About Pap Smears
The Pap smear test was developed by and named
after Dr. George Papanicolao in 1928 for the purpose of early
identification of cervical cancer. The goal of pap smears is
to identify high-grade precancerous cervical lesions and early-stage
asymptomatic invasive cervical cancer. While it is true that
pap smears have helped to reduce many cervical cancer cases,
too many unnecessary pap smears are done. More is known about
cervical cancer today.
Many women were led to believe that cervical cancer was very
common and that any woman was at risk for cervical cancer for
many years. Also, many women were not informed that 99% of cervical
cancer cases were caused by human papillomavirus (HPV), a sexually
transmitted infection. HPV is contracted through skin-to-skin
contact during sex — vaginal, anal, or even oral sex.
It is not passed through the semen, but is harbored within the
cells of the entire genital region. The truth is cervical cancer
is rare. HPV infections often clear without leading
to cervical cancer. Many women were encouraged to have
yearly pap smears regardless of their risk factors. Since cervical
cancer is in essence a sexually transmitted disease (STD) caused
by HPV, a woman can estimate her personal risk.
Dr. Joel Sherman in his article, “Informed
consent is missing from Pap smears and cervical cancer screening”
argues that AIDS is more dangerous than cervical cancer. He
shared his concern about HIV in the below statement:
“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.”
Women are often pushed into having Pap smears,
but rarely told that they might not need them or asked if they
want them. Informed consent for Pap smears is often missing.
Every woman should be informed of risk factors for cervical
cancer, pros and cons of cervical cancer screenings, high incidence
of abnormalities that resolve spontaneously, and complications
from HPV Treatments such as biopsies and colposcopies.
A number of doctors still demand that woman has
a pap smear / pelvic exam before prescribing birth control pills.
"Hormonal oral contraception can be prescribed safely without
a pelvic examination, according to guidelines from the World
Health Organization and the American College of Obstetricians
and Gynecologists. While weight, blood pressure, and health
history are required before prescription of hormonal contraception,
screening for sexually transmitted infections and cancer are
not necessary to evaluate patients for initiation of oral contraceptive
use for birth control." (Source: Pelvic
Exam Necessary For Contraception Rx?)
Sometimes, women will go to their doctor for
other reasons such as ear problem or sore throat and get a lecture
that they need a pap smear. Check out Pap
Test Coercion Getting More Attention. Some women feel obligated
to submit to a pap smear at those appointments.
The guidelines for pap smears are too general. The guidelines
do not take into consideration that not all women have the same
risk levels and risk factors for cervical cancer. One area of
concern is that a woman who has never been exposed to HPV generally
does not need a pap smear. Also, the guidelines are not good
for high-risk women who may need pap smears more often. Check
out some guidelines in the United States and Canada:
Medical Association Journal - Cervical Cancer Screening
Cancer Society - Cervical Cancer Screening
Every doctor’s office should have pamphlets
about pros and cons about Pap smears and risk levels and risk
factors that increase a woman’s chances of cervical cancer
for women to help them assess their risk levels for cervical
cancer. It would be very helpful to have a list of risk levels
and risk factors like the list below.
Risk Levels and Factors for Cervical
Zero to very low risk level:
- *A true virgin woman who has never engaged
in any kind of sexual activity including heavy petting, oral
sex, anal sex, and skin to genital contact.
- *A woman who has never engaged in any
type of sexual activity with anyone except for one sexual
partner who also never engaged in any type of sexual activity
with anyone else.
*Other factors that could
slightly increase the chance of cervical cancer in this group
1.) Based on some studies,
smoking could possibly cause cervical cancer without HPV infection.
2.) Mother took DES (also known as diethylstilbestrol)
during pregnancy with you between 1938 - 1971
to prevent miscarriage and premature delivery. It is estimated
that only 1 in 1,000 women who were exposed to DES in the
womb will develop cervical cancer. (Source: Cervical
Cancer And DES Exposure)
3.) Mother had HPV infection when she gave
birth to you (only applies to vaginal birth). The risk of
HPV transmission to the baby during childbirth is very low.
Even if babies do get the HPV virus, their bodies usually
clear the virus on their own. (Source: HPV
4.) You had a Pap smear with an unsterile
speculum. (Sources: Infected
By Unsterile Speculum and Hygiene
woes at Dallas County’s Parkland hospital led to OB/GYN
Low risk level:
- *A woman who has never had HPV infection
and is in a long-term mutually monogamous relationship with
a man who is not infected with HPV.
*Check out other factors
that could slightly increase your chances of cervical cancer
in the zero to very low risk level group.
High risk level:
- A woman who has had multiple sexual partners.
- A woman in a relationship with a man who had multiple sexual
- A rape victim.
- A smoker who has HPV infection.
- A woman who is infected with HIV or other STDS such as
- HPV infected woman with a weakened immune system.
Women infected with HIV that causes AIDS are at an extremely
high risk for developing cervical cancer. Check out this article:
Women Have Higher Risk of Incident Invasive Cervical Cancer.
Keep in mind that HPV has the ability to hide, or to pop up
when we are least expecting it. The virus will often flare up
whether or not external symptoms manifest when women are under
emotional stress or their immune system is weakened. Sometimes,
the virus can lie dormant for decades. It is possible for HPV
infection to reactivate years later.
The HPV test should be offered to women who have been exposed
to HPV since the HPV test detects precancerous lesions better
than pap smears. Check out HPV
Tests “better” than Pap smear at cervical cancer
detection and Battling
Cervical Cancer: DNA Test More Effective Than Pap Smear.
There are many reports of Pap smears not detecting abnormal
cells until it's too late and the cancer is advanced. The HPV
DNA test, on the other hand, tests for the actual virus, which
makes it much more effective as a test for cervical cancer.
“Women should ask their gynecologist for the HPV DNA test,
in addition to the Pap test. The DNA test is not a blood test
or even a separate test. The testing is done with the same swab
sample used for the Pap test. If both tests come back negative,
you can have 100 percent peace of mind that you are not at risk
for cervical cancer at least, in the near future.” (Source:
Battling Cervical Cancer: DNA Test More Effective Than Pap Smear
By Dr. Marie Savard.
For women who need pap smears and HPV DNA tests, we strongly
recommend that they only allow a female doctor or mid-level
provider (midwife, physician’s assistant, or nurse practitioner)
to do a pap smear on them. It is always very risky for a woman
to allow a male doctor do a pap smear her because he could easily
sexually abuse her. Check out why
women should avoid male doctors for female health issues.
Also, it would be prudent for you to ask your doctor if she
can use a disposable speculum for your pap smear instead of
a metal speculum that is reused to reduce your chances of getting
HPV or other STDs from speculum that may have not been sterilized
properly. Make sure your doctor washes her hands and uses brand
new gloves before doing your pap smear.
In conclusion, all women should be offered informed
consent about pap smears and decide for themselves whether or
not to screen/what age to begin screening. Providers’
offices should have pamphlets that fully explain both the pros
and cons of pap smears and risk levels. Then each individual
woman should decide for herself. Doctors should never
require a woman to have a pap smear for a prescription or physical
Medical Disclaimer: The information on this
web site is for educational purposes only. It is not intended
in any manner as professional medical advice. You should consult
a healthcare provider to determine the appropriateness of the
information on this article for your own situation, or if you
have questions or issues regarding a medical condition.
Other Related Articles:
HPV Vaccine Should Be Avoided?
Pap Smears Necessary For Virgin Women?
You Should Know About All-Female OB/Gyn Practices?
Women Should Avoid Male Doctors For Intimate Examinations?
consent is missing from Pap smears and cervical cancer screening
By Dr. Joel Sherman
Pap Smears Necessary For Virgin Women?
Cancer and DES Exposure
By Unsterile Speculum
woes at Dallas County’s Parkland hospital led to OB/GYN
Pap smears and HPV
Boosts Cervical Cancer Risk
and Cervical Cancer
Smoking and Reduce Your Cervical Cancer Risk
Consent for Pap Tests/Pelvic Exams Still Not Offered to Women
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Birth Control Hostage
Test Coercion Getting More Attention