Tilted Forum Project Discussion Community - View Single Post - Gyn. Pelvic Exam

Julia51 · 03-29-2009, 06:29 PM

I just wanted to mention that women in Australia and the UK DON'T have routine pelvic exams - they are considered unnecessary in asymptomatic women and in fact, my GP said they can be harmful...(false positive, unnecessary further testing, discomfort, anxiety - low clinical value)
I was surprised to read that US women are expected to have all these invasive annual exams...

In Australia - women are offered cervical screening every 2 years - starting 2 or 3 years after they start having sex...but the two yearly internal has been criticized as too often and many doctors ahve moved to 3 or 5 yearly intervals.
Too frequent screening exposes women to lots of false positives and unnecessary follow-up - colposcopy and biopsies, which can cause other problems. (psycho sexual problems, cervical stenosis, problems with fertility and during pregnancy etc)

Many are also critical of testing women under 25 or 30 as these women are more likely to return false positives or have treatment for changes that would resolve without any further treatment. UK now only screens from age 25, Finland and the Netherlands from 30...and these countries opt for 3 and 5 yearly intervals - so fewer women face the anxiety of a false positive. .
It sounds like US women are over-screened - I was shocked to read some US doctors even test virgins!
Cervical cancer is uncommon (about 1% of women) and the Test is unreliable...
Of the 1% that get cancer, one third of those women will have received one or more false NEGATIVES - they may be disadvantaged by screening because they're falsely reassured by the Test and delay seeing a Dr for symptoms - so that leaves about 0.66% of women who'll benefit from the test.
All women and especially, low risk women need to consider the risk v the benefits of testing.
Annual screening means 95% of women will have a colposcopy and biopsies, yet only a tiny number will have any sign of cancer - two yearly - it's almost 78%...(Koutsky)
Sadly, women are rarely given access to complete information - without risk information, you can't give informed consent.
The General Medical Council in the UK has warned doctors about the need for informed consent and now require doctors to reveal they have a conflict of interest (paid to recruit women and to take smears), disclose to women they have a low chance of benefiting from the test and explain they have a fairly high risk of an incorrect test result that may lead to further testing. (the risk varies with your sexual history, age and screening interval)
Cervical cancer is (in almost every case) caused by HPV...
My husband and I were virgins when we married - my GP, after discussing the very low risk of benefiting and the high risk of harm - left the decision to me - no smears at all or once every 5, 7 to 10 years.

Breast exams - doctors have been reminded in the UK and Australia NOT to routinely examine breasts in women under 40 or 45...(false positives, false reassurance, low clinical value, unnecessary biopsies)
I started to have a CBE when I was 45 (every 18 mths or so)
Women are offered mammograms every two years from age 50 - I've decided not to have mammograms - there is lots of worrying research about this test - they can INCREASE the risk of breast cancer, (bruising of the tissue) have a high rate of false positives and unnecessary biopsies and they detect a slow moving cancer (Ductal Carcinoma In Situ) that roughly 40% of older women have to some degree - in most cases, DCIS will never harm you - however, once biopsied, it can become aggressive and once diagnosed, the breast usually comes off (the doctor fears liability)

I think it's really important for women to do their reading - it's the only way to safely negotiate the medical world - and US women are IMO being put through lots of unnecessary invasive tests and being overscreened...exposing yourselves to harm!

BTW the only exam required for the Pill is a blood pressure check - there are lots of articles on-line critical of the US practice of holding the Pill until women agree to unnecessary exams.
Good luck everyone....anyone interested should look at articles by Prof Michael Baum, Dr Angela Raffles (her research showed that 1000 women need to have regular testing for 35 years to save ONE woman from cervical cancer!) - also, L. Koutsky Cancer prevention, Fall 2004, Issue 4 & RM DeMay "Should we abandon pap smear testing" Jnl of Clinical Pathology 2000...

03-29-2009, 06:29 PM	#43 (permalink)
Julia51 Upright	I just wanted to mention that women in Australia and the UK DON'T have routine pelvic exams - they are considered unnecessary in asymptomatic women and in fact, my GP said they can be harmful...(false positive, unnecessary further testing, discomfort, anxiety - low clinical value) I was surprised to read that US women are expected to have all these invasive annual exams... In Australia - women are offered cervical screening every 2 years - starting 2 or 3 years after they start having sex...but the two yearly internal has been criticized as too often and many doctors ahve moved to 3 or 5 yearly intervals. Too frequent screening exposes women to lots of false positives and unnecessary follow-up - colposcopy and biopsies, which can cause other problems. (psycho sexual problems, cervical stenosis, problems with fertility and during pregnancy etc) Many are also critical of testing women under 25 or 30 as these women are more likely to return false positives or have treatment for changes that would resolve without any further treatment. UK now only screens from age 25, Finland and the Netherlands from 30...and these countries opt for 3 and 5 yearly intervals - so fewer women face the anxiety of a false positive. . It sounds like US women are over-screened - I was shocked to read some US doctors even test virgins! Cervical cancer is uncommon (about 1% of women) and the Test is unreliable... Of the 1% that get cancer, one third of those women will have received one or more false NEGATIVES - they may be disadvantaged by screening because they're falsely reassured by the Test and delay seeing a Dr for symptoms - so that leaves about 0.66% of women who'll benefit from the test. All women and especially, low risk women need to consider the risk v the benefits of testing. Annual screening means 95% of women will have a colposcopy and biopsies, yet only a tiny number will have any sign of cancer - two yearly - it's almost 78%...(Koutsky) Sadly, women are rarely given access to complete information - without risk information, you can't give informed consent. The General Medical Council in the UK has warned doctors about the need for informed consent and now require doctors to reveal they have a conflict of interest (paid to recruit women and to take smears), disclose to women they have a low chance of benefiting from the test and explain they have a fairly high risk of an incorrect test result that may lead to further testing. (the risk varies with your sexual history, age and screening interval) Cervical cancer is (in almost every case) caused by HPV... My husband and I were virgins when we married - my GP, after discussing the very low risk of benefiting and the high risk of harm - left the decision to me - no smears at all or once every 5, 7 to 10 years. Breast exams - doctors have been reminded in the UK and Australia NOT to routinely examine breasts in women under 40 or 45...(false positives, false reassurance, low clinical value, unnecessary biopsies) I started to have a CBE when I was 45 (every 18 mths or so) Women are offered mammograms every two years from age 50 - I've decided not to have mammograms - there is lots of worrying research about this test - they can INCREASE the risk of breast cancer, (bruising of the tissue) have a high rate of false positives and unnecessary biopsies and they detect a slow moving cancer (Ductal Carcinoma In Situ) that roughly 40% of older women have to some degree - in most cases, DCIS will never harm you - however, once biopsied, it can become aggressive and once diagnosed, the breast usually comes off (the doctor fears liability) I think it's really important for women to do their reading - it's the only way to safely negotiate the medical world - and US women are IMO being put through lots of unnecessary invasive tests and being overscreened...exposing yourselves to harm! BTW the only exam required for the Pill is a blood pressure check - there are lots of articles on-line critical of the US practice of holding the Pill until women agree to unnecessary exams. Good luck everyone....anyone interested should look at articles by Prof Michael Baum, Dr Angela Raffles (her research showed that 1000 women need to have regular testing for 35 years to save ONE woman from cervical cancer!) - also, L. Koutsky Cancer prevention, Fall 2004, Issue 4 & RM DeMay "Should we abandon pap smear testing" Jnl of Clinical Pathology 2000...