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Truth 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:

1.) Canadian Medical Association Journal - Cervical Cancer Screening Recommendations

2.) American Cancer Society - Cervical Cancer Screening Recommendations

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 Cancer:

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 are:

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 and Pregnancy).

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 alerts)

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 partners.

  • A rape victim.

  • A smoker who has HPV infection.

  • A woman who is infected with HIV or other STDS such as Chlamydia.

  • 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: HIV-Infected 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 test may be better than Pap smears to detect early cervical cancer: Study. 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.

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 on 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 exams.

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:

Why HPV Vaccine Should Be Avoided?

Are Pap Smears Necessary For Virgin Women?

What You Should Know About All-Female OB/Gyn Practices?

Why Women Should Avoid Male Doctors For Intimate Examinations?

Female Patient Modesty


Informed consent is missing from Pap smears and cervical cancer screening By Dr. Joel Sherman

Are Pap Smears Necessary For Virgin Women?

Cervical Cancer and DES Exposure

HPV and Pregnancy

Infected By Unsterile Speculum

Hygiene woes at Dallas County’s Parkland hospital led to OB/GYN alerts

Abnormal Pap smears and HPV

Smoking Boosts Cervical Cancer Risk

Smoking and Cervical Cancer

Stop Smoking and Reduce Your Cervical Cancer Risk

Informed Consent for Pap Tests/Pelvic Exams Still Not Offered to Women

How Often Do You Need a Pap Smear? A Pelvic Exam? The Low Down on What’s Down Below!

Holding Birth Control Hostage

Pap Test Coercion Getting More Attention

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 articles about medical procedures for your own situation, or if you have questions or issues regarding a medical condition.

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