Hello everyone!
I read this article today online and I wanted to share it here as I think it contains some great information and tips for any woman who feels nervous or anxious during her annual exam:
http://www.carolinalive.com/news/story.aspx?id=315014#.VFJinPTF-xk
I like the idea of bringing a close friend with you if you are both comfortable with it and also to ask questions ahead of time about what to expect. That would really help women feel more in control of the whole process. Are there any other tips that you would add to this list? Michelle
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I thank you for your honesty and assure you from a husbands point of view I feel both my wife and I are both violated in the worst possible way. The emotional anxiety is mind blowing.
April 9, 2019 - 1:42pmThis Comment
I am a college student who is considering allowing medical students to perform pelvic exams on me (of course for very good compensation!) ANyone know of any short/long term risks/effects associated with unnecessary pelvic exams AND I do not meant emotional/mental risks, only possible physical ones. thank you!
February 15, 2011 - 9:12amThis Comment
There really is not data on physical risks of multiple pelvic exams, as it would depend on many factors (frequency of exam, medical tools used, etc).
It is important to ask the medical school for the list of possible and probable risks for these procedures (this list must be provided, by law). Have you received this documentation?
February 15, 2011 - 12:18pmThis Comment
It's such a shame American woman don't look at the clinical evidence for themselves and medical practices around the world. All these articles pushing routine pelvic exams, breast exams and how to cope with them - I have a better idea and it's good for your health - reject these exams!
I've never had a routine bimanual pelvic, recto-vaginal, rectal or breast exam - none are evidence based - they're of poor clinical value in the absence of symptoms and expose you to risk. That's why so many American woman are constantly having procedures and biopsies and some are harmed by these unnecessary interventions. 1 in 3 of you will have had a hysterectomy by age 60 - a very high number!
Our doctors don't recommend these exams at any age and I'd refuse them if anyone ever suggested I have one.
I also rejected pap tests more than 25 years ago - the cancer is rare, my personal risk is near zero, but our screening program condemns 77% of women at some point to colposcopy and usually some sort of biopsy. That's HUGE over-detection and over-treatment for a cancer with a lifetime risk of 0.65% and only 0.45% (at most) benefit from testing. (0.20% get false negatives and may be disadvantaged by false reassurance and delay seeing a Dr for symptoms)
Some women are left with health problems after unnecessary procedures - cervical stenosis that may require surgery and can cause infections and/or endometriosis also, infertility and more c-sections OR cervical incompetence - miscarriages, high risk pregnancy requiring cervical cerclage and premature babies and of course, psych issues. Cone biopsies and LEEP carry the most risk to your body.
I'd urge every woman to examine her risk profile before agreeing to cervical smears. Women under 30 don't benefit, but produce very high rates of false positives - 1 in 3 will be abnormal, yet cancer is very rare in this age group. (and rare in all age groups) - see research by Angela Raffle linked to Dr Joel Sherman's medical privacy forum under women's privacy issues - in the side bar. Dr Raffle's research rocked the UK and made doctors squirm - "1000 women need regular smears for 35 years to save ONE woman from cervical cancer" BMJ: 2003 also see commentary at, "Why I'll never have another smear test" by Anna Saybourn (on line)
February 7, 2011 - 2:03amRichard DeMay, American pathologist, has also published an informative article, "Should we abandon pap smear testing" - also, online.
If you want to have pap tests, consider the Finnish program - 5 to 7 tests in total - 5 yearly from age 30 - they have the lowest rates of cc in the world and JUST as importantly, send the fewest women for colposcopy/biopsies - fewer false positives, but even so, it's such an unreliable test that even 35%-55% of Finnish women will be referred - almost all are false positives. With no screening your lifetime risk of cc is 0.65% and less than that if you're low risk. Using condoms with a partner of unknown HPV status reduces the risk of infection by 70%, perhaps higher with perfect use. That's a huge benefit to cover a very small risk.
Still the Finnish program is better than the States who send almost every screened woman for colposcopy/biopsies at some stage (95%) and in Australia it's 77%...the UK - 65%
"No country in the world has reported a decline in the incidence of or the mortality from cervical cancer in women under 30, irrespective of cervical screening. Many countries do not perform cervical screening on women under 30" Taken from "Cervical cancer screening" - pull-out guide for doctors in "Australian Doctor" 2006 by Assoc Prof Margaret Davy, Director, Gyn-oncology, Royal Adelaide Hospital and Dr Shorne, GP. (on line)
Cervical cancer is rare, always was and was in decline before screening started...don't over-do pap tests, if you choose to have them at all.
Women not sexually active don't need pap tests, you're accepting risk for no benefit - nor do women in lifetime mutually monogamous relationships and women who've had full hysterectomies for benign conditions - also, low risk women be careful with this testing, know the risks and make an informed decision about testing. ALL women should look at their risk profile and make their own decision about testing.
I recently also rejected mammograms - far too much risk with false positives and over-diagnosis also, the risks of testing concerned me - radiation and compression of delicate breast tissue. See: "The risks and benefits of mammograms" at the Nordic Cochrane Institute website.
Clinical breast exams are not recommended either - they don't help, but they cause biopsies.
You don't need to cope with all of these exams - they're either unnecessary and potentially harmful or optional - make up your own mind.
This Comment
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."
http://agalltyr.wordpress.com/2010/11/28/a-pelvic-exam-is-rape/
December 2, 2010 - 2:03amThis Comment
I am kind of shocked...but I guess that was the emotion you were hoping to achieve by your choice of a beginning statement.
I am actually surprised after I read your article that you are against routine pelvic exams for the emotional well-being of women, yet you choose to play on our emotions with such intense, violent and attention-seeking words.
You said you did not want to discuss the physical reasons for a pelvic exam, as your stance is something like, "well, yeah, pelvic exams may physically help women" but you think the cost (emotional trauma for the husband that sees this as cheating) is not worth the benefit (potential decrease in women's morbidity and mortality through early detection).
Interesting.
Do you also not see the benefit of men receiving prostate checks and are also against colonoscopies for men and women?
What about dentists, as the mouth can be used in sex as well, and if you are saying all doctors think they are "godlike" and want to insert their instruments into us...it seems as you are purposefully making every doctor visit into a sexual experience, or worse-- a traumatic sexually violating experience.
I actually find it insulting that you would dare compare a routine annual exam in which the woman CHOOSES her doctor, CHOOSES the time and place, CHOOSES to have tests conducted that may decrease her chances of disease progression....to a violent act perpetrated against the women in which she has NO CONTROL over the person, NO CONTROL over the time and place.
There are doctors that can help people get better. There are doctors that can help people maintain their health. These doctors perform tests and exams on people...and yes, people have different body parts. Some body parts are inside, some are outside. If a body part happens to be a vagina, anus, urethra, mouth, ear canal, nasal passage...something that is an opening to our body, you are suggesting that it is a violation...and even rape? Or, are you only referring to the "private" body parts of the vagina, anus and urethra? Or, are you only referring to the private body parts on women? Is this only for routine exams, and someone must wait until they are symptomatic before having these private parts checked by a doctor?
December 2, 2010 - 10:47amThis Comment
I also feel that it is a violation. Invasive and dehumanizing describes quite a bit of the medical industry.
We could all use a bit more compassion on this subject.
August 25, 2017 - 5:50pmThis Comment
I’d urge every woman to do her reading and make an informed decision about the need for and value of these exams. 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.
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.
Those exams are NOT clinically required for the Pill… I should add women not yet sexually active are excluded from testing in other countries, guidelines calling for ALL women to test from 21, that is BAD medical advice.
May 24, 2011 - 7:31amAlso, 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.
This Comment
Hi Alison,
Wow, your tips are fantastic! And isn't that just so true about socks. And it is good to write down when your last period began, as once you get in there your mind can go blank. Thank you so much for adding to the list and offering such great suggestions.
June 28, 2009 - 11:00pmThis Comment
Great tips on preparing for a pelvic exam and/or pap smear. I have a few other tips to add:
1. Be sure to schedule your visit when you are not currently menstruating
2. This is the only doctor that I see on a regular basis, so I also combine it with getting my cholesterol checked. Your doctor can order lab tests to be done, and they are more than happy to do this!
3. My anxiety is reduced if I wear socks during my appointment, as a few doctor's offices I have been to did not have the little "footies" covering the stirrups and my feet were cold!
4. Make a list of questions that you have, write them down, and bring the list with you to the doctor's office.
5. Be sure you know your LMP: the date of your last menstrual period (the date it began), as you will need to know this information, along with any other medications you are taking, and any symptoms or problems you've had in the previous year. Don't be shy---they need to know this information!
There are also other special groups of women who may need more time and attention from their doctor, who will have special needs and concerns, including:
- teens for their first ever visit
- women who have been sexually assaulted in their past
If you are in one of these categories, please be sure to tell the nurse about your special situation, and your doctor and nurses will accommodate your specific needs for your appointment.
June 28, 2009 - 6:46amThis Comment