Study: Risk of urinary tract infection increases after a pap smear

Dr Jeffrey Tiemstra, Dr Patricia Chico, and Emily Pela conducted research to determine if the incidence of urinary tract infection increased following a pap smear and pelvic examination. Urinary tract infection (UTI) is a common clinical condition, especially for women. It is calculated that at least one third of women in the United States will be diagnosed with a UTI before the age of 24, and the lifetime risk for UTI is estimated to be 60.4% (Griebling, 2005).

Sexual intercourse is strongly associated with incidence of UTIs (Moore et al., 2008). The mechanisms for increased risk of UTI due to sexual intercourse include “propulsion of bacteria up the urethra into the bladder; microtrauma to the urethra and bladder mucosa, allowing bacterial adhesion; and alteration of normal flora” (Tiemstra, Chico, & Pela, 2011, p. 296).

A pelvic examination, including speculum insertion and insertion of fingers into the vagina, involves similar mechanisms. Given the similar mechanisms between intercourse and a pelvic exam, the researchers presumed that a pap smear and pelvic exam may increase risk of UTIs in the same manner as sexual intercourse.

A total of 1582 women participated in the study. The researchers investigated the frequency of UTIs and other genitourinary problems following the study participant’s pap smears and pelvic exams. The researchers found that UTIs and other urinary complaints were significantly more frequent during the first 7 weeks after a pap smear compared with weeks 8 to 14, 8 to 48, and 8 to 52. The study also revealed that Candidal and bacterial vaginitis was slightly more frequent during the first 7 weeks after a pap and pelvic exam compared with weeks 8 to 48 and 8 to 52.

Given the increased frequency of UTIs following a pap smear and pelvic exam, the researchers make a number of recommendations that include:

  • eliminating the bimanual exam during pap smear screening
  • adherence to guidelines for less frequent pap smear screening in low-risk women
  • self-sampling techniques that avoid speculum insertion should be given more consideration

The full study can be viewed here: https://www.jabfm.org/content/24/3/296.long#ref-1

Resources

Griebling, T. L. (2004). Urinary tract infections in women. In: Litwin MS, Saigal CS, eds. Urologic diseases in America. NIH publication no. 04–5512. US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Washington, DC: US Government Publishing Office: 153–183.

Moore, E. E., Hawes, S. E., Scholes, D., Boyko, E. J., Hughes, J. P., & Fihn, S. D. (2008). Sexual intercourse and risk of symptomatic urinary tract infection in post-menopausal women. Journal Of General Internal Medicine, 23(5), 595–599.

Tiemstra, J. D., Chico, P. D., & Pela, E. (2011). Genitourinary infections after a routine pelvic exam. The Journal of the American Board of Family Medicine, 24(3), 296-303.

27 comments

  1. Hey everyone! I have recently heard about ordering birth control pills online through apps. I think after looking at the different ones, Lemonaide Health seems like the most reliable one. I would like to ask, has anyone had any experiences with ordering birth control online? The sole reason for me taking birth control is to help with the extremely painful periods I used to have. The pill has been the ONLY thing that eased and regulated all of the horrible problems I used to have. Since my recent call to my doctor, they said they are only going to rewrite my prescription if I go in for a “wellness” exam. Of course that is the LAST THING ON EARTH I WANT TO DO!!! I am wondering if ordering birth control via apps is the best option for me because I am sick of doctors ALWAYS trying to coerce me into doing those awful invasive exams. Last time they wrote my prescription, they asked about a pap test, and I said no. Guess what? They said “okay that’s fine just come in and let us know.” That’s it! Now this time, they said they will not give me another refill after this one that they just prescribed if I don’t go in for the exam. Honestly, how dare they. How DARE they do that to me. They didn’t give me the choice to say no! I NEED my pills more than I will ever need an exam, because if I don’t continue using birth control, I will go back to the way I was, with the 7+ day long HEAVY periods, DEBILITATING cramps that would last for 3 and a half days straight, low back pain, awful bloating, my cycle was always fewer than 28 days and would sometimes come a whole week early, and the horrible nauseating feelings. I have been close to throwing up several times they were so bad. If anyone has had positive experiences about ordering birth control online, PLEASE let me know, thank you! 🙂 I’d rather sprain my ankle again than go through a pap test and another painful period!!

    • I’ve ordered it online but not recently. You can order it by mail from India or Mexico and never had any problems with customs. Perfectly safe and much cheaper. Just choose a pharmacy with good reviews.

    • For most of the birth control apps I think they are less likely to prescribe if you want it for an off label use. If it’s for contraception only then you’re good but if you mention wanting it for heavy and painful periods then I think it will seriously limit your ability to get them, depending on who the individual prescriber is. Just say it’s for contraception. These pills should have been otc years ago.

    • I use PillClub. It cost me $0 (with insurance) and they respond within hours of every text I’ve sent. My kid gets the stickers and chocolates. The freebie condoms are stacking up in husband’s bedside table (he refuses rubbers despite my disastrous labor, I refuse to fully rely on my pills, and I’ve become allergic to his semen since it took 3 years to get pregnant). All I have to do is go to any drugstore, take a blood pressure once a year, and send them a copy of the BP. They automatically send out the package. It’s in a discreet, plain brown package. Bonus is I also have the option of including Plan B whenever I need it. The dr consult was little more than “is there a family history of clots or high BP” and a BP measurement pic. I have PMDD, endometriosis, and cysts (I did NOT tell them this, all I said was I wanted to skip periods and wanted to prevent another pregnancy). I skip the placebos, but haven’t had a period or any cramps in 18 months. My midwife was the one who referred me to them, by law she is not allowed to prescribe medication. I can not recommend PillClub enough!!

  2. Anonymous I think we are in different countries I’m in UK but my 23 year old daughter uses an online service here called Superdrug UK. She had to do an nonlinear consult but was never even asked about smear tests. Even if you are asked online I’m sure you could fudge the issue?

    • So far, some good news is I discussed my situation to my husband, and he said that if I reschedule my appointment to when he doesn’t work, he will come in with me and back me up if they won’t listen to me! I’m seriously thankful for him so much… however, don’t get me wrong, I’m so glad he’s here to help me out and take bullets for me, but watch them immediately drop the exam when he says not to do the exam on me and just give me my pills, because he’s a male… I hate that most women can’t get through the healthcare system without the say of another man -_- aside from that, I am relieved that he’s full on 100% agreeing with me that these practices are ridiculous and that he’ll be there to defend my reasoning. If they still won’t accept, we’re walking out of the office and finding another doctor!

      • Anonymous, I am happy for you that you have a husband who is so supportive, but it is awful that we need to have men back us up in order to get our doctors to respect our wishes.

        The only time I have sought out Ob/Gyn care was to evaluate pelvic pain a couple of years ago and when two ultrasounds were classified as normal, I was dismissed. I have continued to have issues. I’ve often suspected that a missing piece for me is that where I have not been in a relationship, I can’t complain of pain during sex. I bet you anything that if a guy brought me to a doctor and complained that I was avoiding sex due to it being painful, they would take my situation more seriously because we can’t have guys not having their needs met. The fact that I feel deformed in my body, have spent days in bed due to pain or dehydration from gory digestive issues, the fact that I have to avoid eating certain things, doesn’t matter because as a woman my life matters less.

      • BH – Having a husband accompany you, and say that he’s not having sex because you have too much pain during sex does not help. BTDT. It does help to have a man to back you up though when refusing some test or treatment – patient refusal should be enough. They take the man more seriously, PLUS he can serve as a witness if they try to force or coerce you into having it.

        I’ve got an appointment tomorrow to evaluate my diabetes and get new prescriptions tomorrow. Last time was an awful high-pressure sales attempt on a pap. I had a melt-down right before the last appointment, and had to reschedule. I’m not going to let them do that to me again! I’ve got my ducks in a row better now – although I spent an ungodly amount of time over the past year brooding about my evident theory-only rights to informed consent and refusal.

      • @Beth I hope your appointment went okay and there were no or minimal coercion attempts. I just saw your comment now and am thinking about you. I go absolutely bonkers before appointments. The meltdowns really are the worst. It just goes to show how destructive the trauma is from these exams and that it lasts a lifetime.

      • Seriously I would threaten them with a report to the medical council. The only requirement for the pill is a blood pressure test…..that is it! Stay strong and refuse with the threat….your pill will be forthcoming I am sure! No-one can demand you open your legs for anything….ever! Just say NO – your body your rules! It is always a good idea to take someone with you to every single consult, be it your husband or a friend/family member.

    • BethKCZ – best of luck to you on your appointment. I have an appointment coming up tomorrow (Wednesday) and it is a “new patient” visit since my insurance dropped my last provider, whom I really only used as a walk-in clinic anyway.

      Quite frankly, I’m terrified. I’ve avoided annual physicals and routine appointments for almost a decade, but where I’m 33, I do think maybe I’m at the age where it’s time to have a doctor. I have no idea what they are going to want to ask me or do to me at this point. Case in point, the last time I saw a healthcare provider she yelled at me that I needed to have a physical, saying, “We do age-appropriate screenings–pap smears, breast exams”–but didn’t say anything else. So apparently, when I am a woman, my heart, lungs, and kidneys don’t matter. What is more, when I countered that I thought breast exams were no longer recommended, she said she still did them on “women who wanted them.” I found this upsetting. Obviously, I don’t want one or I would’ve have arranged to have one done. What is more, she made it sound as though they were mandatory until I pointed out that they aren’t–which is actually true according to the American Cancer Society. She also then proceeded to belittle me and be rude to me the entire appointment regarding the issues I was there for and made fun of me when I became distressed and started shaking.

      Needless to say, I am thankful my insurance dropped this provider, but I have no idea what I am walking into with my new one. I find it beyond frustrating that I seem to stumble upon providers who still feel that they can push breast exams but can’t find one who will say, “The CDC *recommends* pap smears at 3-5 year intervals, but I recognize that these exams can be difficult for women and think it’s important for them to be the ultimate choosers or what tests they are willing to subject themselves too. The magic there is that they can still *do* paps on women who want them.

      Good luck again, Beth!

      • BH, it’s astonishing that some doctors feel so entitled to speak to their patients, or some of them, so rudely, so disrespectfully, I wonder if it’s manning their “non-compliant” female patients who get that attitude?
        We wouldn’t accept that sort of treatment from any other service provider, I don’t think it’s acceptable from a doctor either. A clear sign this is not a doctor I could respect or work with – goodbye!
        I think the profession trusted women like children or second class citizens for so long, some still hang on to those dysfunctional attitudes.
        Her comments make no sense anyway, routine breast exams are not recommended and all screening is elective, that means it’s up to you!
        Of course, I know it’s more difficult in the States to doctor shop to find someone who treats women like adults with legal rights, not mere bodies.

      • I said that I’d come back and let you all know how it went.

        It went well! I’ve now got the business card of the nursing supervisor. The doctor has assured me that she won’t force me – but the last guy sure as h*** tried! I wrote her a letter, and enclosed a “dear doctor” letter I found on ACESTOOHIGH.COM that these tests trigger abuse survivors – they were talking about sexual abuse, but when it has happened in medical situations, you’ve got a double-whammy of it.

        She’s got my refusal on record – both the doctor and the nursing supervisor. It’s evidently insufficient that I write REFUSED under “date of last Pap smear”.

        DH called them and sternly explained the situation to them – and mentioned that I’d been talking to the State BAR association (association of attorneys) – that I’d had “enough”. And, that I would walk out, refuse to pay for the appointment with only unwanted/refused services offered – and go to Mexico where I can buy my needed medications. He told them that I understand what passes for medical care to be nothing more or less than an institutionalized rape culture. He said they audibly cringed over some of this, but, that’s the way it goes.

        We certainly would not accept such treatment from any other service provider! In fact, we would have the Consumer Protection Laws on our side if they performed services we stated we did not want AND tried to charge for them.

        I’m okay now for the next year. But, early in 2021, I’ll have to return, and deal with this pap-crap again I fear. 😦 I fear that I’m going to have to take some legal action JUST TO GET VERY BASIC MEDICAL CARE and willing to PAY FOR IT. This is absurd.

  3. “I think the profession trusted women like children”
    Should say “treated” women like children…auto correct!

    • Elizabeth (Aust) – thank you for your support! Glad to know that I am not the only one who was horrified by this rudeness. For what it’s worth – this wasn’t even an actual M.D., but a nurse practitioner, a growing trend in the U.S. is to give primary care to nurse practitioners to make up for the lack of doctors going into primary care. I think nurse practitioners might be more likely to hang onto doing “soft services” like breast exams because, quite truthfully, they aren’t qualified to do all the stuff that an M.D. can and they’re trying to hide/compensate for that.

      At this point, I’ve decided I want to see a real M.D. I figure they are so busy that if something’s not recommended, they won’t want to bother with it, and they will be more likely to try to diagnose/treat issues rather than just triage me to specialists which is what this previous practice did.

  4. I think you’re right, BH

    I happened upon a UK online forum for medical practice nurses about 8 years ago and was appalled at the way they were speaking about women, “we chase them down and get them smeared” – “we catch them at the counter and put them on the spot” – that sort of bullying and insulting language/behaviour. Talk about power going to their heads, they sounded like a paramilitary unit!

    I posted – pointing out how unprofessional they all were, how disrespectful to women, that they should be sent off for retraining, naturally, my comments were unwelcome, they assumed everyone would agree they were warriors for the program and cheer them on…

    I assume these women felt obliged to do this because they were trained that way or getting everyone screened – reaching a target – was their brief – either way, it was telling that none of them saw a problem with their treatment of women.

    We bang on about domestic violence, that includes bullying and intimidation, yet we allow the medical profession to treat women in this way, not all doctors and nurses but we’ve all experienced the attitude that appears whenever pap testing is mentioned to us – speaking down to us, talking over the top of us, dismissing our concerns, some women are even called names, “well, you’re a very silly woman”…very 1950s stuff.

    Its only when more women call it out or sack these “professionals” that we’ll slowly see attitudes changing, I think this behaviour got worse because it ran unchecked, it was actually encouraged…I can already see attitudes changing, but oh, so slowly…at least now, more women are not as fearful to raise their concerns or admit they choose not to screen.

    I’ve found as an informed women, and an older woman, I can manage in the consult room but as a young woman, I stayed away, and had to live around cervical screening, I resent that…I should have been able to seek medical help whenever I felt it was necessary, I should have been able to ask for the Pill without agreeing to an assault.
    Women who did not want to screen were silenced back then, so we were terribly vulnerable in the consult room – we were the naughty, silly women who had to be shown the way. “just get used to it, it’s part of being a woman”…
    Well, not this woman
    Good luck finding a balanced and respectful doctor who’ll respect your wishes and address your health concerns – it’s worth the hunt.

    • I think their attitudes also reveals a lot about their intelligence (or lack thereof) and highlights a shocking lack of knowledge and understanding of the science of screening. They really are incredibly misinformed and don’t have the capacity or self awareness to even realise their shortcomings on the subject.

  5. The same anonymous person above is also me again. So, I came back from my appointment. My blood pressure was high of course because I was so f***ing nervous about how everything was gonna go. Thankfully with the help of my husband, I didn’t get a pap test. She was a bit stern about the risks and all that but then she said “I won’t like force you or anything” and then mentioned her liability and all that. I was a bit stuck there and then my husband asked if there was some sort of waiver or something I could sign saying I refused. She said yes, then I refused. She reluctantly said okay lol. Anyway, I came home, and saw that using birth control for 5 years or more supposedly increases the risk of cervical cancer. Now, I know the cancer is rare, but should I worry since I’ve been on the pill for almost 5 years for regulating my periods? It’s the only thing that had helped, and I don’t want to have to live the whole rest of my life on the pill, despite how much it HAS helped. I’m honestly thinking that after I have kids, whenever it’ll be, to just get a complete hysterectomy and never worry about my periods, because if I just got my tubes tied, I’d still have periods. Also, are there any stupid requirements and regulations I’ll need to even get a hysterectomy? Like, how many kids, certain conditions like cysts and other things, and husband’s permission, etc etc… because I just CANNOT go get a pap test but have a slightly higher risk from taking the pill for so many years, but it’s the only thing that’s helped my awful periods.

    • The risk of CC “because of the pill” isn’t actually because of the pill, but because the majority of women tend to use just the pill and no condom. Condoms greatly reduce the risk of HPV, which causes over 99% of CC.

      When I went in to talk about a hysterectomy, I was told the following were requirements (never could figure out if it was my GYN’s requirement or insurance): at least 2 kids, letter of recommendation by 2 doctors (preferably 2 GYN and a GP), at least 12 months of therapy plus a psychiatrist’s letter of recommendation, husband’s written and verbal permission, and a 12 month waiting period.

      I went in for a hysterectomy in 2014, after a traumatic labor. Had I given birth in a hospital, I would have had a crash csection with hysterectomy (as in I would have been totally knocked out and forced) and most likely a dead baby due to the conditions that my doctors “forgot” to tell me in pregnancy. But because we “survived”, I might want more so all of the doctors gave me a flat NO. I’m 30 now, still have my 1 kid, and I haven’t had sex with my husband in 6+ years because he refuses condoms (and he found the one guy who feels “incomplete” after being bullied into a vasectomy and then left by his wife), but is ok with my risking my congenital solitary kidney on the pill. Keep in mind, my husband is 46. We are done having kids.

      Just my two cents.

      • Thank you for your input!!
        I am of course good for the next year for refills, but because of that I’m afraid that next time I go in to get m prescription rewritten for refills for the next year, I will be asked to do a pap smear again. I don’t want to have to go through the annoying process of telling them no every time… so I am honestly thinking of just getting my pills online and via mail just so I won’t have to deal with that anymore. Also, I would like to point out that she said that the reason there are higher risks for cervical cancer with the pill is because “they put more hormones into our bodies.” Is that *really* true, or is it just a scare tactic???

      • Scare tactic. HPV causes cc, not bc hormones. I have heard that women on bc hormones have a slightly increased but negligible risk of breast cancer but that could simply be due to them getting “screened” more often. Again, that risk is so tiny they can’t reliably recreate it in studies to confirm it’s caused by the pill. Just use pill club and avoid the office, you can have your RX moved to pill club. You can even get Plan B sent if and when you need it.

  6. Thank you, OverItAll!
    I personally am not really afraid of the breast cancer risk, because I have heard all over that if you do self breast massages daily, it greatly decreases the risk. I have been doing them daily recently, and keep in mind that I have very dense, ropey-textured breast tissue, and they have never felt better! They don’t feel sore all the time, they’re not super tender like they used to be, and they’re not as rock-hard firm!

    Another question regarding periods and pills… so I’m worried that if I actually do have endometriosis, I understand it affects fertility. I’m not sure when it’ll be, but once my husband and I start actually trying for kids, I’m afraid that once I get off the pill, I’ll go back to the awful periods I used to have and it’ll take me several months to get pregnant.

    Again, I’ve never been tested, but because my periods used to be so painful I’ve suspected I might have it. So, my question is, after going on the pill for however many years (for me it’s been almost 5 years), do your periods eventually regulate on their own? I know everyone’s different, but I’m just so afraid it might take me a long time to get pregnant, and I’d rather break my ankle than get another crappy period!!
    I talked to my mom about this, and she said to just go back to what I used to do before the pill, like heating pad, Midol, tea, etc. But the thing is, over the years before the pill, my periods got more and more painful no matter what I did. The Midol was the only thing to actually somewhat relieve the pain, but it started to weaken over time, so absolutely NOTHING was able to relieve my pain. I was just stuck with seemingly endless pain for 3+ days straight. When I get off the pill I want to immediately get pregnant, but I’m worried it might take longer because of me possibly having endo. Sighh… It’s been rough thinking about this lately 😦

    • I have endometriosis, PMDD, ovarian cysts, congenital solitary kidney with my left ovary non-developed. I was diagnosed by eliminating other health issues: there’s no actual test for endometriosis. Nothing I took (including Percocet, oxy, morphine, etc) would stop the pain. I was told I was sterile and now have a 7.5 year old. I took my pills 4 years and did have difficulty getting pregnant due to my health conditions. However, I got pregnant the first try on guaifenesin (plain robitussin). Every doctor/midwife/nurse said it was because guaifenesin makes your cervical mucus super slippery which helps the sperm slide right through. My periods post-baby were absolutely horrendous just like pre-pregnancy, but went from my “smear of blood” to bleeding heavily 7-10 days, which is why I got back on the pill. Go on the pill for however long you want and when you get off start taking guaifenesin at the proper dose every 12 hours 3 days before, the day of, and 3 days after you ovulate. ~not a doctor, but that’s how I got knocked up~

      • Great to know, thank you so much I will keep all those in mind. I think the only thing that worries me about the pill now is blood clot problems. I already have spider veins in my left leg which I’m worried might turn into varicose veins later down the road. I’m just afraid that the pill will possibly give me a heart attack or something lol. I think those were one of the risk for prolonged use on the label… I know everyone’s different, but of course having generalized anxiety, this girl can’t help but worry about those little things ya know? Hope I don’t sound crazy! I’m grateful for the pill and all the ways it’s helped me. I have had no other side effects I know of. My breasts have been fine, no spotting in between periods, no mood changes, no nothing! I just can’t help but worry about long term affects. I should probably be fine, and I have greatly appreciated your input with all the questions I’ve had.

      • On the risk for Cervical Cancer – either diagnosis or death, a reliable source is the National Cancer Institute (US) at https://knowyourchances.cancer.gov/special_cancer_tables.php

        There is the infamous “Why I’ll Never Have Another Pap Smear” at https://www.theguardian.com/society/2003/may/22/genderissues.publichealth Also there is https://www.washingtonpost.com/news/to-your-health/wp/2018/07/03/hpv-test-is-better-than-pap-smear-at-detecting-cervical-pre-cancer-study-says/ That tells of how inaccurate pap tests are.

        There are charts comparing the total mortality within 10 or 20 years of screened and unscreened population. Even given the differences between those likely to screen or not, there is a small but consistent increase in overall mortality in the *screened* populations!

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