Pap smears are invasive and have potential for harm. Currently in women’s health care, verbal and written consent for pap smears is lacking. Information and consent in relation to pap smears is sometimes not offered to women and some women are even led to mistakenly believe that pap smears are mandatory.
Dr. Joel Sherman, in his article (source) on the absence of informed consent, states that women are “pushed into getting Paps, but never told the pros and cons of screening”. The fact that cervical cancer is rare is usually not mentioned to women, nor is the fact that screening is potentially harmful. Dr. Sherman notes that he has seen “a spontaneous outpouring of sentiment from women who are angry that the facts on cervical cancer have been hidden from them”.
Dr. Andrew Rouse, senior lecturer at the University of Birmingham, outlines formal informed consent guidelines (source) that doctors should be following prior to performing pap smears. These guidelines should include the following five steps:
1. Inform women of the absolute benefit of their participation in the
cervical screening programme. The benefit to an individual woman of
attending the National Health Services Cervical Screening program is extremely small.
2. Inform women of the inaccuracy of the test and disadvantages of being
3. Always make sure that women understand what they have been told
4. Inform women that because the Health Authority pays them to perform Pap
smears that there may be a conflict of interest.
5. Familiarize themselves with the General Medical Council’s booklet: Seeking patients
consent: the ethical considerations.
Dr. Margaret McCarthy, a GP who does not have pap smears, states that she thinks it’s “bad practice to cajole and occasionally frighten women into smear tests” (source). Dr. McCarthy notes that doctors are incentivized to perform smears, that women have been cajoled and occasionally frightened into having smears, and that women have “felt humiliated, bullied, harried” when wishing to decline. Dr. McCarthy states “a great many women are being directed into cervical screening without knowing that it’s a choice and without giving fully informed consent”.
Providing a written consent form to women prior to a pap smear may help to improve current practices. A pap smear consent form could also help to establish a respectful shared decision process between women and their doctors. Women would have an opportunity to ask questions, to weigh the pros and cons of screening, and to make an informed choice.
Below is an example of a pap smear consent form. Unfortunately the use of such forms does not appear to be standard practice. In the meantime women still have the option to simply say ‘no’ to a pap smear if they choose to forego the test.
PAP SMEAR CONSENT
I, __________________________________________________________ (please print your full name),
□ AUTHORIZE a pap smear collection. I have been provided with information and I am aware of the potential benefits and the potential harms.
□ DECLINE to have pap smear collection. I understand that if I request to return to the office to have the pap smear done at a separate visit I may be responsible for that visit in its entirety.
PATIENT Signature: ____________________________________ Date/Time: ________________
WITNESS Signature: ____________________________________ Date/Time: ________________
PHYSICIAN Signature: ___________________________________ Date/Time: ________________
i do not like in the UK but I have a question. The check box DECLINE and the statement if the patient returns to the office for a pap smear later they will be responsible for that visit. Does that mean they are responsible for the cost for the office visit and the test processing cost? I would not sign and I would not pay for my free healthcare. What extortion!
This is an exellent article. I was never told it was a choice. I thought it was mandatory. That sounds stupid. But thats how it was carried out. Everone connected to smears pretended there was no choice
Yesterday i put my new book on kindle. Its called ‘the british cervical screening programme – thirty years of pap rape?
I hold nothing back. Any funds i make from it will go to charity. I’m not interested in making anything from it. My reward is getting back at my rapists
I love everyone who contributes to this site. X
I don’t have Kindle, can the book be downloaded on android?
It can only be downloaded on kindle. X
Congratulations on your book, Linda 🙂
I don’t have Kindle, but i know your book must be eye-opening, cathartic, poignant, empowering, and just all around awesome. It’s so good that it will reach so many women.
Linda it is brilliant and it should be in print. Congratulations on this. The history of screening is especially important to know. Find a brave publisher!
Linda I downloaded the book and started to read. Yayyy linda! ! Brilliant so far. Thank u 4 the mention at the start. Means a lot . Let’s hope it reaches lots more women xx
Hi Kat. I have posted about the book without consenting Sue the owner of this site. I may have overstepped a line.
Sue if you want to remove that post thats fine i should have asked you first x
Whatever you do is AOK with me! I’m happy you finished the book, a lot of work, and delighted you linked this site. Good for you! Finding the old blogcritics site (Elizabeth, Chrissy, Mary, Chas, Mint and others there) gave me courage to start up this blog, which has been incredibly therapeutic. I was wondering if your work on the book was healing for you as well?
Hi Sue. You and this site have helped me heal. When i found you i was very low but now i am good. Ive found friends here. Real friends. Even only we all lived closer we could do coffee all the time.
The book has helped with my anger.
Thanks Linda. I wish we could do coffee! I got a better understanding of how much everyone on blogcritics meant to me when the site was shut down 😦
Really thankful though that everyone found this site, and backup plan – meet on the unnecessary pap smears wordpress site or on Women Against Stirrups in the unfortunate event this blog gets shut down by admin. Concerns about safety related to speaking out have calmed down, but still can’t entirely shake the feeling of being hunted.
I’m glad to hear the book has helped you with your anger. So awesome Linda!
It’s fascinating that a male ob/gyn came up with those guidelines. Perhaps he found his soul. Wonder what happened to cause him to do this when pap smears are so lucrative and pleasuring.
This Pap Smear Consent Form needs work. It appears to do the same as the nurse in the examining room – protect the ob/gyn, not the women. You see, the statement in the Decline box is longer than the statement in the Authorize box. It indicates that if they do go ahead with it the next time, that the ob/gyn will not be at fault for anything that happens – if they choose to do – other things during the exam.
There isn’t any guarantee that the ob/gyns will follow these guidelines. They may use the consent form as another way to cajole women, but in writing. If they authorize, no problem – they were going to do it anyway. It’s those that check the Decline box they want to ensnare – as the statement implies, they figure they are informed women. Sure, they may allow them to check off – No, they decline a pap smear. However, that’s money down the drain – no incentive payments from those smart women. Sooo, the ob/gyns – the greedy and lecherous ones (might that be all of them?) won’t let them get away without turning on the charm and filling their heads with doubt and fear that they just mayyyyy be making a mistake. Cervical cancer may still be just around the corner.
This “consent” forms leaves enough room for the ob/gyns to fill their heads with enough fear that they will come back and check the Authorize box next time and ignore the previous Decline form they signed that essentially states – “it’s going to be your fault if I molest you with a bimanual (okay, that was redundant….) if you feel uncomfortable, if it results in prescribing more of the same needless tests – colposcopy.etc….all your fault” part. Imagine women trying to present a lawsuit with this in their files. The ob/gyns would use it against them.
This ob/gyn who came up with the guidelines has to know that in his long career he hasn’t diagnosed anyone and if so it may be one – questionably at that. Why not then, just tell women the truth – how rare it is and and not do the smears – offer the self-testing kits. He knows the truth, but alas, he’s torn and still wants to get paid and enjoy half-naked women in stirrups – evidently still wants to do the pap smears for reasons we already know. That’s why until he admits – the truth – I take his guidelines and the consent form with a grain of salt.
When i used to go for smears i used to fill in some kind of ‘consent’ form. It was presented by the nurse as just something to be filled in to confirm the smear was being done.
It was never given to me on the premis i understood the pros and cons of screening that i knew as an individual the benefit to me of getting the test. That i even consented of my own free will to having it. There was nothing like that.
Practice nurses must have known this and carried on with the ruse anyway. Shame on them.
I was talking to another woman a few days ago who was regularly ‘attacked’ in Haydock where i used to live. They have basically gotten away with this behaviour and there will never be any way to get recompense for what they did in the name of health care.
‘All’ doctors and ‘all’ their nusrses as well as anyone else connected with the programme are culpable for the way they carried it out.
The only reason the new leaflets are written to promote choice is because the immunisation programme for certain strains of HPV will effect those coming to the first smear soon and have a knock on effect numbers of those developing cervical cancer. Dont think for a moment that the change was because public health england had their collective consciounesses pricked.
The whole programme has been operating unethically since its inception. If i had been given a choice i would have decided against smears to ‘save’ myself for John. They pretended it was mandatory and accepted the risks on my behalf. It is a shame for me it wasn’t risk free for me and the gamble soured. I ended up having unecesaary treatment just like many others.
Someone should be made take responsibilty for all the harm thats been done but that will never happen.
Public health england refuse to acknowledge my complaints. They know i am writing the truth when i email them. They just choose to bury my comments.
Pap smears will never make me not angry at the greedy healthcare system -_-
Thank you for your book Linda. I don’t have a Kindle and didn’t finish Braille class because I got sick and wasn’t allowed to take Braille software into the critical care unit, but I will sure get a copy of your “30 Years of Pap Rape” if it becomes available in audio.
I would like to do more to help get the word around about this injustice to women, but I sure don’t know how. I took a baby step and wrote a letter to the editor of the local paper in response to all of the fuss over the repeal of “Obama Care”, which was never a national health care program anyway but simply Obama pandering to the insurance industry. I know enough to feel certain that Trump Care is no solution to Obama Care. Both sides are content to let screening tests, which prevent nothing, get passed off as “preventative care” or “health care” as if they were in and of themselves some kind of cure.
It appears that most of the people posting here live in the U.K. I live in the U.S., in Orlando, Florida. Here we have a system in which tremendous sums of money are spent on junk like pap smears while patients needing care are denied coverage by their insurance companies and then often left to die from neglect with their “preexisting conditions”. Even if cervical cancer were common enough to justify mass screening, this does not mean that the pap rape would save lives. Knowing that you have a disease is no cure for that disease. In fact, a patient who knows about the disease could be endangered by that knowledge. Depression can kill you.
I am curious about something though. How did those of you who have mentioned the “target bonus” for pap smears learn that doctors get paid such an incentive? This is the only place that I have ever heard of it.
http://qof.digital.nhs.uk/ and http://www.nhsemployers.org/~/media/Employers/Documents/Primary%20care%20contracts/QOF/2016-17/2016-17%20QOF%20guidance%20documents.pdf
The Quality and Outcomes Framework (QOF)
Incentive Programmes – if you search further there will be more information available, but they do like to keep these incentives hidden from us! It is also not in the Screening Leaflet and it should be as there is a conflict of interest!
For those who live in Australia, the form also must clearly disclose the fact that, by default, women’s personal and medical details are forwarded to Pap Smear Registers or Cervical Screening Registers. These screening registers used to be government-run in every Australian state, but now are in the process of being sold off to Telstra for country-wide management.
To stop your personal details from being pushed around the medical system and private enterprise, every Australian woman must explicitly ask the doctor to write on the pap smear collection form “Not for PSR” or “Not for Pap Smear Register”. This must be done each and every time the woman is agreeing to have a pap smear. This is a very important step to protect one’s privacy, yet doctors never tell their patients about this option. Australian women are entered into the registers without their knowledge or explicit consent, and then those registers compile dossiers on women’s genitals and harass women about being screened again and again.
If you have been entered into one of those registers without your explicit consent and have been contacted by the register, and if you don’t want to be hassled about this screening or have your privacy violated, you have the right to opt out and delete all your personal details from the register. Contact the register that holds your data and request a total removal.
Ever notice any time a testing procedure is done for male issues,the guidelines always require discussion, input from the male patient, and informed consent. But if its a woman’s issue, nope. We never get any information and the guidelines never, ever say anything about discussion and informed consent. A perfect example of this is prostate cancer screening. I’m fed up with the misogyny. Luckily, my doctors don’t even bring up the tests. They only focus on the health concerns I’ve presented.
Yep it assumed we will have them. When was your last Pap smear? Was it normal? Never have they asked if I had one. I have had an argument with a nurse over this.
Here in New Zealand we can opt off the register but it is kept quiet and health professionals are economical with information. Women are never told that by being on the register the screening programme has access to ALL our Medical records without our consent. An evaluator from the programne can access whatever they like. If a GP refuses to hand the information over, they can be fined $10 000. Not many women know about this. It can about because of an amendment to the 1956 Health Act in 2004.
Doctors have to provide patient information to the screening programme evaluators if asked. Women are never told this. Even if you opt off the screening register, they can access your notes if you develop Ca cervix without consent.
I wanted to let everyone know that a Florida company has come up with some self pap smear kits women can do at their homes. The kit also tests for HPV. You can find more information at http://selfpap.com/. I think this is a great way to reduce unnecessary pap smears in the doctor’s office.
This selfpap test kit is not currently available.
I don’t like it because the test results are only released to a doctor and not to the woman herself. The other reason is that an endocervical brush is part of the kit which could spread hpv up the cervical canal if an hpv infection is present when a woman does the test. This could result in hpv infecting in the endocervical canal.
The test also has options for testing hpv and other pathogens. Some of the stds can be tested for with a urine test. If the test was simply an hpv test that differentiated hpv by strains rather than just postive or negative, I would consider this test as useful.
I think you can still order Solopap on line here, but it’s a Pap test and HPV test so not a good test, the HPV test should stand alone. I assume lots of women get confusing results and end up in medical hands having unnecessary further testing, colposcopy etc.
Also, your results are sent to your GP – if you don’t have a doctor, they say on their website that a Solopap doctor will call you with the results. Not sure what happens then, do they record the result on the screening register? Obviously the program doesn’t feel threatened by Solopap or they would have blocked access or cancelled it’s approval (like they did with the Delphi Screener) so I assume they have a cosy arrangement with them.
I was forced to have one at 14 years old; I was still a virgin and had no boyfriend nor any desire to find one at that point. I felt raped for sure. I heard it can damage your cervix and it completely illegal. The dr had a lady hold me down and they forced it on me. Who knows how many others they did that to, too.
That’s just horrifying, can’t imagine how traumatic an experience that would be, especially at such a young age.
This screening test led to…we’ll never know how many…sexual assaults. No doubt in my mind predatory doctors rejoiced when this testing was rolled out with the emphasis on numbers…consent was so often ignored. (and that was okay)
I’m so sorry this happened to you…
Even if this happened a long time ago, you could still send a letter of complaint, how could any doctor justify the restraint of a teenager to perform a Pap test? Was this an opportunistic test or did your mother arrange a well woman exam?
I agree that the situation of being held down and forcibly penetrated is a horrifying event.
Even if exposingassualt’s mother arranged a “well woman exam”, while parents have an assortment of rights over their children, no parent has a right to consent to what amounts to a sexual penetration of a minor child. Many so-called parents have been convicted of sexual assault or accessory to that when arranging for someone to have sex with their minor child for (money or other benefits to the parent). This should be seen for what it is in the doctor’s office just as it is in with the sex trafficker or porn producer.
The degree to which these rapes damage lives cannot be overstated. I often wonder how many girls and women have had their natural development disrupted by gyn rape, whether it be social development, psychological, or sexual. It disrupts an individual’s experience of personhood and of being someone, versus something.
Yes, absolutely consider filing a complaint with strong emphasis on how it made you feel at the time and how it has affected you since.
Do you remember the name of the nurse and doctor?