exactly that

ETA: 18 Sept. 2010 After this post was linked at FWD/Forward in the RR, it was brought to my attention that this post possibly could be triggering to some people. This post should have a trigger warning for a graphic description of a medical procedure done on a young virgin girl. The procedure was upsetting to her, and the description could be potentially upsetting to readers who have had similar experiences or who have been sexually assaulted, or medically raped/assaulted. My most sincere apologies for not having the forethought to include this warning sooner, and to anyone whom this lack of thought may have hurt. ~OYD

Where did it come from?

A conversation starts about shaming in OB/GYN care, which is an important one.

Suddenly all of these people have flown out of the wood work to make sure that all of we lady folk know that getting our pap smears and pelvic exams is Just! So! Important! Medical and non-medical alike.

They need not even all be lady folk themselves, but experts who have lady relatives who have had their lives saved by paps, so they must impart to us the urgency to spread our thighs and allow ourselves to have invasive medical procedures that we do not want. Medical procedures that can be painful, traumatizing, and even, as has been show, unnecessary.

But there is a whole slew of thing that keep we peeps, and I say “peeps” because I am certain that there are people who do receive pelvic exams and paps who do not identify as women who may also feel bullied or forced into these medical procedures that they do not want as frequently as people feel the need to force us into them.

Why with all the pressure? Even when most of the information I found says every 2-3 years (I think it is worth noting that the Australia site is the only one that has information specifically for people with disabilities)? Even that information is varied. It seems that people, even medical providers pressure people to get paps every year. Especially if you want birth control. There seems to be this habit of holding birth control hostage if you are unwilling to submit to having a metal or plastic instrument shoved into your vagina and having bits of your cervix dug out.

Even on virgins. Oh, yes. In the U.S., for I can not speak to other nations, there is this fixation with making sure that doctors or other practitioners are the first ones to shove things into the genitals of virgins girls seeking birth control, whether or not she is seeking it for sex. Even though there are several good medical reasons why she could want birth control that don’t involve wanting to partake in heterosexual intercourse.

When I was fourteen, I was having period cramps from hell. I was bleeding like a stuck pig for three days straight out of ten. I would need to miss at least one day of school a month due to period cramps because I couldn’t get out of bed from the pain. Sometimes I would vomit from the pain.

Eventually, the cramping started coming when I wasn’t having my period. I was having cramping so bad that I was begging to miss school during this time as well. I remember my mother thinking I was a hypochondriac around this time of my life. She would sometimes groan, and often joke to her friends that I always thought something was wrong with me. I would often try to hide pain from her because I didn’t want her to laugh or make fun of me. She even had our doctor convinced that I was making things up. When I finally got in to see him, he chucked, and without really examining me, told me I had Mittelschmerz, and that what I needed was to stop coddling my body during my cramps and to get up and start being active during my cramps. This would not be the first doctor my mother convinced to laugh at my pain in my life.

So, I tried following his advice, and I would damn near pass out during gym class or band. The pain was so bad that I couldn’t eat and it would bring me to tears, dizziness, and I would dry heave. Finally my mother took me to the doctor again, who finally did an ultrasound and determined that I had large ovarian cysts that were causing me to have painful periods. I needed to see a gynecologist for a consult.

On top of being worried that anyone at church would think that I was having sex (because I knew so little about sex education at the time that I thought that the GYN was only for people having sex or babies), I was nervous. Incredibly nervous. I thought for sure that everyone thought that I had done something already and was lying about it. The gynecologist was the brother of my science teacher, and we were in a relatively small town. I was so worried that someone would KNOW WHERE I WAS. Also, that I was A LYING SEX HAVING SLUT!

Yes, I had cysts, and the doctor said that the best treatment was going to be to put me on the birth control pill (OH THE MORTIFICATION!) because it would help reduce them and ease my period. It was supposed to reduce my period and help them be shorter and lighter (let’s get this clear, for me this was a lie! I still have 8-9 day periods that are reminiscent of a butcher shop). He wanted to know if I was sexually active (OH MY GOD DID HE JUST SAY THAT WAS HE TALKING TO ME *FACE FLUSHING SCARLET*), and even though I said no, I had to have a pelvic exam and pap smear anyway, because that was routine procedure for prescribing birth control. (Wait. What?)

My mother had dropped me off and signed all the consent forms. How nice of her. I had no idea what was going on. What? OK. I guess so. What did that mean? You want to put WHAT? WHERE?

Suddenly this doctor, this man, whom I didn’t really know but looked an awful lot like my eighth grade science teacher, which made me really uncomfortable, was feeling my breasts, telling me that I needed to do the same thing in the shower (Uh-huh, OK, keep looking at the ceiling. That was nice of them to put a poster up there…). I had to put my feet in stirrups, which reminded me of riding horses as our friend’s farm, and certainly didn’t put me at ease. I was naked, and I had never been naked in front of any man who was not may Daddy trying to help me dress for bed, and that hadn’t been since I was about ten, and it wasn’t like this.

I was asked to slide down until I was squatting. There was cold jelly, and a metal thing, and even though he was talking to me through most of it, I remember the poster of the wooded lake on the ceiling, with the bridge over it, with one of those quasi-religious inspirational sayings on it. Suddenly I was being penetrated by metal objects and fingers…and it felt wrong and awful and I just was always told that this shouldn’t happen… not like this. Hot tears ran down my face. He asked if I was OK as he felt around inside me while pressing down on the outside of me at the same time. I could only nod, afraid of what my voice would sound like if I gave in to it. I don’t even know why they bother with gowns. They are laid open, and my whole being, my essence felt exposed on the cold crunchy paper. I didn’t know what to do with my hands. I shoved them into my hair, and pulled tight.

I didn’t know that doctors ever did this.

(The poster has a lake…are those birch trees?)

And it hurt. And he felt my ovaries to check for the cysts. And he took his sample…and it felt like a sample of my soul left me.

For all the talk of how having sex outside of marriage or whatever message had been pounded on me for however long, and how it would leave me hollow and leave me feeling worthless and damaged, and for all the ways I had been told that casual sex would leave me reeling and feeling depressed and with a hole of missing self-esteem, nothing I did in my consensual sex life has ever compared to the way that pelvic exam and pap smear felt to me, a fourteen year old girl. A person rising on the crest of womanhood, not yet there but ready to fly, and having had myself violated before I took my first steps.

I left that doctor’s office with a script in my hand and a hole in the depths of my soul and a hollow in my heart. I walked to my friend’s house, because I remember that my mother was on second shift. A long and lonely walk toting my French horn, the plastic molding of the case banging against my shin. They were the kind of friends that had become a second family to me, who kind of took me in as the kid who needed looking after sometimes and loved me intensely. I remember the mother, telling her where I had been and what had happened. And while I have never experienced what I consider sexual assault outright, I can imagine that this must be an ember of that fire. I cried, feeling dirty and awful and ashamed, as she held me.

My friend’s mother looked me in the face and leaned against the carved post dividing the kitchen, holding my face in her hands, as I looked into her angular face, with her short wavy hair, and her kind, almost smirkish smile that always had a way of washing comfort over me.

“Being a woman is Hell”, she said, which surprised me a bit, this being back in my church days. “Going to the gynecologist can feel as embarrassing as Hell, but it won’t always be so awful”. She hugged me against her shoulder, and brought me some Texas Sheet Cake, because it seems that chocolate could always help me calm down sometimes. Or maybe is was a combination thing.

I wonder if maybe it is a combination thing. If maybe I had been informed a little more and had an iota of a clue about women’s health care, and what a pelvic exam and pap smear is all about.

Or, maybe if things like pap smears aren’t forced upon young people who are not sexually active, or upon people who don’t want them. If we don’t hold birth control hostage. If we don’t do things like force people to the outside of their own health care, we might be more prepared. We need to set clear guidelines (OH WAIT! ACOG!) to make sure that folks know what doctors are expecting and what is actually needed, so they can be aware of what is suggested to keep them healthy. This “maybe every year, but it is really only needed every so-and-so years, but, hrmmm…we feel like doing it every two years stuff” isn’t cutting it. We have a right to know the guidelines, and to insist that we only have invasive medical procedures as often as needed. Not as often as someone else who is not us feels like it. Even Scarleteen, a site I love, is vague on the expectations of the requirements for paps and pelvics. We need our medical professionals to stick to what ACOG has laid out (or, in my case, I would like them to just be aware of what ACOG has put out before I am), so we can get a standard measure of care. ACOG has said the risk of being treated for a false positive is not worth testing every year.


When I see articles like this, I realize it is more about making sure we control women, who just can’t be left to their own medical decisions! They are all so silly! This isn’t about shaming women for being nervous or embarrassed (for very good reason). This is about understanding that people have a right to autonomy over their own bodies. Yes, even teenagers! (I know, I am so silly, thinking they might be people who have thoughts about their medical care!) And health care is a part of that autonomy. An important part.

Education, consistency, and plain ol’ listening to patients might help. Listening to women and people in general who have to have these procedures might be a step. Re-evaluating the reasons for insisting on them for simple things like birth control, especially for non-sexual reasons in virgin teenagers might be a step. Being more compassionate to people experiencing GYN care for the first time — or even in general — might be a step. Including women in conversations about their reproductive care might be a step.

But demanding, shaming, controlling, hostage taking of parts of care? That is not helping.

It could kill, and I venture to say it will do the opposite of what all of your concern-trolling of reproductive health is intending to do.

Kid had it right, learned it in Pre-school even: My face, my space. My body, my business.


Comments on: "Medical Autonomy Chronicles: The Virgin Pap Smear" (32)

  1. Wow. I never knew that once-a-year was too often. Everyone has always told me once a year, and I go once a year because I need the BC. I’m going to rethink that now.

    The rest of my response to this post is at my tumblr.

    • I am saying that you, for your own sake, would be well served to do some research on your own reproductive health care. I have had so many awful experiences that have lead me to being aggressive with my providers. I go in armed, so to speak. ACOG has new pap guidelines as of last year.

      I have no right to tell anyone “you should do THIS!”, but I hope that reproductive health education can be accessible to those who need it, and this is an area that is clearly muddled.

  2. I was molested as a 7 year old, for a year. When I finally told my mother, she called the police who called a lawyer who called a doctor. Suddenly, I was in a room by myself with a strange man down between my legs again, only this time he had my mother’s permission. It was less traumatizing than the molestation, but only because it was for one day not a whole year. It was just as much a violation, and to say it brought up “old” wounds would only be slightly inaccurate.

    I have endometriosis and the cramps and pain can be crippling. My mother also pretended no pain of mine was real, and the hormonal assault of my periods was just typical teenage brattiness.

  3. Ouyang, my first pap smear was like that; the gyn I was referred to also humiliated me and hurt me in a way that my family doctor did not during manual exam (suspected cyst). I had to have birth control for heavy periods and made the mistake of telling one person that some people did need it for health issues (and he thus wrongly told the whole school I was having sex, which I was not).

    The medical problems that birth control pills can cause or worsen have nothing to do with (unlikely) cancer in young women. Holding birth control hostage to forced medical exams can leave women with unwanted pregnancies or unable to have sex in order to prevent pregnancy. Sure, check women’s blood pressure, for history of clots, severe migraines, etc., even have a follow-up to check for these or for severe depression that some people get as a side effect. Their saying, “no birth control for you if you don’t let us stick cold metal duck lips up your hoo haa” is just wrong; it’s not the way most people fantasize about stretching or breaking their hymen.

    Cancer screenings are important, sometimes a younger woman may need an exam, but in general drs. need to be aware of the trauma they can cause. An external ultrasound may be a better way in some circumstances.

    Anyway, really good/important essay.

    • For me, fridawrites, it was just the gateway into a long line of reproductive healthcare issues that entailed a bunch of professionals (apparently the term is used here loosely) either not trusting me or not allowing me the space to be involved in the decisions involved in said reproductive health care. Hell, it didn’t ever seem to limit itself to my reproductive healthcare…

      It hurts to know that mine is probably not a lone voice.

  4. You’re right, it’s the tip of the iceberg in terms of medical care. The paternalism can make decision making difficult and cause me to distrust many of them in return.

    Exactly–it’s painful to know that this is happening to others. Hoping to change it for my kids! Or that my kids will be part of the change.

  5. I wasn’t much better off than you were. My mother was with me and had told me what was going to happen, but it was still scary and strange and unwanted, and it hurt. I still remember when the nurse gently suggested to the doctor that she use one finger for the internal exam, and the doctor just said curtly “no, she can take two.” I was obviously no more than an object to her. And afterwards I was bleeding.

    I’m lucky that my mother was outraged on my behalf and convinced me that exams shouldn’t be like that, which meant my subsequent experiences with different doctors were much better.

  6. Thank you so much for writing this. A few months ago I went to the gynecologist for the first time to get birth control for regulation purposes. I am a virgin and a teenager, and she did insist on doing the exam, even though I was terrified. It hurt tremendously, and not once did she pause even when I was crying. To everyone else, it’s not supposed to be a big deal, but to me, it is. I’m so glad to see someone on my side. Thank you.

  7. This culture is so messed up and sick.

    I am so very glad you wrote about this lady, thank you and HUGS!!!

    I went to the gynecologist for the first time at age 26. It was a horrific experience. I was recovering from sexual assault and an attempted rape. I felt violated and sexually assaulted. I made sure to have a woman gynecologist but they still treated me like a machine and not a human being. They did ask if I was sexually active and I said no. I wasn’t because after my attempted rape I needed to heal. I am 28 and soon to be 29 and I don’t want to get a pap smear unless I can do it myself. I am disgusted with modern day mainstream and western medicine so I will not participate in it. I have friends in their 60’s who have not been to a doctor or gyno in years and they are fine. There has to be another way in which our health is treated more holistically. Until then, I am choosing to not participate in it.

    • In Inga Musico’s Cunt, I believe she may talk about how to go about doing your own self exams. You need to obtain a reusable speculum, and she mentions that you may be able to get a clinic to give one to you or sell one to you for a low price, but there is a lot of info in there about making sure you stay healthy and only seeing a GYN in case of something more dire.

  8. I’m in the UK.

    You get your first smear at 25 if sexually active for at least three years, if you’re not sexually active? No smear. You don’t get a smear if you want/nee BC (because there’s no need to do one) and nobody is ever examined bimanually unless they are pregnant, or assumed to be suffering a gynaecological problem.

    The US system boils down to to things – money and control. They have repeated, guaranteed income from forcing kids as young as you were to submit to invasive, unnecessary tests on a yearly basis. They also get to send the message that you – as someone with a vagina – can never be healthy. You are pre-sick, and only the all-knowing doctors can save you by violating you and controlling your body and mind. Not to mention that unnecessary procedures like LEEP and colposcopies are ruining the future fertility of young Americans, because the smear tests are picking up cell changes related to physical maturation, and not disease.


  9. OYD, thanks for writing and sharing this excruciating and oppressive experience. It is possible for the pelvic exams to be bearable; my first sure as hell wasn’t.

    As it happens, I’m someone for whom annual pelvic exams seem to be medically indicated:
    I’m a DES daughter. My mother was given the DES hormone during my gestation; her doctor had been told it would help prevent another miscarriage (she’d had two). My first OB/GYN exam, at age 16, was to get a baseline on my (atypical) anatomy and screen for the rare vaginal cancer correlated with DES exposure. My cockscomb cervix looked eroded, which can be a precursor to cervical cancer. Nowadays doctors use a colposcope, basically an insertable microscope, to examine this atypical tissue in place. Back then, nobody had a clue how to do it, so he painted my vaginal walls with iodine. (That hurt.)

    Didn’t I want birth control pills? It was the 60s, after all. Didn’t I? I insisted I did not, I did not wish to take a drug every day when I had no plans for sexual activity.

    I can’t explain why the doctor thought it would be a good idea to cauterize my cervix. The electro-cautery device looked like a curling iron. I asked, “What are you going to do with that?” He responded that he was going to “get rid of that nasty discharge by burning off some tissue.” (Nasty? discharge? Burning??????!!!!!) I asked, “So where’s the anesthetic?” He replied “Oh, you don’t have any pain receptors on your cervix.”

    I beg to differ.

    My mother waited for me in the car. When I described what had happened, she said “OB/GYNs aren’t much fun, are they.” Thanks Mom. It surprised me when for the next few days, I awoke to a rush of fluid from the blisters which came up where he had cauterized my flesh.

    I was able to convince my mother to bring me to a different OB/GYN when I decided to get a diaphragm.

    • NO PAIN RECEPTORS ON YOUR CERVIX? That’s such bullshit! Anyone who has ever had a pap smear–or had sex with a guy whose penis is too long–knows that’s not true. God, that sounds so painful and awful.

  10. I’m not sure exactly when, because it was long ago and also because I just can’t remember stuff like that, but sometime between 4 and 7, I actually had my first pap smear, or something like it. Apparently I had more discharge than I should, so my parents took it to our doctor. They told me later on that my father was also immediately an incest suspect because of that, which must have been awful even though he understood why, but I was not aware of that back then. Both my parents were present to hold my hand and such, but I can’t recall anyone actually telling me what would happen (which does not mean no one did, but that I either don’t remember it or it didn’t get through to me). It hurt like hell, more than anything I had experienced so far, for far too long and I cried a lot (I may have screamed), and I had no idea what was going on. Then when they found nothing wrong based on that, I had to go to hospital for X-rays. I did like that part, very interesting (they wouldn’t let me bring home the pictures :( ). In the end nothing was wrong, I just had more discharge than other girls. That memory has always been much more clear than most others from that period.

    In general though, they don’t test women under 30 or 35 or so here, and then not yearly. When I requested a pap smear a year or so ago (I was 26 or 27) my doctor thought it was incredibly odd, but she allowed it because I had been on the pill since 16 and sexually active for a long time too. I was kinda afraid it would hurt again, but it was only very cold (the hot water wasn’t working). I guess being a whole lot bigger than I was at 4-7 helped.

  11. I’m in NZ, and was repeatedly told by doctors that if I hadn’t been sexually active, I didn’t need a smear. They said it without me even asking. I’ve been thinking for years since I read about these compulsory-even-before-you-are-active Gyno visits that the US system is messed up.

  12. There are, as I see it, two main problems with pap smears and pelvic exams and all of the other so-called ‘well-woman’ screening interventions:

    Firstly, it is assumed that people will want and need these interventions, because after all, they are for our own good. And anyway, preventative medicine is always a good thing, so informed consent can just be bypassed.

    Secondly, facts backed up with scientific studies are remarkably thin on the ground when it comes to the information provided to people targeted for screening. Emotive stories of women being ‘saved’ by pap tests abound, but actual, honest facts? Hmm, no, they would scare people away from screening.

    The result of huge amounts of propaganda, pressure from doctors and – worst of all, I think – pressure from society and particularly from women already in the system is that people don’t actually know how rare the diseases are that they’re being screened for. They have no idea what the risks of the test are, how frequent false positives are and what adverse outcomes might be. In the rush to tell people that they must be screened in order to be responsible, the concept of informed consent, the right to make a decision about what happens to your own body has gone out of the window.

    I was amazed and appalled when I first found out what American women have to endure just to get hormonal birth control- even though pelvic exams for asymptomatic women are seen in most European as pointless and unnecessary, and the World Health Organisation says that only a blood pressure check is needed to prescribe birth control safely. Annual gyn exams sound like a horrific relic from the past, not a 21st century reality.

  13. brilliantmindbrokenbody said:

    I had my first exam at 14, due to a suspected yeast infection.

    I still wonder, in retrospect, why they couldn’t just stick a swab in and look for yeast. I had to have a full exam downstairs, and it was agony. I cried and whimpered. My mother was there, and I kept throwing pleading/accusing looks at her.

    I’m built on very petite lines, especially vaginally. I’ve had to fight with about 1/2 of my pap providers to get a pediatric size ‘scope used. I’m small enough that NO ONE has ever had trouble finding my cervix with one. I mean, I can’t even wear tampons without a lot of discomfort. Either they don’t go in far enough and they slide out, they hang up on my still partially intact hymen, or they rub my cervix painfully.

    When I was 16, I went on the pill for painful periods and they told me I’d need a pap either at 21 or after I was sexually active, when I told them about the painful horror of my first exam. I was very, VERY thankful that they didn’t require one then. That was my then student health place, and they were wonderful.

    Some of my pap providers haven’t had a peds scope, because it’s a college practice, and those have been a lot more difficult. Fortunately, they were also the most sensitive providers – they didn’t open the scope any farther than they absolutely had to, moved very slowly, waited when I said to, so on.

    My last pap, they finally – FINALLY – decided that I only need them every other year, as it’s painful. No more holding my birth control hostage so I’ll come get them. It makes me so ANGRY that they do that. I mean, I’m a moderately low risk for cervical cancer – negative tests for HPV, most of my sexual relationships long-term and all monogamous, so on. They consider me lower risk now that I’m over 25. I’ve never been one for risky sex – I required negative STD tests from all partners before we went skin-to-skin. I used condoms even though they hurt me, especially before I figured out that spermicides cause me a nasty reaction.

    I wish – OH how I wish – that the standards stating we only need paps every 2 years had come out long ago. I would not have objected to having a pap done every 2-3 years.

    And I come to this from the perspective of someone who has lost a loved one to cervical cancer. My aunt died of it when I was a freshman in college. She was never one for doing what she was told, so I suspect she didn’t get hers done as often as she was supposed to. I’m not considered an elevated risk because she got a form of cancer that isn’t genetically linked. (she had small cell carcinoma, which is exceptionally rare outside of tobacco-caused lung cancer)


  14. Thank you for writing this. I’m contemplating to whether my first (and only) pap smear might have been considered sexual assault by the doctor. The doctor seemed rushed and frustrated like I was taking up her time, was very unsympathetic to me crying and in pain as she jammed a cold, metal tube up my virgin vagina hole. It got stuck half way in, and she told me, kind of peeved, to relax so she could stick it up further. Dammit, i didn’t know how to relax! I almost fainted at the end of it. And all i wanted was some birth control to control my acne and periods.

    Now, at age 24, I’ve found a wonderful boy I want to lose my virginity to, but i’m too scared to try to get birth control because i’ll need another one of those horrendous pap smears.

    • Sarah, I want to hug you like that friend’s mother hugged me all those years ago. I also wish I had some cake, because it seems like cake makes these things better… or something.

      Birth control should not be held hostage by pap smears, and I agree that what you experienced is akin to sexual assault, and I would urge you to find a way to get some kind of counseling if you need it. I hope you can find someone who can do a more sensitive exam next time, but as far as I know (last I checked) as long as your last exam was clean and you are not sexually active yet, you don’t need a pap to get BC. Just a prescription. Perhaps a clinic, health department, or a center (like Planned Parenthood or someone similar) could help you out? I wish I was better at this sort of thing.

      I wish you luck, and I recommend Scarleteen for information if you have further needs. Heather Corinna is awesome, and the site might have better resources to help you find a way to obtain what you need without reopening your wounds.

  15. […] are some really simple and important things that are continually taken for granted, like informed consent for medical procedures. All too often, medical practitioners simply don’t think it necessary to explain procedures to […]

  16. OverItAll said:

    What doctors don’t tell you is that in order to save *one* life, 1,000 women will have to test at least once a year for *35* years, according to Dr. Angela Raffle’s research. If you quit the cervical-damage (aka pap smear), your chance of developing cervical cancer is 0.68%. If you test yearly, it’s 0.58%. So a whopping 0.10% chance difference. Plus, pap smears are related to miscarriages and early babies.

    Also, by forcing women to undergo paps/pelvics, doctors are committing rape. Informed consent is also missing from the packet they give you. My suggestion, do your research on paps (only 20% to 50% accurate), Informed Consent (Legally REQUIRED for ALL procedures), Female Genital Mutilation according to the World Health Organization (According to who, paps ARE considered FGM, with the exception of it being a “medical procedure.” ).

    Also, check out the comments on this page filled with women PROVING how unnecessary paps/pelvics/breast exams are.

  17. Matthew Chiglinsky said:

    A pelvic exam is rape.

    “Discomfort/pain, shame/embarrassment, and/or a feeling of being violated, as a result of penetration of the sexual organs by a person in whom a woman has no sexual interest, achieved through coercion, fear, and/or intimidation.”


    • Matthew, there are some words missing from your thesis. A pelvic exam without informed consent is rape.

      *reads your post*

      Ah. I’m pretty sure I’ve seen you before. And I for one am really, deeply uninterested in your ideas about whether women you think you own are betraying and cheating on you by choosing gynaecological care.

  18. I am absolutely terrified of getting my physical each year because I’m afraid of getting the pap smear. I’ve had three ‘attempts’ by doctors to do this to me, and every time I would cry scream and completely freak out. At least the first doctor I saw realized it was worthless to try a second time and sent me for ultrasounds instead.

    I had cysts, so I guess its important to check, but I’m a virgin and its so painful, no matter how much I relax and calm beforehand. I can’t do it.

    There are alternatives out there being researched that are better, they aren’t mainstream, I think we should push for these alternatives (home tests, where the woman collects her viginal fluids to send in for blood tests, and other tests)

    I’d rather collect my fluid than have a piece of sharp plastic shoved inside me.

  19. Elizabeth said:

    Your story really upset me, I cannot imagine going through that experience at any age; let alone at 14 years of age.
    I have serious concerns about the American “healthcare” system, especially womens healthcare. I believe you’re all being deceived and treated appallingly resulting in major harm to your health – both physically and mentally.
    I’ve been posting to a site called Blogcritics and the topic, “Unnecessary Pap smears” – over 3000 posts so far, many from American women angry about the coercion and harmful excess in your system.
    As an Australian woman (who has also lived in the UK) I can tell you these exams are NOT necessary for the safe and continuing use of the Pill. (or for anything else in a symptom-free woman)
    Your medical history and a blood pressure test is all that’s required for the Pill.
    Holding birth control hostage is an unethical try-on – it is a violation of your human rights and a breach of the Patient Bill of Rights. Challenge the Dr, ask what law or regulation makes these exams compulsory for the Pill (or anything else), report the Dr, complain, go over the doctor’s head…American women need to start making a lot of noise – fight back! (Google, “women wanting birth control get unneeded pelvic exams” which appeared in the mass media recently and take a copy along with you to your next consult)

    The other evil deception – well-woman exams.
    Our doctors do NOT recommend them at any age in an asymptomatic woman. I’m middle aged and have never had one – nor would I ever agree to one.
    The routine pelvic exam is of low to poor clinical value in the absence of symptoms and exposes you to risk (more unnecessary and possibly harmful procedures and even surgery)
    The routine rectal exam and recto-vaginal exam – same thing, poor clinical value without symptoms and risk! Not recommended by our doctors.
    Routine breast exams – not recommended – there is no evidence they reduce the death rate from breast cancer, but they cause biopsies.

    I’d urge every woman to do her reading and make an informed decision about the need for and value of these exams. In my opinion, they should be called sick-woman exams because they are far more likely to harm you!

    Pap tests are never compulsory, never! The pap test like any other cancer screening test has risks and benefits and legally and ethically requires your informed consent. Fewer than 1% of women benefit from pap tests (0.65%) according to American pathologist, Richard DeMay – 0.35% get false negatives and may be disadvantaged by testing and 99% derive no benefit at all. (I’ve seen figures even less impressive – in Australia the lifetime risk of cervical cancer is 0.65% and around 0.45% benefit from smears)

    Look at your risk profile before deciding to have pap tests. The Finnish program provides some protection from false positives – they offer 5 yearly screening from age 30, 5 to 7 tests in total. They have the lowest rates of cc in the world and send the fewest women for colposcopy/biopsies. (fewer false positives) Annual and biannual testing is over-testing and produces very high rates of false positives and over-treatment. Annual will send 95% of women at some point for colposcopy/biopsies – Two yearly – 78%
    Three yearly – 65% Five yearly – still high at 35%-55% (depending on the research) Almost all referrals are false positives.
    Women under 25 (some say 30) do not benefit from testing, but produce very high rates of false positives. CC in this group is VERY rare and rare in all age groups. The tiny death rate from cc in young women remains the same whether you screen or not.
    As a low risk woman, I made an informed decision not to have testing more than 20 years ago. My risk of cc is near zero, while even 5 yearly testing carries a high risk of cervical biopsies – too much risk for me.

    Mammograms have risks too – there are serious concerns about false positives and over-diagnosis. (ductal carcinoma and lobular carcinoma)
    It’s important to do your reading and control your healthcare – unnecessary treatments and biopsies to the cervix can cause damage and lead to infertility, miscarriages, high risk pregnancy, premature babies, more c-sections and psych issues.
    The use of stirrups is another disturbing feature of your system – they are not used in consult situations in this country. (or the UK)

    Dr Joel Sherman’s medical privacy forum is a wealth of information – see under women’s privacy issues the articles listed in the side bar. I’d recommend the Richard DeMay article and research by Angela Raffle. (1000 women need regular screening for 35 years to save ONE woman from cc (BMJ;2003) Commentary: “Why I’ll never have another smear test” by Anna Saybourn (online) There are also lots of articles by Heather Dixon and others on the real value of these well-woman exams and the unethical practice of doctors holding BC hostage…
    Once informed you’re better able to protect yourself from harm and to control every consultation. IMO, doctors are careful and respectful when faced with an informed woman.
    It’s awful to think you faced that consult alone and endured what sounds like unnecessary exams.
    Those exams are NOT clinically required for the Pill…my heart goes out to you and thank you for speaking out about your experience and warning others….
    I should add women not yet sexually active are excluded from testing in other countries, although I see your guidelines call for ALL women to test from 21, that is BAD medical advice.
    Also, women who’ve had complete hysterectomies for benign conditions should be excluded from testing. One other group often overlooked – women in lifetime mutually monogamous relationships are most unlikely to benefit from testing – their risk of cc is near zero.
    Whether you’re low or high risk, the risk from this cancer is very small and tiny for low risk women – it is your decision whether you screen and if you do, avoid over-screening and early screening.

    • Whew! That is a very long and highly informative comment! Thank you! I don’t usually have such long commentary, but I appreciate your swingin’ by to leave such a thoughtful response.

      You make so many good points, Elizabeth. You really do.

      One thing that I always hesitate to do though, is make it sound as though people have a responsibility to demand or fight back against stubborn doctors, especially in the U.S. where the Heath Insurance Machine rules all. While I am very privileged now, thanks to TRICARE (military medical insurance), and can do things like refuse services from my doctors (well, now that I am no longer Active Duty), demand a different provider like I did when I was refused an IUD by a rather uninformed Nurse-Midwife last year, and insist that a doctor listen to me (provided I have the energy to fight with them over my care after all of the many things I have to fight about with them sometimes), many people here do not have that.

      For many people, refusing a smear or exam in order to get BC will mean that a doctor will refuse to give them that script, and then they will be either labeled a belligerent patient and treated hostilely or they will have to seek out another provider for that same service. All well and good if you are insured or if your insurance doesn’t have a limit on how many times a year you can see an OB/GYN in the States for BC screenings or “well woman” exams. Or if your insurance also doesn’t demand said exams for BC. I know that these tests should not be mandatory, I intimated as much above, but the way our health system works (or doesn’t, as the case may be) is making it very difficult to do anything but cave under the pressure. It isn’t easy to take time out of schedules to go to appointments. Many docs here won’t prescribe BC at the first appointment — they insist on “getting to know you” first. Even if they don’t insist on smears or exams, that is going to be extra appointments. All of this has to be paid for, which goes back to the issue of insurance.

      Until the U.S. fixes its problem of insurance and choosing money or quality of life and making health care a commodity instead of a right, women are going to keep paying this price. We aren’t exactly all uniformed victims over here in the States. We just, many of us, happen to be stuck in that rock and hard place many people hear so much about. Even if we did rebel and raise a fuss (and I think that many of us who are able are in fact doing just that) it may or may not do us any good.

      Much of it comes down to a matter of privilege.

  20. Elizabeth said:

    Good luck, Ouyang…
    Please feel free to drop over at blogcritics or Dr Sherman’s site and join in the discussion. Personally, I think more American women are becoming aware of what is and isn’t required and that they have a right to choose – articles like, “Women who want birth control get unneeded pelvic exams” are really helpful – informing more women.

    One of the posters at blogcritics, an American, refused the pelvic and pap and when it was clear she wasn’t backing down, got her BC…she then wrote to the Clinic and asked what law required these exams for BC and explained how she’d been reduced to tears in the consult room. After going over their head, the Clinic advised she’d get her BC in the future without a well-woman exam or screening and they confirmed these exams were recommended, but optional. Another asked her lawyer to draft a letter and she got her script immediately….
    These measures shouldn’t be necessary….but it will take time to change the system.
    We have our problems here too; there is zero respect for informed consent and our doctors are paid financial incentives by the Govt to reach targets for pap tests (undisclosed to women) That puts our doctors in a conflict of interest situation so most women are completely unaware of the real benefits of testing or the risks. We also have high rates of over-treatment.
    I agree with your comments…the last paragraph is spot-on
    There are a few things in your health care system that make it more difficult for women to avoid unnecessary/excessive exams/tests – the widespread acceptance and pressure to have well-woman exams, the practice of defensive medicine, profits and insurance issues. I was alarmed to read that 1 in 3 women in the States will have a hysterectomy by age 60, that’s very high. (600,000 every year)
    I understand some American women use a gynaecologist as their primary physician – I think that’s probably a bad idea.
    Anyway, here’s hoping for change.
    Nice chatting to you…

    • I’ve never known anyone who uses a GYN as a PCM, but that doesn’t mean it doesn’t happen here. It could be relatively common and I just am unaware. I’ve always had them as separate providers. In our TRICARE system here, however we are expected to get our pelvics and paps from our PCMs, which I am not comfortable with, and which is another reason I didn’t get mine when the nurse midwife ordered me to.

  21. This is the most amazing article. It sums up my feelings EXACTLY! I’ve never read something that so accurately and overwhelmingly summarizes my thoughts and feelings. I’m military as well and the constant sexual assault just doesn’t seem justified when the vast majority of active duty are males who are not subjected to yearly horrendous exams. Any tips for convincing the docs to leave me alone?

    • YUP! I sure do!

      Know the current information about OB/GYN care. It’s a huge pain, but the information is out there in medical journals that are free to the public to read. Your doctors should be reading them as well, and if they are not, you will be prepared. Information is your best defense against needless invasion of your body, and the best weapon you have to insist upon your rights as a patient.

      I had an ectopic pregnancy a few summers ago that ended in termination. My IUD had to be removed in order to safely handle the situation, and I was promised that I would be able to simply get another as soon as my body recovered.

      When I went back to get it, the nurse midwife tried to block me from getting one, telling me that IUDs increased the risk of ectopic pregnancy. This is both false, and irresponsible of her. The truth is that IUDs do not affect the chances of ectopic pregnancy. Rather, they are so effective at preventing pregnancy that just about the only failure that happens would have to be an ectopic pregnancy. The odds are that you would have had that same ectopic even without the IUD, but it stands out because it is birth control failure. The statistics get skewed.

      I did my research, and found a journal article that was less than a month old demonstrating that there was no contraindication with IUDs and ectopic pregnancies. I took it with me to my actual GYN and showed it to him, and he THANKED me for being informed and for showing this to him, because he said he had read that there had been such info, but hadn’t yet read the article. I got my IUD that day. He was also understanding about my concerns with paps and pelvics. He has been one of my greatest women’s health care allies at this hospital.

      That was more than you asked for, but honestly, while we shouldn’t HAVE to go to such lengths, knowing your shit about your body and about your medical options is an invaluable weapon. Doctors and other medical professionals do not know everything, and are fallible just like everyone else, they just tend to forget it more often, IMO.

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