. Please keep us posted, we care!

  13. I’ve been having a pap smear annually for around 35 years, all normal, and I’m sick and tired of it. I called my ob-gyn and asked for an order for a mammogram which I should get annually especially since this year I can get 3D. Every year I have gotten a mammogram I get a report that there is no sign of cancer but that they can’t tell because of dense breast tissue. My Ob-gyn said I don’t have to have a pap every year but I do have to come in for a pelvic exam annually in order for them to write an order for a mammogram. So they’re going to do a pelvic exam but no pap smear? This is crazy and it’s all about billing for the additional service.

    • What are they looking for in these pelvic exams? Spare change? The bimanual exam is deprecated by all medical organizations, the ACOG being the only one that recommends it, but no real reason. Just an observation that women talk to their providers about things they might not otherwise during the bimanual exam – which lacks specificity or sensitivity to diagnosing any disease.

      Why have a mammogram? It increases the ionizing radiation your breasts will have been exposed to over your lifetime, increasing your chances of cancer. It increases lead time bias for diagnosis, but the evidence that it increases the life expectancy just from breast cancer is unconvincing. It does greatly increase the chances of having more surgery.

      • Well, ya know, bethkz, it may not have any clinical value, but it’s a crucial BONDING exercise. You know, like the deep and inescapable lifelong bond that a rape victim has with her rapist. Barf.

  14. I refused to even start mammograms. I have never had one.

    Also you’d expect a mammogram clinic to have the most updated equipment but can you even ask before making an appointment? I am sure that many clinic have old clunky machines that are churning out excessive radiation. Doctors will lie and say that new mammograms are better, less radiations, can see cancer better or you have less chance of removing your whole breast. Is just having a chink taken out much better than losing all or both breasts? Do I even want to think about it?

    Plus the bit about making sure not to use ANY lotions, creams, deodorant, perfume on your breasts or underarms before going For a mammogram. How does using an aluminum antiperspirant affect mammograms? Even if you do not use it the morning of, there could be residual metal particles in the area.

    • Same Moo. I declined my first “invitation ” to breast crushing and opted out immediately afterwards. I should have had my 2nd end of last year if I’d stayed in the programme

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