# Refusing PAP smears



## Greaseball (Feb 1, 2002)

I have decided not to do these anymore if I can possibly avoid it! Here's why:

1.) They hurt. Even if a doctor says "Oh, it doesn't hurt the way I do it!" it still hurts.

2.) The American Cancer Society says that monogamous women do not need the pap every year - only every three years.

3.) It is invasive, too invasive to go through with someone you have just met.

4.) I am not at risk for STD's.

5.) The federally funded health clinic I go to even admits they do it because of policy and liability issues, not health issues. They also say that only the non-paying clients have to do it.

What do you all think? Is this not a good idea? Does anyone else refuse the pap?


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## rianna (Jul 28, 2002)

I hat them and dont go to the doctor for any reason (yet). My mother had not had one in 25 years! She recently went in to get one and was so scared... everything was fine of course. I feel they are only a need when you think there is a problem.


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## Lucy (Nov 21, 2001)

well I must admit, I only get a pap when I am pregnant, they seem to want to do one on your first ob visit. However, I do feel like they are a good idea to do routinely. I mean, dont they screen for cancer? Isnt that why they collect the cells and send them off to the lab? In my view, even if they only detect a small amt of cancers from these screenings, its a good thing. I think its kinda like the controversy with mammograms, they are not perfect, but they do more good than harm.

It is no longer painful to me, used to be, but more like uncomfortable. I do think the right practioner makes all the difference though.


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## Lucy (Nov 21, 2001)

btw Greaseball, I love your sig line!


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## indiegirl (Apr 15, 2002)

Sorry, but I think Paps are absolutely necessary. I've known too many women who have had cervical cancer. I have the risk factors, so I will have one every year. I guess my question is, why not? If you can do something proactive about early detection, then why not? I'm sorry they hurt for you and that you don't have a doc whom you feel comfortable with. That is a big deal. I still think its a bigger deal to die at 35 or 40 b/c it was too late to do anything.

JMO


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## daylily (Dec 1, 2001)

I've been told by a doctor, and later by my midwife that as long as you have a history of normal paps, it's OK to go every other year. I wouldn't want to skip them altogether though. I worked in an OB/GYN's office. One of my jobs was to record the PAP results in people's charts. The vast majority are normal, and lots of the abnormals are problems that resolve themselves, but once in a while there'd be someone with an abnormal PAP who didn't have the risk factors for HPV.

Side bar: about 5 years ago, I'd gone more than 2 years without a PAP (I didn't even show up for my post-partum check up with dd that year) and my Dr. called me at home on a Saturday morning to tell me I was overdue! Tacky, huh?


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## mamaduck (Mar 6, 2002)

I used to feel the same way about them, but I found out that the birth center where I had my son also does annual exams and paps for non-pregnant women. It makes all the difference. Now I actually look forward to spending 1/2 hour with one of the midwives and going over how I've been doing etc.. They are son nurturing. And it doesn't hurt as much with a woman's hands either.


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## CrunchyGranolaMom (Feb 5, 2002)

Hmmm, you think it's tacky that your healthcare provider called you at home, Daylilly, to tell you you were overdue for a Pap? Interesting. I'd take it as an almost unbelievable (in this day-and-age) sign of an MD who cares about their patients as actual people and cares about their health!

To each his/her own, but as an RN, if it had been two years since I'd seen a patient, it would really be something if I felt that they were doing something not in their best health interests, so I remembered their full name, looked up their chart, and then spent the time to call and remind them to come in.


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## daylily (Dec 1, 2001)

I should have explained, lovinglife, that my HMO sent him a list of the names and numbers of us "bad" patients, so he was just plowing through the list. I also should have mentioned that he knows my dh well, and had called dh about another matter and then said "oh, can I talk to Daylily? Hi, Daylily, you're overdue for your PAP." I just felt like big brother was watching. So my knee jerk reaction was to think "Screw you" rather than to jump and make an appointment. I don't like to think that a faceless HMO is keeping tabs on its members.


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## Irishmommy (Nov 19, 2001)

Paps should not hurt. My dr. (female) always warms the speculum up first, which also helps. They have different sizes of them too, so ask (or tell!) the dr. to use a smaller size.

I would hate to think that I died young and left my kids motherless just because I didn't bother getting a pap.


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## AmyG (Jan 30, 2002)

I get mine on time. It's not my favorite thing, but it's worth it to me. I even do it every year instead of every other year, even though I've only had normal ones. I've seen too many studies that show that many are incorrectly read, and I'd hate to think that I could have cancer for as much as 4 years without knowing.

To me, the benefits outweigh the risks. Actually, I can't really think of any risks, other than some slight discomfort and possible anxiety if you get a false positive and have to have another. They shouldn't be too uncomfortable. You may feel some cramping, like a period, but if you really have pain, the doctor did it wrong. (I did have a male doctor-in-training scrape me with the speculum once. OUCH! Now I only let real doctors do it.)


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## Arduinna (May 30, 2002)

Well, I think they are important.

1. I've had an abnormal pap before that resulted in treatment being needed.

2 I've had cancer (non gyno kind) so it's something that is real to me, not a theoretical risk.

3 my cousin had cervical cancer and she ended up need a hystorectomy. Early detection at the dysplasia stage would have resulted in her keeping her organs.

4 I don't want to lose my uterus to something that is easly detected before it ever gets to the cancer stage. Pain or not, embarassment or not.

5 cancer kills (I only had a 30% chance of surviving) and my child needs me to be her mother.

Of course we do all have the freedom to choose what to do. For me the risk isn't worth it on this one.


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## CrunchyGranolaMom (Feb 5, 2002)

Ah, now I understand. I was *sure* there was something that I wasn't understanding correctly!


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## Greaseball (Feb 1, 2002)

Actually, my plan was to do them every three years as suggested by the American Cancer Society, not skip them all together.

I really don't know why they hurt. It's not the spec being too big or too cold, it's when they touch the cervix and stick that thing inside it.

I think that soft organs should be examined with soft instruments - not wood, metal and plastic. And that prickly brush also hurts. And the STD tests hurt the most, because they leave the thing sticking out of your cervix for a few minutes. (And they always tell me I can't refuse the STD test.)

Perhaps someday when I have insurance I can see a real doctor. That may make a difference. Also, if they would use nitrous oxide like I get at the dentist that would make a big difference.

You would think, with all the medical technology today, they would have invented a way to make something painless.


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## Irishmommy (Nov 19, 2001)

What do you mean, you can't refuse an std test? I've never been offered one in my life, and certainly not related to a pap.


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## lilyka (Nov 20, 2001)

The way my midwife does a pap it takes less than 10 seconds and doesn't hurt. I refuse the full finger up the butt exam and have never even heard of the whole STD thing.

I don't think having laughing gas would be a good idea. Call me paranoid but I don't want to be naked and in a vunrebal spot when I am too looped to do anything about it.

I agree. for you every three years is plenty. I get one every time I get preg which is about every three years.

Here is my tip. for the next three years save your money and pay a real healthcare provider to render her services. Chances are if you are at a clinic they probably aren't taking thier time, skilled or cautious and they probably aren't terribly concerned if you are comfortable. Some things are just worth caughing up the money for. That is coming from someone that has never had health insurance so I cough up the dough regularly (guy at the clinic thinks I am a depressed hypocondriac who self diagnosis, Dr. I pay said "Your right, you have very low thyroid, hear get some treatment" and I feel much better).

One more thing. Never trust a man when he says this isn't going to hurt. He doesn't have a cervix. He has no idea how sensitive they are.


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## merpk (Dec 19, 2001)

Greaseball, I don't think PAP smears have anything to do with STD's. They're all about cancer.

Cancer sucks.

Cave on this one, get a PAP smear done. Please.

- Amy


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## AmyG (Jan 30, 2002)

I think they do take a swab for STD's and other germies. It's just like a Q-tip, although I've never had it left in for any period of time. They take the Pap smear with that hard thing that actually takes off part of your cervix. The other should just be a quick wipe, like a throat culture.

I think most of them do take the swab most of the time and they just don't tell the patients. I've only been told that's what they were doing once, but they do it every time.


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## holistimom (Jul 29, 2002)

Regarding STD's and PAP smears. PAP smears are done to test for cervical cancer. HPV, human papilloma virus, spread by sexual contact, is present in almost all cases of cervical cancer. This info is from the Woman's Harvard Newsletter. Sometimes an HPV DNA test is done to determine the strain of HPV. If Thin Prep PAP is used, the HPV DNA testing can be done from the same sample at a later date.


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## Greaseball (Feb 1, 2002)

I had a Pap at my 6-week checkup, so I'm good to go for a while. (DD is almost 8 mo.)

I do agree some things are worth paying extra for. Right now I'm seeing a dentist who charges about $500 every time I see him, and I get the laughing gas which adds about $100. I could have the same things done for free somewhere else, but I would not be treated nicely or be made comfortable, and that's important to me.

I've always been forced to do the STD test, and I'm told it's because I get Medicaid. They told me that if I paid for the appointment I wouldn't have to do it.

I let a man do it once because it was in the ER. Never again! I don't know what I was thinking.

Planned Parenthood is usually nice, although it still hurts. I may try them when the next time comes.


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## lilyka (Nov 20, 2001)

I just wanted to clarify. you aren't refusing pap smears all together. Just the frequent footrest miles and opting ot have it done every now and then instead of every year.


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## Greaseball (Feb 1, 2002)

Yes, that's right! I should have specified that.

Also, has it been established that they are safe during pregnancy, seeing as how they irritate the cervix and all?


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## daylily (Dec 1, 2001)

I'm pretty sure PAPS are safe during pregnancy, but I think it's outrageous that because you have medicaid you must get an STD test. WTF??? Is this the gov't's way of saying that low income women sleep around? I think it's discrimination, and it's YOUR body. You have the right to decide what tests not to have. What on earth would they do if you refused it? Hold you down and force it on you? They couldn't do that!


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## merpk (Dec 19, 2001)

I don't think either of my OB/GYNs has ever done a PAP smear on me during a pregnancy.

My history of miscarriages may play into that, though ...

- Amy


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## Greaseball (Feb 1, 2002)

Yes, I think that some people have the perception that low-income women sleep around.

One time when I was 17 I went to get a pap, pills and a chlamydia test, because I found out an ex had it. So they tell me that I have to be tested for all STD's, and I say no, I just want to be tested for the one I might have. So they say that because I refused their tests, they would not provide services to me until I agreed to do them all. No paps, no birth control, and no tests for only one STD. So I'm 17, homeless, and with no income, and I can't get health services because I won't do it their way.

Luckily, my old high school nurse agreed to see me at the school, even though I was no longer a student. (I continued to go there until I was 20!)


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## dfoy (Nov 20, 2001)

Paps are life-savers.

My dh's 1st wife died of cervical cancer at age 29. Hadn't had a pap in 3 years.

When I was 25 I had an abnormal pap. Had precancerous cells removed with laser surgery. Would have turned to cancer eventually if I had not been proactive.

I was not at risk for STDs and neither was my dh's 1st wife. That is not the only risk factor for cervical cancer.

The other thing to think of is this: even if you think you are not at risk now for STDs, you can aquire different STDs (herpes being one) that lay in dormancy for years. Maybe it was from a sexual partner that you thought you were monogamous with. Maybe you both were monogamous but he got the STD from a previous relationship and passed it unknowingly on to you. Just because one aquires an STD doesn't mean they are promiscuous.


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## Alenushka (Jul 27, 2002)

I think PAP is a must and is a life saver. When I worked in oncology unit I saw quiet a few cases ofwomen with really bad cervical cancer which could have been prevented. 75-90% of people in US have HPV. Some have strin which have been connected to cancer. It is possibale to have dormant HPV even after being in 10-15 of monogomous relationship. It could be contracted fomr a previous partner or a current partner who has an asymptomatic HPV. If you can , switch you doctor. I have never had a PAP which hurt (I had the same 2 OBs for the past 10 years) Please, please find a good pain free docotr and take care of yourself.
I had an abnormal PAP and abnormal ceel and I had to be treated. 3 month after birth. I shudder to think what would have happened if I missed my PAP, pre canceorus cells and left my son wihout mom


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## Alenushka (Jul 27, 2002)

Quote:

_Originally posted by Greaseball_
*Yes, I think that some people have the perception that low-income women sleep around.

One time when I was 17 I went to get a pap, pills and a chlamydia test, because I found out an ex had it. So they tell me that I have to be tested for all STD's, and I say no, I just want to be tested for the one I might have. So they say that because I refused their tests, they would not provide services to me until I agreed to do them all. No paps, no birth control, and no tests for only one STD. So I'm 17, homeless, and with no income, and I can't get health services because I won't do it their way.

Luckily, my old high school nurse agreed to see me at the school, even though I was no longer a student. (I continued to go there until I was 20!)*
While I agree some people think that poor people sleep around and foreigner do not know how to take care of their health, in this case there was a good reason for this clinik to test you for everything. Ofthen people have more than one STD. If you have oe the risk is higher for another. This why if a partner diagnosed with one, it behooves the other partner to get tested for eveything elce in case the other partners test were falce positive. I do not really understand the stigam attached to STD and why people get so offende about testing. STD has nothing with sleeping around. One can have one partner b efaithful and get something. 1 in 4 american has or had an STD. I look at PAP smear and STD chek as something like my dental check up. STD, cold etc all caused by germs who do not discriminate between poor and rich, citizens and green card holders


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## Greaseball (Feb 1, 2002)

What I don't understand is sometimes I've been refused an STD test for something that it would have been a good idea to test for. Like when I was pg, an old ex contacted me and said he had herpes and he had known all along that he had it when we were together. We never had unprotected sex, but I figured I'd get tested anyway. But when I told my ob group about it, they said there was no test for herpes and there was nothing they could do. I never got any sores or anything so they told me not to worry.

Then I do some more research and I find out there are all kinds of tests for herpes that can be done on a person who does not have sores.

No matter what, I believe consumers have the right to choose their own treatments. If I decide, for example, to immunize myself against Hep B but not against Hep A, that should be no one's business but my own.

The stigma about testing at the County Health Dept, at least where I used to live, is that if you test positive they put your name on a list which is available to the general public. They have an almost militant approach to wiping out disease at all costs. Just like with immunization campaigns.

Anyway...I just got "Women's Bodies, Women's Wisdom" and they say that a pap should never cause pain and that if it does, it's the doctor and not you. I will definitely find another doctor!


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## MamaMae (Nov 26, 2001)

Oh, please get your PAPs, and often!

I had no "abnormal" gyn history, nor was I at risk, but at a routine exam a few years ago, we discovered cervical cancer. It was already invasive...and I had had a normal PAP just 12 months earlier! It CAN spread very fast, as it did with me. Luckily, after several surgeries and treatments, it receded, but didn't go completely away. It kept coming back, and I saw hysterectomy in my future. So we got pregnant with DS, and it's been clear ever since! The wonders of pregnancy hormones!

Lesson learned? Get a PAP!







I get them now every 6 months by my midwife. She's much more gentle with them than many doctors I've been to.


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## Els' 3 Ones (Nov 19, 2001)

I go every few years. I do firmly believe that a healthy, functioning immune system is hard at work all the time fighting back things we are not aware of - cancer being one of them.

I'm curious to know if anyone else has heard that a pap done while pregnant is not reliable..............I had 3 different providers with my 3 pregs and all said that yet I hear of women getting them "routinely" as part of the ob care. ? ¿ ?


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## New Moon (Aug 4, 2002)

Okay, looked it up in "Understanding diagnostic tests in the childbearing year" by Anne Frye. You are right, pregnancy (especially the 1st pg) causes changes in the cervix that make it difficult to assess for cancer. Okay here goes..."Squamous metaplasia (cell transformations) commonly occurs during adolescence, the 1st pg, after the 1st birth, but can occur throughout life. During pg , especially the 1st, the transformation zone (on the cervix)...increases in size and may develop atypical epitheleum (cells). These atypical cells usually slough off at delivery, but sometimes remain or recur." page 269. Then, on page 280, "A postitive (PAP) test during pregnancy is more difficult to interpret because of the changes that pregnancy naturally causes in the cervical tissues. First a repeat test should be performed. If this also comes back positive then (treatment should be sought)." So what she's saying is yes, it may be difficult, but you still should do it. It also says there should be no blood involved, so be sure to wait until bleeding has stopped for a postpartum PAP. I had an abnormal PAP during my postpartum with my 1st kid, but then it went back to normal after a bit. I cant remember if I was still bleeding, though. Hmmm.... Anyway, hope that helps. All this talk about PAPs reminds me I need to get one! Luckily I know lots of midwives =)
Blessings
New Moon


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## edddiek (Jul 21, 2014)

Called her at home? She's probably hot. The you will die if you don't scare tactic certainly works...unless we are talking about HIV...which is much more common. 


taken from web MD - The American Cancer Society (ACS) predicts that there will be just over 11,000 cases (cervical cancer) in 2009. There will be nearly as many cases of testicular cancer, 8,400. In comparison both breast and prostate cancer are just under 200,000. For comparison’s sake, HIV (AIDS) is an even more dangerous STD with a five times greater incidence than cervical cancer. Yet no one ever suggests that everyone be tested for HIV, and there are laws in many states restricting testing. Testing is suggested only for those at risk, but this tactic is never used for cervical cancer.


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