A New Frontier in Awkward: Do Your Own Pap-Smears

Hmm. Lemme think. Spread-eagle with the heinie half-way up toward the sky whilst having a large metal object shoved up inside and cranked open very uncomfortably with two people looking on barking commands VERSUS having privacy and being substantially more relaxed and in control. What do you think? Also, there's still lots of pressure for women who've always been celibate to undergo a pap test and that's just insane. This is all about big $$ and instilling fear into women (which isnt' working on me, btw). Men wouldn't stand this nonsense.

I have refused smear tests for years; having been sexually abused by more doctors than I care to remember. Even so, a smear test is degradating and let's face it, unncessary to have done by a clinician when women can do it themselves. After all, if we can find our G-Spots, can fit a Dutch cap etc etc. how difficult can it be?

The domination and undermining of women's bodies (and let's face it, our intelligence) is the last bastion of patriarchy. And there is no place worse than in the UK, on the grand NHS for this. I mentioned to my (female GP) about the Dutch trial and she simply said, women were incapable of finding their cervix. I think that attitude confirms my point!

Having been abused as a child, I will die before doing a pap test. I have suffered enough degradation. If I could do one at home by myself, I certainly would. This would save so many more lives.

Wow...at last, some honest responses.
I get so tired of women trotting out the same old stuff - the fear campaign has worked a treat!
The mass screening campaign does not differentiate between a couple who were virgins in an exclusive relationship and a woman who has sex at 15 and has had 100 partners and smokes....
I feel the campaign is abusive - women can't think for themselves - others control their bodies. I will not be treated as a sheep...
We now have GP's pressuring women to have smears if they present with a cold...

You are dead right - men would not stand for this nonsense.
They refused to have digital exams for prostate cancer and now have a blood test...
Women submit - if you want birth control you have to have a smear - is that consent? No
The scare campaign worked and lots of people are getting rich on it...
We have a blood test more reliable than smears (almost 100%) it's called the CSA test - wonder how long it will take to become widely available.
It was patented in 2005 (I think)...we need to contact our politicians and get things moving....
Naturally doctors and pathologists will be against it...they will lose control of our bodies and lose millions.
I think for myself and refuse to be railroaded - I got the facts and made my own decision.
The medical profession does not like women thinking for themselves - well, get over it!

I just wanted to add that I worked at the Medical Board for a few years and some women are sexually assaulted by male doctors when they are pressured and intimidated to agree to pap smears - the current campaign facilitates opportunistic and predatory male doctors.

I refuse to see a gynecologist for an ironic reason: when I wanted birth control, I was coerced into vaginal, rectal and breast exams, and also pap tests. The doctor--a woman at planned parenthood-- bragged that the birth control and the tests had nothing to do with one another, but "Withholding pills will force you to come in and be tested. If you won't come in and be tested on your own, then we have to find a way to make you come in."

I can't tell you how disgusted and ashamed I felt...I wasn't interested in test results at that point, and hated myself for allowing the violation in exchange for the pills. The feeling of having been blackmailed, and having allowed the blackmail haunts me to this day.

I was relieved when the boyfriend and I broke up because it meant not having to 'sell' myself for pills.

My sex life has been intermittent since that experience...sometimes, I 'd rather not bother than have to worry about balancing fear of pregnancy over abuse by doctors.

I haven't had a pap in years...still not sure if they are of any use to me or not, but definitely not willing to go back into the stirrups.

If I could do the test with dignity and privacy, I would. Until I can, I'll take my chances.

I wouldn't worry about not having smear tests (unless you're high risk - family history or compromised immune system)....
Look at the comments being made by Professor Michael Baum - a top UK breast surgeon who set up breast cancer screening....he's brave enough to tell us the truth and face the fury of the screening lobby.
Testing is a vote winner and makes millions for the screening industry.
He believes the benefits of cancer screening are overstated and the risks barely mentioned - he considers this hugely disrespectful to women.
I agree!
The statistics are also a shock - the fear campaign would have you believe every second woman gets cervical cancer - it's actually an uncommon cancer - 1.7% of women would get it with no screening at all - we're burning down a forest to get to a few high risk trees.
A few women have been helped by cervical screening and thousands have been harmed - this test is unreliable - lots of false positives which means many women are put through degrading and harmful unnecessary biopsies - some are left with permanent damage to the cervix.
Many "abnormal" smears simply show common changes (particularly in young women) that would resolve without further treatment.
Also, pathologists afraid of litigation are erring on the safe side and sending more smears back as inconclusive or abnormal....
I'd encourage all women to get to the facts before agreeing to cancer screening - refuse them if you're unhappy with the risk v benefit analysis.
It's ridiculous that the brain washing is so complete some women are afraid to admit they choose not to have smears. Why? It's your body and you're entitled to make informed decisions about your body and health without fear and intimidation.
Remember, you don't HAVE to have these tests.
If a Dr refuses you the Pill without a Pelvic exam and smear - leave and report them - they cannot refuse you access to birth control....
The emerging evidence is that women who have regular mammograms have MORE breast cancer than unscreened women.
Google Professor Michael Baum and read his articles on the risks of mass cancer screening - it's disgusting that women have not been told the full facts and subjected to embarrassing exams without informed consent.
You can't consent to something forced on you - or when the full facts are withheld....
It's only when we refuse to be used and manipulated that the funds can hopefully, be redirected into research for better drugs and treatment for women who actually have these diseases.
The so-called miracle smear may not have reduced the mortality rate of cervical cancer anyway - some some the reduction is more about increasing numbers of women having hysterectomies over the last 30 years.
BTW I've had one smear in 50 years - did my own research and found the test lacking in lots of very concerning ways - I made an informed decision not to have smears and have been forced to re-open my decision making process every time I visit the Dr...
So many of my friends have been harmed by this testing - some physically, others psychologically...
It breaks my heart....
I had my first mammogram last year and four unnecessary biopsies - I have now asked to be removed from the breast cancer registry after conducting my own research.
One final point - GP's in Australia and the UK often get incentives to recruit women into these screening campaigns - this deters them IMO from providing full risk v benefit information.
Demand to be treated as an individual.....

I am young, and I have never had a pap, and probably will refuse to until we are provided with a private method of doing it at home. I don't even think I would mind it as much if there was a private method to do it at the doctor's office - the doctor hands you the self-screening device, you step into a bathroom, perform the test, step out, hand off your sample and they are the ones that go through the trouble of mailing it off to the labs. I would much prefer something totally at home, but in the meantime...
The only concern I have is that I might be higher-risk. My mother developed cervical dysplasia and finally found out after several false negative paps. The treatment they used might be the culprit for her weak cervix, though, which caused her much trouble in her pregnancy with my sibling..

Anyhow. I consider observed urine tests and other such exams in the same boat with these, and will kindly tell my doctor/midwife that I will refuse until I can perform one myself.

Glad to see I'm not the only adamantly protesting this.

Friends, thank you for your responses to this article. Reading them has brought me comfort; there are women like me who believe the PAP smear is wrong on many levels.

The only reason I even go to the gyn is for birth control for my polycystic ovaries. I am celibate and have been all my life. The PAP smear strikes me as a violation of my body. Until I can find a man with whom to share love freely in the context of marriage, I don't want a PAP. Despite the doctors’ obvious disapproval and my own fear, I have refused it every time; I am 23 years old.

The doctors' lack of consideration for us women as individuals, abstinent versus promiscuous, and those like me with special conditions like PCOS makes me angry. I despise this culture of fear created by cancers and how the doctors use it (and their fear of malpractice suits) to make us do degrading things. This part echoes many comments made before; thank you all for affirming what I thought I was alone in feeling.

I pray that a less invasive method can be legitimized to help us all. (If not, I may well be considering alternative medicine for PCOS.)

Other than refusing the PAP smear ourselves, what can be done? Are there any organized groups out there for women’s dignity? What politicians would one call?

Iris, this is what you can do....
The big problem with pap smears - they are unreliable - that combined with an uncommon cancer (I just read an article that puts your lifetime risk in an unscreened population at just 1%) means false positives...which usually means colposcopy and biopsies - some women are left with permanent damage (mental and physical)...
and we are forcing this unreliable and potentially harmful Test on HEALTHY women!
Also, risk information is withheld from women....

Did you know 1000 women need to be tested regularly for 35 years to save ONE woman from cervical cancer? (Statistics by Dr Angela Raffles - UK cervical cancer screening expert)
Puts it into perspective...don't you think?
Did you know the pap smear is only 50% reliable - some say as low as 30% - others as high as 60%...with pathologists being sued when they miss something, they're erring on the side of caution and there has been a surge in the number of smears being labelled "inconclusive" or "abnormal"....so more invasive, unpleasant procedures.
Did you know that almost 78% of women who have regular screening will have a colposcopy and biopsies in her screening life, with only a small number having any malignancy? (L. Koutsky, Cancer Prevention Fall 2004, Issue 4) (almost 95% with annual screening)
Don't live in fear - do your reading - understand the real risk...

Now...back to your question Iris - a blood test has been patented in the States - it's called the Cervical Specific Antigen test (CSA Test) - it's almost 100% reliable which means only women with a problem with be sent for colposcopy etc - we can stop harming healthy women. You'll find information on the Onconix website....
I understand women will have to fight to get access - there are lots of vested interests in the unreliable pap smear - millions of dollars being made....
Write to your politicians and fight for this Test....
I was also, refused the Pill 30 years ago - I refused to give in...I almost took the AMA to Court because the clinical practice is totally unsupported by medical literature and medical associations around the world - a blood pressure check is all that's required....(I'm a lawyer)
I (with my husband's support) attended a Billings Method workshop and worked with a teacher for 6 months...it took some time, but I gradually gained confidence - it has never let me down, I have a deep understanding of my body and I'm no one's prisoner - I'm free to refuse any and all exams and tests - yeah!!!
Also, US women are brainwashed into thinking they need annual breast, rectal and pelvic exams - this is not the clinical practice in Australia - these exams are considered unnecessary in asymptomatic women and can be harmful. (it doesn't happen in the UK either)
I started having breast checks in my 40's...the risk goes up with age (young women only have a 1% chance of breast cancer, but a high chance of false positives given young breasts are naturally lumpy)...
I think women are put through far too much....we need to question the need and stand up for ourselves...
I read an interesting Article about the real value of pap smears recently....you might find it interesting
"Should we abandon Pap smear Testing?" by Richard M. DeMay MD American Journal of Clinical Pathology 2000
114 Suppl. s48-s51
http://www.guardian.co.uk/society/2003/may/22/genderissues.publichealth (Dr Raffles research)
Fascinating reading....

Some good comments here. I am a gynecologist practicing in the US. Most physicians would (appropriately) be offended at the suggestion that they are knowingly part of some grand conspiracy to subjugate women (or men, for that matter). Medicine has made significant strides in recent years with respect to evidence-based practice. You can find just about anything you want on the internet so be careful.
That being said, most physicians i know would welcome a reliable home-pap kit. We recognize that patients do not want to be treated like a piece of meat. We know that some of the most valuable tests can be humiliating, at best and that if we were to find better ways of doing them, patients would be more willing to undergo surveillance. For example, CT-colonoscopy and camera-capsule screening would be much more acceptable than the traditional colonoscopy. Newer breast imaging techniques use gravity and ultrasound rather than glass plates with breast compression. A reliable private pap kit (either done at home or in the office) would be a welcome addition.
Sadly, many such 'novel' techniques exist but are not yet thought of as 'cost-effective.' Eventually, these will become commonplace (recall that HPV DNA testing was considered too expensive initially but may, in the near future, replace the standard pap smear as a first-line diagnositic test, an essential step in creating a decent home-pap product) but I fear that these could be rationed in some kind of universal care system where cost is a major driver.
I post this to let readers know that most of us chose our profession to protect the health of our patients. Improving delivery of care while preserving patient choice and dignity should never be considered a bad thing.

I am 26 and I have been removed from the national programme at my request. Due to the information that was sent to me in my home, I believed that I, as a virgin should have a cervical smear test. I went along and had it. it was the most distressing, traumatic expeirence of my life and I am so angry that they did nothing to prevent this happening to me. I really struggle with feelings of hatred for the NHS and my previous GP practices because of this.

The US health care system violates the rights of women every day.
Even though the US F & D Administration, WHO, Planned Parenthood and the American College of Obs & Gyn's ALL say that pelvic exams and pap smears are NOT required for hormonal birth control....most US doctors still refuse to prescribe BCP's without them - choosing to ignore the recommendations of these organizations..
Do not be coerced into this exam or test....
Asymptomatic women DO NOT need annual gyn exams - look around the world - they are not done elsewhere and they often lead to even more invasive and possibly harmful testing.
It's true - the pap sear has risks as well as benefits - testing before 30 and too frequently increases your chances of a false positive - and unnecessary biopsies.
I'm a low risk woman and have chosen not to have pap smears.
If I were high risk, I'd probably follow the Finnish program - start at 30 and then 5-yearly until 50, 55 or 60 - they have the lowest rates of cervical cancer in the world and the lowest rate of biopsies (and false positives)
Don't agree to this Test or exam unless you have made an informed decision to do so - your health may be on the line.
Doctors have a huge conflict of interest - they make a fortune from this testing and this exam and all the follow-up...
Sadly, they are the last people who'll tell you the truth about this testing and exam.
Planned Parenthood offer the HOPE scheme - you can get Pills with just a simple blood pressure check.
It is only by making a stand that we can stop this outrageous practice.
Womanhood is not a disease....

and what good can come from being submitted in stirrups with the legs spread wide open in front of a stranger who's going to put his fingers inside you ????? Of course, a DIY pap smear or blood test is a much better option for women. Like someone else already pointed out, the reason why women are still being submitted to this long outdated, barbaric pelvic exam, is because they never demand anything better. At least, men have enough selfrespect and won't massively accept to be humiliated in the name of goodness/science whatever..so they got what they wanted: a non-invasive blood test instead of the finger ass exam.

Women are too much accepting of being treated like a little victim, little girl, being treated in a paternalisitic way equals being treated 'good' for most of them apperently, but not for me and I'm happy to see not for the other commentors on here either!

I think more women should refuse the gyn / pelvic exam for many reasons. There are hardly any good reasons to have them anyway. First of all we need to undo our brains of this massive brainwashing cancer hysteria and stop getting overchecked and then if you do want to get tested, there should be by all means a dignifying way to do it: either a do it yourself pap smear or a CSA blood test (more accurate than the very inaccurate pap smear with all its false postives..). Breast thermography instead of the cancer causing boob smashing mammography etc. Oh and btw the bimanual exam can be skipped as well, it's useless in detecting the size of the ovaries and what not. You can only be sure that the woman has a vagina by doing that, but I don't think women need to have this information confirmed by a man or woman in a white coat.

For all those who are afraid of pelvic exams, who want better alternatives, who believe womanhood is not a disease, who are against unnecesary humiliating and degrading gyn exams and other medical tests, you can visit this site : http://health.groups.yahoo.com/group/womenagainststirrups/

American doctors exaggerate the risk of this cancer...they use fear to force women to agree to this test.
If you have an opportunity to visit the Netherlands or Finland, you'll see a healthier approach.
Women are given honest information about the risks and limitations of screening.
Annual and biannual screening means lots of women face biopsies for false positives.
Our doctors don't care about putting women through this test more than absolutely necessary, when it's totally unnecessary or sending us off for biopsies for false positives.
They don't care about our health...just catching as many cases of cancer as possible.
In other countries, the health of all women is respected and the need NOT to medicalize our lives and bodies is acknowledged.

In the countries I mentioned...women under 30 are not offered screening.
Why?
Dcotors know that one in every 13 smears in women under 25 leads to colposcopy...yet cancer in that age group is very rare. They know screening young women causes more harm than good. Our cervix changes over those years and we don't need treatment..these changes are a normal part of life.
Biopsies can leave women with continuing health problems.

Women are tested every 5 years until they're about 55 or 60....
Why?
Doctors know that annual and biannual testing simply leads to over-treatment for false positives.
You end up harming more women.
So, you can see the US system is designed to catch cancer, even the rare cases...with no regard for the health and well-being of the vast majority of women who'll never get this cancer.
We test virgins, young women, annually...we even test thousands of women who've had complete hysterectomies for benign conditions.
They'd test the family cat if it were unlucky enough to stroll through the surgery!
IMO, our doctors are unethical...
There emphasis ignores the health of the majority and that's unacceptable.
It means we have to be careful with US recommendations...doctors won't tell you what is in YOUR best interests...they're simply chasing the cases of cancer.
No one accounts or cares for the huge number of women harmed or disadvanataged by this testing.
We must protect our health and bodies.
Do some research on-line...even send some emails to foreign medical associations seeking information about their programs...
I considered my risk profile and then made a decision about testing.
I use the HOPE program at Planned Parenthood so I can access birth control pills without the exam.
I will not follow a program that totally disregards the containment of harm to healthy women.

Can I just add...that's also how I found out annual gyn exams are NOT recommended in other countries...in fact, doctors don't recommend then AT ALL
Another example of our doctors pushing excessive and in this case, totally unnecessary invasive exams onto us with no regard for our feelings or health.
To think we're put through those revoltingly invasive exams every year from teens and told it's incredibly important for our health....only to find the test is of such low clinical value and has risks...that the vast majority of the world's doctors don't recommend it AT ALL, AT ANY AGE, EVER....unless you have symptoms.
The day that dawned on me...was one of the happiest and saddest days of my life.
The distress these exams cause...the embarrassment, the demeaning nature....the horrifying exposure - all totally unnecessary for healthy women with no symptoms.
The happiest...because I'll never have it again.
I doubt I'll ever forgive our doctors for that one...the cruelest deception of all.

i live in the usa and am terribly afraid of getting a pap smear. i have a fear of medical test results which i am seeing a therapist for. i feel fine and have no known health problems. i finally broke down and went to get a pap and pelvic exam about a year ago. the pelvic exam was normal and i was terrified of getting the pap test results back because i have never had one and i'm afraid that at my age and never having one they will probably find something abnormal and cancerous. anyhow, after the 10 days of worry and panic attacks waiting for the test reuslts they came back 'inconclusive' not enough cells were available for viewing. the nurse practitioner said to come back in 3 or 4 months to retest and i have been to scared to go back. i have had 3 sex partners in my life and those three men have been with other women before me so i'm sure i've been exposed to hpv strains in my lifetime. my boyfriend had a wart removed from his penis a while back (which i know is lowgrade hpv) and his doctor just said for me to keep up with my pap tests. after my pap test i bled/spotted for about 24 hours and the test itself was somewhat painful and humiliating. i'm comptemplating getting another pap soon to just ease my mind and worry but i'm yet to have the mental strength to go through this. the nurse practitioner said i was the oldest woman she had ever met who had never had a pap test.
could somone please respond to my post and give your thoughts.

thank you

i live in the usa and am terribly afraid of getting a pap smear. i have a fear of medical test results which i am seeing a therapist for. i feel fine and have no known health problems. i finally broke down and went to get a pap and pelvic exam about a year ago. the pelvic exam was normal and i was terrified of getting the pap test results back because i have never had one and i'm afraid that at my age and never having one they will probably find something abnormal and cancerous. anyhow, after the 10 days of worry and panic attacks waiting for the test reuslts they came back 'inconclusive' not enough cells were available for viewing. the nurse practitioner said to come back in 3 or 4 months to retest and i have been to scared to go back. i have had 3 sex partners in my life and those three men have been with other women before me so i'm sure i've been exposed to hpv strains in my lifetime. my boyfriend had a wart removed from his penis a while back (which i know is lowgrade hpv) and his doctor just said for me to keep up with my pap tests. after my pap test i bled/spotted for about 24 hours and the test itself was somewhat painful and humiliating. i'm comptemplating getting another pap soon to just ease my mind and worry but i'm yet to have the mental strength to go through this. the nurse practitioner said i was the oldest woman she had ever met who had never had a pap test.
could somone please respond to my post and give your thoughts.

thank you

LeeAnn,
The thing about testing...no one should tell you to get tested or not to get tested...it MUST be your decision.
Informed consent is required for all cancer screening, yet this is largely ignored by doctors.
Inconclusive tests are common with smear tests - it's a very unreliable test full stop.
Having to go through such an unpleasant test again...
I can understand how you feel...

Did you use condoms with your three sexual partners? Condoms reduce the risk of transmission of HPV by up to 70% according to one study...and some doctors believe the protection may be even higher.
This is an uncommon cancer...if you look at the incidence rates of this cancer and compare it to almost any other cancer, it's right down the bottom.
It was always uncommon...even before screening...so don't panic!
I think many women think the risk of this cancer is HUGE because of all the hype and over-treatment caused by false positives.
It's a very small risk, even for a high risk woman. (I think it's one in 196 women in Australia whereas lung cancer is one in 25!) Yet women worry far more about cervical cancer than they do breast cancer, which is far more common at one in about 68....

It makes no sense...except doctors use fear to push women into screening - I think that's disrespectful and unacceptable. We need facts, not fear.
Every woman will feel differently about risk and screening - some low risk women get tested regularly. Some may prefer to accept the fairly high risk of an unnecessary biopsy to do all they can to catch this uncommon cancer. Some people feel reassured by screening.
Of course, screening does not catch all cases - about one third of women who get this cancer have had a recent Normal smear. The test is unreliable and very bad at picking up adenocarcinoma. (one rare type of cervical cancer)

The risk of a false positive is much greater than the likelihood of cervical cancer for low risk women, but some will choose to have screening anyway.
The small risk is of greater concern that other factors.
(of course, IMO, many have no idea of the real risk of this cancer or their likelihood of benefiting, because they've never been told by their doctors)

Other women will prefer to live with the very small risk...even some high risk women may prefer to live with the still fairly small risk. (especially women with a history of sexual assault) The risks of over-treatment or the unpleasantness of the Test or the rareness of the cancer makes them fall the other way - not to screen, or screen less frequently...
Only you can make that assessment of risk...what sits best with you?

As adults, we make decsions about our health every day...smoking is a far greater risk to your health for example. Being an unhealthy weight is another example.
If you're incredibly worried...I'd do some reading...if you're still afraid or worried, maybe speak to a sympathetic doctor or counsellor.
If you have screening, be careful with over-screening - choose a schedule that will give you some protection from false positives. Annual and biannual is too frequent, in my opinion...

Don't worry - it saddens me that women spend so much time worrying about this uncommon cancer.

I've attached a few articles that might help you....one on over-screening and another on the real risk of this cancer.
Look at your risk profile...
http://www.mja.com.au/public/issues/176_11_030602/dic10690_fm.html
http://www.guardian.co.uk/society/2003/may/22/genderissues.publichealth
http://www.guardian.co.uk/society/2003/nov/15/medicineandhealth.publichealth
There is also a great discussion under Women's Issues on Dr Joel Sherman's Patient Privacy blog.
http://www.bmj.com/cgi/eletters/320/7238/872#8402 (see figures by A. Rouse on the number of women who benefit from smears)
Good luck, LeeAnn - hope you feel better very soon.