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

Eliz52 · 05-18-2011, 11:10 PM

Twenty2,
If you and your husband were virgins when you got together, you need to be very careful with cervical screening. You accept high risks for no benefit - cervical cancer is linked to HPV, a sexually transmitted disease. (as you know)
Your age worries me as well...no country in the world has shown a benefit testing women under 30, but testing young women produces lots of false positives which means fear and worry while you wait to re-test or referral for colposcopy and usually some sort of biopsy - cervical damage can leave you with problems (especially after unnecessary LEEP and cone biopsies) cervical stenosis - infertility, infections, endometriosis and may require surgery if the cervix is scarred shut, cervical incompetence - miscarriages, high risk pregnancies, premature babies and more c-sections. 1 in 3 pap tests are "abnormal" (false positives) in young women caused by the pap test picking up normal changes in the maturing cervix. (or transient and harmless infections) CC is very rare in women under 30 and testing usually misses the very rare case anyway...these women get false negatives. (usually because the very rare case in a young woman is an adenocarcinoma and the pap is bad at picking up this even rarer form of cc)
Due to over-screening (annual testing) and including young women - the States has a very high lifetime risk of referral - 95% - almost all are false positives. (DeMay article)
The lifetime risk of cc is 0.65% but with no randomized controlled trials we'll never know "for sure" if anyone is actually helped by pap tests, if they are, the numbers are very small, less than 0.45% - after you take off the false negative women and factor in the other things that are naturally reducing the cases of cc - better condoms, more hysterectomies, less STD, better hygiene, fewer women smoking...
Anyway, many countries do not test sexually active women before 25 or 30 and then only 3 or 5 yearly to 50, 55 or 60, but in your case...you need to be VERY careful. (American doctors even test virgins from age 21 which makes no sense at all)
I'm a low risk woman and have always declined pap tests - the risks are too high for a near zero risk of cc. A high risk woman only has a remote chance of benefiting from pap tests.
I believe your doctor was dishonest with you...pap tests are an elective cancer screening test and have nothing to do with birth control. I'd report him and even seek legal advice.
Dr Robert Hatcher from the "Managing contraception" site has some harsh words for doctors who "hold" scripts. Also, see: "Women after birth control get unneeded pelvic exams" WSJ
Sadly, I can't link articles at the moment (this is my first post and you need 15 posts under your name before you have linking privileges)
The article by Dr Hatcher - search his name plus add the words, pelvic exams and birth control and it should appear....

Routine bimanual pelvic, rectal, recto-vaginal and breast exams are not recommended by our doctors - they are of poor clinical value and risk your health - they partly explain your high rates for hysterectomies, cervical and breast biopsies, other procedures and even surgery. (removal of healthy ovaries etc) See: "Questioning the value of the routine pelvic exam" and comments by Dr Carolyn Westhoff.

I think doctors who mislead and coerce women into pelvic exams or pap tests need to be challenged and reported - I know the practice is widespread in the States, but there are many American doctors working toward change.
You'll find some great references and discussion at Dr Joel Sherman's medical privacy forum under women's privacy issues - see research by Dr Angela Raffle, Prof Baum and Dr DeMay. You might also like to share your story at Blogcritics and "Unnecessary pap smears" - which has more than 4500 posts from concerned women.
Hope this information helps...

---------- Post added at 07:10 AM ---------- Previous post was at 07:04 AM ----------

The other important reference for: Sexually active women under 30 don't benefit from pap tests (only American doctors test women not sexually active - it makes no sense at all and risks their health) - See: "Cervical cancer screening" in "Australian Doctor" 2006 by Assoc Prof Margaret Davy and Dr Shorne - it's a download.
Angela Raffle's research rocked the UK in 2003/4, "1000 women need regular smears for 35 years to save one woman from cervical cancer"...she also talks about the high numbers of false positives produced by young women - 1 in 3 smears.
You'll find the reference in the British Medical Journal at Dr Sherman's site.
See commentary at, "Why I'll never have another smear test" by Anna Saybourn.

05-18-2011, 11:10 PM	#51 (permalink)
Eliz52 Upright	Twenty2, If you and your husband were virgins when you got together, you need to be very careful with cervical screening. You accept high risks for no benefit - cervical cancer is linked to HPV, a sexually transmitted disease. (as you know) Your age worries me as well...no country in the world has shown a benefit testing women under 30, but testing young women produces lots of false positives which means fear and worry while you wait to re-test or referral for colposcopy and usually some sort of biopsy - cervical damage can leave you with problems (especially after unnecessary LEEP and cone biopsies) cervical stenosis - infertility, infections, endometriosis and may require surgery if the cervix is scarred shut, cervical incompetence - miscarriages, high risk pregnancies, premature babies and more c-sections. 1 in 3 pap tests are "abnormal" (false positives) in young women caused by the pap test picking up normal changes in the maturing cervix. (or transient and harmless infections) CC is very rare in women under 30 and testing usually misses the very rare case anyway...these women get false negatives. (usually because the very rare case in a young woman is an adenocarcinoma and the pap is bad at picking up this even rarer form of cc) Due to over-screening (annual testing) and including young women - the States has a very high lifetime risk of referral - 95% - almost all are false positives. (DeMay article) The lifetime risk of cc is 0.65% but with no randomized controlled trials we'll never know "for sure" if anyone is actually helped by pap tests, if they are, the numbers are very small, less than 0.45% - after you take off the false negative women and factor in the other things that are naturally reducing the cases of cc - better condoms, more hysterectomies, less STD, better hygiene, fewer women smoking... Anyway, many countries do not test sexually active women before 25 or 30 and then only 3 or 5 yearly to 50, 55 or 60, but in your case...you need to be VERY careful. (American doctors even test virgins from age 21 which makes no sense at all) I'm a low risk woman and have always declined pap tests - the risks are too high for a near zero risk of cc. A high risk woman only has a remote chance of benefiting from pap tests. I believe your doctor was dishonest with you...pap tests are an elective cancer screening test and have nothing to do with birth control. I'd report him and even seek legal advice. Dr Robert Hatcher from the "Managing contraception" site has some harsh words for doctors who "hold" scripts. Also, see: "Women after birth control get unneeded pelvic exams" WSJ Sadly, I can't link articles at the moment (this is my first post and you need 15 posts under your name before you have linking privileges) The article by Dr Hatcher - search his name plus add the words, pelvic exams and birth control and it should appear.... Routine bimanual pelvic, rectal, recto-vaginal and breast exams are not recommended by our doctors - they are of poor clinical value and risk your health - they partly explain your high rates for hysterectomies, cervical and breast biopsies, other procedures and even surgery. (removal of healthy ovaries etc) See: "Questioning the value of the routine pelvic exam" and comments by Dr Carolyn Westhoff. I think doctors who mislead and coerce women into pelvic exams or pap tests need to be challenged and reported - I know the practice is widespread in the States, but there are many American doctors working toward change. You'll find some great references and discussion at Dr Joel Sherman's medical privacy forum under women's privacy issues - see research by Dr Angela Raffle, Prof Baum and Dr DeMay. You might also like to share your story at Blogcritics and "Unnecessary pap smears" - which has more than 4500 posts from concerned women. Hope this information helps... ---------- Post added at 07:10 AM ---------- Previous post was at 07:04 AM ---------- The other important reference for: Sexually active women under 30 don't benefit from pap tests (only American doctors test women not sexually active - it makes no sense at all and risks their health) - See: "Cervical cancer screening" in "Australian Doctor" 2006 by Assoc Prof Margaret Davy and Dr Shorne - it's a download. Angela Raffle's research rocked the UK in 2003/4, "1000 women need regular smears for 35 years to save one woman from cervical cancer"...she also talks about the high numbers of false positives produced by young women - 1 in 3 smears. You'll find the reference in the British Medical Journal at Dr Sherman's site. See commentary at, "Why I'll never have another smear test" by Anna Saybourn.