Pap smears, fat-shaming, and the lithotomy trap

[x-posted at FWD/Forward]

So I’m sitting watching the evening news, and on comes a chap telling us women and girls that we oughtta go and get more Pap smears. Then on comes a woman to talk about how Pap screening rates are going down in young women, and to speculate about possible causes for this. The cervical cancer vaccine comes up, as does the “awkwardness” of the test, and our inappropriate embarrassment, which we apparently need to get over.

What I don’t hear addressed in the mainstream media in these discussions of Pap screening? Well, lots of things, like heterosexism, and ignorance about Pap age/sexual experience guidelines, and sexual assault (inside and outside the medical system). However, the one that really stood out in my mind today is also a factor that isn’t going to be fixed by lecturing women. Fatphobic abuse in the medical system.

There has been a fair bit of talk around the feminist traps about some of the other factors, especially the aftermath of sexual assault and its effects on medical interactions. I’m not going to go into that in this post, but it’s a huge, huge issue. What I would like to talk about for a moment, not because it’s more important but just because I have a first-person anecdote, is medical fatphobia.

We know fatphobia kills. In all sorts of ways, in all sorts of settings. And one way in which it can kill is the horrendous tendency of doctors – quite a few doctors, from the stories I hear around the place – to trap women and girls on their backs so that they can shame them while they’re vulnerable. And what they don’t realise, or don’t care about, is just how long-lasting the effects of this can be – and not in a good way.

Medical education materials abound with motherhood statements about ‘Preventive Medicine’ and ‘Lifestyle Intervention’ and ‘Opportunistic Behavioural Education’. General practitioners are exhorted, over and over again, to take any and all opportunities they can to tell people they’re fat. Really, over and over. And OVER. And doctors, labouring under the mistaken impression that this will cause said people to magically become skinny and therefore ‘healthy’, go ahead and do it, then smugly boast about it between themselves, sighing about how no-one ever listens to them. Or, perhaps, under the impression that they can then self-satisfiedly sit back and tick a box on the chart about how they’ve engaged in initial Lifestyle Education, which they learned all about at the last Lap-Band seminar.

Medical education is a powerful, powerful matrix of fat hate, based on the twin premises that telling people they’re fat is (a) helpful and (b) harmless.

So let’s talk about how that plays out in practice:

When I was 19, I had a Pap smear. It was my first. I went to the nearest available doctor, who worked in a setting where they dealt with a late of people in late adolescence and early adulthood. I wasn’t particularly concerned about it; a very little vague unease at the unknown, but no particular trepidation. I didn’t bother taking anyone with me, and I just booked the appointment in between other things I had to do, like med school classes and whatnot. And off I went.

I got my Pill script, had my BP taken, then assumed the position. And the doctor came up into his position, as they do, then stopped.

He looked at my thigh. “Not quite the right spot,” I thought, “but hey, he probably knows what I’m doing more than I do.”

Then he touched my thigh. Around the middle, underneath (in lithotomy position).

Then he JIGGLED IT.

He jiggled my thigh.

And then he grimaced.

And then he did the Pap smear. I was frozen, completely unable (by my inexperience, position, and by general medical disempowerment) to say anything.

And then I fled.

Was I ‘traumatised’? I didn’t have nightmares. I went and got my next Pap smear dutifully, largely because I really didn’t have any choice – no Pap smear, no Pill script. (Ask me about contraceptive hostage-taking! You know you want to!)

But every time I get a Pap smear, every single time, even now more than twenty years later, I see his face. I see him jiggling my thigh with that look of disgust. Every time I lie down and spread my legs for the speculum, I am reminded of exactly how repugnant my body is.

My first impulse is to tell you exactly how fat I wasn’t, back then. To tell you that it wasn’t ok for him to do that because I was physically fit at the time. To tell you at length about how my aerobic capacity was at the 95th centile, that I could do a hundred pushups, that I could swim a k without stopping, that I was beating my fit male friends at squash, that I was getting State medals in my chosen sport. But that’s all irrelevant – because fat-shaming isn’t ok for people who are actually fat any more than it’s ok for people who aren’t. Fat-shaming doesn’t get a pass when it’s limited to people as fat as I am now, or twice as fat as me, or whatever. Fat-shaming isn’t bad because it’s directed at inbetweenies as well as at fat people. Fat-shaming is harmful for EVERYONE. Fat-shaming is not.ok.

As long as some doctors keep seeing lithotomy position as a prime opportunity to ladle on the shame, girls and women are going to avoid Pap smears. So hey, ball’s in your court, medical profession. Fix it. Get your own house in order, and meanwhile, stop telling US we’re the ones doing it wrong.



Categories: gender & feminism, health

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44 replies

  1. I don’t remember my first pap smear. I wish I was better at remembering firsts.
    What an awful first pap smear story you have.. honestly, doctors! For a profession choosing to work intimately with people so many of them have so far to go before they will in any way be sensitive human beings..
    I find your observations very powerful, the way in which you are able to critically and non-defensively evaluate your own profession. Thank you for these posts, always so enlightening and so thought-provoking.

  2. blue milk: One of my points, which I completely failed to make in the post, was that this is (to my mind) pretty much the least-bad medical fat-shaming story around. It’s kind of as good as it gets. Which is … horrible.

  3. Should be an exam question for doctors.

    Q) Which medical examination will be quickly forgotten by you but most likely remembered forever by your patient if you are in any way insensitive during it?
    A) Any one in which your patient has no pants on. (Times a billion if they are also lying prone and have their legs spread apart when you execute your insensitivities).

  4. I remember my first. I had gone to a doctor at home (c/f in the university town where I mostly lived) to get a prescription for the pill, before I had ever had intercourse with anyone. I said to the male doctor that I had never had sex with anyone, and he still insisted on doing a smear test. Clearly he was not up with the research suggesting that cervical cancer is likely an STD. It wasn’t outrageously uncomfortable, or difficult: I’ve never experienced anything other than mild discomfort with a smear test. But it was… difficult, and it has stuck in my mind. But not overly so. I don’t think I’ve thought about it for years, not even while having subsequent smear tests done. It was only thinking about ‘first’ that brought it back.
    What a wretched experience, Lauredhel. Thank you for telling the story. I ‘get’ the problem of fat-shaming intellectually, but your story, and other stories that I’ve read on other people blogs, have brought it alive for me. The best kind of gossip.

  5. I know the feeling of being fat shamed by a Dr. A Dr I would like to point out who was significantly overweight herself. She measured my height and weight for some reason I’m not sure of now and then when I was shown to be within the healthy weight range (in the upper third) she said I looked a bit overweight and I evidently had a small skeleton or some nonsense. When she then measured my blood pressure, she said it was high, big freaking surprise. She didn’t ask me about my lifestyle habits or eating habits, which at the time were fantastic, I was going to the gym and lifting weights several times a week and eating good healthy food. I’ve suffered from ‘white coat hypertension’ ever since.

  6. At this point in my life, I’ve lost track of the number of stupid things said to me by doctors. Some of them while I was topless for a breast exam.
    I am hugely proud of my cousin who worked as one of the first gynaecological teaching associates in the UK – laywomen who teach doctors how to perform pelvic exams- after having some very negative experiences herself. And she set up a company promoting the use of GTAs. They take a very patient-focused approach, including doing role-plays on how to talk to patients with empathy and sensitivity.

  7. I think more women are doing their own research and making informed decisions not to have screening, to delay it or have it infrequently.
    It’s clear Papscreen do not care about informing women and have no respect for the legal requirement of informed consent, which applies to all screening tests.
    The evidence from overseas is clear, pap tests don’t affect the tiny death rate from cervical cancer in young women, but it causes huge harm through false positives and over-treatment.
    As a result, Finland, who have the lowest rates of cervical cancer in the world don’t offer testing until women are age 30 and then only 5 yearly – 5 to 7 tests in total and some low risk women skip them altogether. That way they contain the harm to young women. The over-treatment can leave you with a damaged cervix and that can mean infertility, miscarriages, problems during pregnancy, pre-term labour and prem babies and psych issues.
    The Australian program over-screens women (by testing young women and doing it 2 yearly) and that is harmful.
    As a low risk woman, my risk of cancer is near zero, I’m not happy to accept a 77% lifetime risk of referral for colposcopy and usually some sort of biopsy to satisfy Papscreen and their fixation with targets. My concern is my health.
    The top risk of this cancer is around 1% so it’s important to assess your level of risk and test accordingly.
    I see more women making informed decisions and protecting their health.
    When 99.35% of women derive no benefit from smears (incl the 0.35% of women who get false negatives) informed consent is vitally important.
    All of the referrals we hear about are not about cancer, but a bad screening test that produces lots of false positives.
    Anyone interested….the facts presented here are taken from medical journal articles at Dr Joel Sherman’s medical privacy blog under women’s privacy issues – see Dr Angela Raffles and Richard DeMay.
    Dr Raffle published some amazing research in the BMJ in 2003, “1000 women need regular smears for 35 years to save ONE woman from cc”.
    See also Blogcritics and Unnecessary Pap Smears & the Violet to Blue site.
    I think we should also stop doctors receiving financial incentives from the Govt when they reach screening targets for pap smears – we’re women with rights, not targets. It accounts for lots of unethical conduct and conflicts with informed consent. (See Financial Incentives Legislation) These payments are concealed from women which is also unethical. My SIL has had a complete hysterectomy for non-cancerous fibroids yet her Dr tried to pressure her to keep having pap smears. This is a highly unethical tactic, putting a woman who can’t benefit from smears through an invasive exam, doctors have been warned about this sort of thing but it continues with doctors chasing target payments. My SIL reported the Dr to the Medical Association and to the surgery.
    Good luck everyone

  8. I’m well and truly overdue for my latest pap smear, and I know full well why I’m reluctant to have one – it has to do with a combination of factors.
    Firstly, there’s the cheerful truth that I’m currently on a low income, and I don’t want to head in and see a doctor when there’s nothing wrong with me, even if I can claim most of the cost back on Medicare.
    Secondly, depending on the version of the path test they do on the blasted thing, I can’t afford to pay for the testing (so I have to be sure that’s going to be covered on Medicare, or I’m going to be the one getting the bill… yays).
    Thirdly, I’m actually fairly time-poor at the moment (so again, I don’t want to have to find time in my day for a medical appointment – because that time for the doctor’s appointment includes things like taking public transport to and fro, waiting in the waiting room because no matter who your GP is, they’re inevitably running late, oh, and the recovery time from what is a rather invasive procedure).
    Fourthly, for reasons which are very similar to the reasons for my being low on time (namely, being a full-time student who’s only just dropped down to part time) I’m fairly low on psychological spoons at the moment. Particularly so since I’ve been off my meds (and consequently off ma heid) for about a fortnight at least – last prescription expired, and I’m only just getting in to see the GP to get a new prescription for the antidepressants today. Given that a pap smear is actually a fairly psych-spoon-intensive process for me (entailing things like fat-shaming, social anxiety, body-image anxiety, physical discomfort, and the whole wonderful continuum of things which require me to be at a reasonable level of psychological comfort before I start, because I sure as hell won’t be after it’s finished) I’ve been putting it off until I’m in a better position to cope with it.
    Fifthly, I’m reluctant to go in and get a pap smear done because I don’t want to have to go for another feckin’ colposcopy – I’ve had two already, the first was highly traumatic (as in physically painful to the point of nearly fainting, along with psychologically traumatic because it was a completely unfamiliar procedure and my anxiety went sky-high), and the second was only marginally better because I knew what to expect before I went in and planned accordingly (in other words, I took the day off work for the appointment, rather than trying to fit things in around a workday schedule).
    Sixthly, and least important on my list of reasons: I moved house about six or seven months back, and I haven’t seen a GP since. I don’t want to go to some strange GP and basically have the first thing on the agenda being for me to lie flat on my back and have them look up my vagina to see whether my cervix is all right.
    To be honest, medical fat shaming is rather low down my list of concerns, since I’ve long (i.e. for at least the past decade) approached the whole issue by telling any doctor I’m seeing that I’ve tried weight loss dieting, and after ten years of it I gave it up because I’d doubled in size and gained a thyroid condition. I am not interested in how much I weigh. I have alternative methods of discovering whether I am undergoing rapid weight loss or gain (the two medically significant pointers) and other than that, I’m quite willing to undergo regular blood tests to check for things like insulin resistant diabetes. If they want to argue about it, I’m more than willing to do so – but I’ll get an email address from them and bombard them with links rather than arguing in their consulting rooms.

  9. I have a somewhat opposite experience to a lot of the commenters here – my first smear test was fine (obvious “oh wow that feels totally weird” feelings aside) and over the past six years I had fabulous treatment – largely, I think, because I was a student and the nurses at my university’s student health service were always over the moon to be treating an upfront, non-smoking young woman who not only knew about smear tests but diaried when her next one was due.
    Now I’ve moved into The Real World, I’ve started getting the fat-shaming, and the shocked looks when my blood pressure turns out to be entirely “normal”, and now I’m starting to worry and put off appointments and feel really uncomfortable going to the doctor. (Not helped by (a) after at least 4 perfectly harmless smear tests, one doctor finally made me bleed and had the gall to blame my cervix for it, and (b) a doctor actually uttering the phrase “if your weight increases we may have to take you off the Pill”, FUCK YOU VERY MUCH.)

  10. I had fabulous treatment – largely, I think, because I was a student and the nurses at my university’s student health service were always over the moon to be treating an upfront, non-smoking young woman who not only knew about smear tests but diaried when her next one was due.

    QoT? I was an “upfront, non-smoking young woman who not only knew about smear tests but diaried when her next one was due.” At a University health service. The staff treated you well because they were decent people who treated you well, not because you had the ‘right’ characteristics of a compliant good little girl.

  11. “I think we should also stop doctors receiving financial incentives from the Govt when they reach screening targets for pap smears ”
    I didn’t know there were financial incentives for reaching screening targets – does someone have a link?
    On a personal note, I have a good friend who was diagnosed with cervical cancer at 19 – personally I think it’s worth the 1000 women being screened to still have her around (although I very much also agree with it being a personal choice, and understand the various reasons why women don’t want it and choose to refuse it).

  12. :waves madly at my dear friend scienticiankate: helloooo!
    I can’t believe you didn’t mention the level of skill difference in administering pap tests in the country you’re now in, compared to Australia.
    That’s what gets me about pap smears… I didn’t mind the first two I had, but then when I had one that showed up an abnormality, in the following two years of treatment (colposcopy and surgery), it was like my vagina went ‘no thanks, had enough, this hurts now’. because I had about 8 lots of people shoving things into me over a 2 year period. so every time I have one it really hurts and I get cramps afterwards, like my insides are affronted that they’re being tormented :again:.
    So I reckon another small part of this is that they fucking hurt.
    I can’t believe the fatshaming stories I’m hearing in this thread. that is fucking terrible. the thigh one just gets me. thighs are, generally, fat! thin, average, plump, all sizes of women tend to have jiggly thighs!

  13. Is it really valid to extrapolate your experience 20 years ago as a prime contributor to why pap smears are avoided today?

    I really sympathise with the experience you had, it was very wrong. I wish those things never happened, and I get mad to hear of doctors being so pig ignorant.

    But it is unfair to load that gun and use it to shoot all the sensitve respectful and capable, doing pap smears today.

  14. Kerry: No, it’s obviously completely invalid. And blatantly clear from the post and from everything else I’ve ever written that this one single experience is absolutely the one and only thing I know about Pap smears, medical fatphobia, fat-shaming, and the interactions between medicos and the people who go to them for help.
    The uppity fat crip will shut up now and let the magically completely reformed medical profession get on with things uncriticised.
    Would you like to buy a clue?

    • it is unfair to load that gun and use it to shoot all the sensitve respectful and capable, doing pap smears today

      Those who are sensitive, respectful and capable are not the problem. Those who aren’t those things are the problem.
      Imagine, if you will, a doctor who has bought into the prevailing wisdom that sie needs to make “helpful” remarks about the dangers of fat bodies to hir fat patients every time sie sees them. Now, this doctor might never dream of making any remark not directly relevant to the procedure actually during the pap smear procedure.
      However, if every other experience with this doctor for a patient has been that even when the patient attends requiring antibiotics for a sore throat, that this doctor remarks upon their being overweight and that they really should “do something about it”, just exactly how comfortable do you think this patient will be in attending that doctor for such an intimate procedure? Have you not read some of the contributions here from women who feel exactly that, and who are amazingly grateful when they find a GP who doesn’t buy into fat-shaming? Doesn’t that tell you that GPs who don’t buy into fat-shaming are actually quite rare?

  15. For that matter, it seems to me that these experiences make good reading for sensitive and respectful providers, because it increases their appreciation for the difficulties that their patients may be experiencing planning, booking and attending an appointment, and then having the test itself.
    I had an appointment for a Pap yesterday (the chance that someone reading Lauredhel’s post would then have a Pap within hours had to be high) and my provider was somewhere in between blatantly awful and sensitive and respectful. In particular I was struck by the difference between the Pap and vaginal exams I had performed in very late pregnancy (VEs throughout pregnancy don’t seem to be as routine in Australia as I believe they are in the US) in which I was thoroughly and sympathetically briefed on what they were doing, what it might feel like, what the goal of the exam was, my right to withdraw consent at any time during the procedure and whether I wanted a second person in the room to chaperone.
    The doctor who did the Pap smear, while it wasn’t traumatic and while we didn’t discuss my body or health while I was having the exam, could well benefit both from a little more training on that kind of informed consent discussion and from knowing about experiences like this.

  16. Kirstente, I also developed white collar syndrome after one bad experience having my blood pressure taken. Maybe it really was high that day, since I turned out to be coming down with something, but ever since one doctor scared me with my suddenly monstrously high blood pressure, it is at least 10 points higher around doctors. I always explain this when I get it measured but most nurses ignore it completely and then I get more notes about how my blood pressure is too high.

  17. And by “white collar” I mean “white coat.”

  18. And by “kirstente” I meant “scienticiankate.” Full of errors!

  19. There is one after-hours doctor surgery I now refuse to go to. I had gone in to get the morning-after pill (as the condom had broke during sex). Not only did he give me The Eye when I explained what I had come in for, he then tried to sell me lap-band surgery.

  20. If we’re doing general Fails of the Medical Profession (should be read in a voice like “Saaaaale of the Centuryyyy”), I have rather a good one.
    Being a responsible 20 year old just out of a relationship, I figured I should go get an STD test. Benefit of future partners and all that. When the results came back, the doctor read every one out in a Serious Voice, with a little drumroll on the desk in between. As in: “AIDS… *drumroll* …false. Herpes… *drumroll* …false.”
    It seems funny now, but I was pretty annoyed at the time. If it happened now I imagine there would be yelling and blood-splattered ballpoint pens involved. And I’ve never had a pap-test, nor am I likely to. Way beyond my personal boundaries, that one.

  21. Great post! Spot on. And it’s not just about fat shaming. I’ve had friends tell me horror stories of doctors taking that moment to give them a lecture on any number of issues including numbers of sexual partners. As a sexual assault survivor It took me over three Years to pluck up the courage to get my first pap. On arrival I got a stern lecture about how irresponsible I was for not coming in sooner. Charming stuff for a SA survivor to endure!

  22. Fatphobia in the medical profession is rampant and extremely harmful. Had to go for my yearly pap today. Last year’s experience was so awful in terms of the shaming and lecturing that I got that I still cry when I think about it. Naked on a table, wrapped in a paper napkin, being lectured by the most horrific (female) doctor I’ve ever encountered. I now get panic attacks and have to take medications before I go to the doctor, because of the treatment I’ve had from doctors in the past. Believe me, if I didn’t have to go to the doctor to get my birth control, I would go nowhere near any of them.
    This year I deemed a success as the (different) doctor didn’t shame me anywhere near as badly, just deemed me a “very healthy lady” (great blood pressure, etc.) and said I have no health problems. But… what was I doing about my weight, and had I considered a Lap-band? I was surprised that the cognitive dissonance from telling me I was healthy but needed to change everything about myself didn’t blow the top of her head off.
    To me, this moderate ridiculousness was an improvement. And it’s still awful.So glad I ran across your post, today of all days.

  23. I remember going to a campus counselor when my father had a serious heart attack to talk over the fears and ramifications. She listened well and I felt better afterwards, so I set up a followup appointment.
    That appointment was literally:
    Counselor: “How is your father doing?”
    Me: “Much improved, he’s coming home next week.”
    Counselor: “Great! So, about your weight…”
    And the rest of the session was dominated by her asking me why I was so fat, what was I doing to lose weight, how it was bad for my health, and so on.
    Guess if I went back. Guess if I discussed my father issues with *anyone* after that, for years and years.

  24. Oh oh- can I tell another (sort of) related story.
    I’ve done a lot of work with girls with eating disorders. It is not uncommon for bulimics (and many anorexics) to have a “healthy” BMI. This does not mean that they do not have disordered eating/ thinking/ self worth issues/ control/ perfectionism issues etc etc etc…
    Hence the reason why we should diagnose anorexia or bulimia at the level of the body. I spoke to one bulimic girl who had dropped from 110kgs to 60kgs in 3 months. Her doctor put her on the scales and told her she did not “qualifiy” as eating disordered. This is not an unusual story to hear.
    In other words these girls are being told “You’re too fat! You’re not there yet! Come back to me when you’re REALLY skinny and then we’ll talk. Until then, get out of my office and dont seek my help fatty!”
    GRRRRRRRRRRRRR

  25. sorry that should have read “Hence the reason why we should NOT diagnose anorexia at the level of the body”

  26. Perhaps a tangent, but has anyone considered (or can anyone share any experience of) using a midwife for what they call “well woman” care, which includes pap smears?
    I know there are independent midwives who provide this service, and I’m wondering whether given that they’re not as immersed in the medical model their care is more likely to be respectful (and I would imagine that they’re well and truly less likely to be recommending things like lap-band surgery, which would be outside their area of practice).

  27. I forgot before I made my Drs appointment that the local Community Health service also runs a Women’s Health service where tests are free and done by nurses (?). Maybe an option for some people. (I’m in NSW).

  28. Great post from Ouyang Dan responding to Lauredhel’s crosspost of this on FWD: Medical Autonomy Chronicles: The Virgin Pap Smear

  29. My “favourite” fatphobic doctor was the one who told me that if I was gaining weight, I should stop taking my antipsychotics.
    My first pap smear was incredibly traumatic. I didn’t get another one for five years, and then was reluctant to get more. The one that led to my diagnosis with aggressive cervical cancer was only eight months or so late, but that’s eight months that could have made a hell of a difference.

  30. Goodness lauredhel, turns out you weren’t so totally off the mark with your wild theories about fat-shaming and reluctance to get pap smears drawn entirely from your own teeny weeny insignificant experiences – look at the comments grow and grow.

  31. I thought that I would add my pap-smear experience to the list. I recently required a sexual health checkup and had a pap-smear performed as well, because I was really overdue. To make it clear (for those who might infer that the need for a sexual health checkup results from having a wide range of sexual partners, which can increase your risk of cervical cancer) I have had only two partners in the last six years.
    The original doctor who performed the test was brilliant – understanding, gentle, non-judgemental.
    I went in today to get my results. Unfortunately, my doctor wasn’t available for a while, so I just went with a random.
    Turns out that I need another pap smear. I replied that I couldn’t do it today because I am bleeding.
    Howdy doody – first, the doctor turned around and made a big deal of reading out my sexual health results. Pointedly.
    Then I recieved a ten minute lecture about why I need to have a pap smear. This woman stated the following:
    ‘you could die,’ ‘you are in a high risk group,’ ‘I am saying this not to scare you, but to terrify you.’
    The lovely lady also mentioned that I may need to go for a more expensive option, but it was only $40 more, and I can budget for that and that I wouldn’t get the bill for a month.
    The doctor assumed the following:
    – that because I had had a sexual health checkup, I was in the high risk group of younger women with multiple sexual partners. (and not to fracking mention, having multiple sexual partners doesn’t mean that you don’t use protection)
    – that I couldn’t afford to look after my own health (I am lucky enough that I can, actually. And you know what, if I couldn’t – no fricking need to talk to me like a 12 year old who needs to learn to budget their pocket money)
    – that I wouldn’t get a pap-smear done, based on the long time between. (which is strange, why would I not want to get one done, when I had sheepishly admitted to not having one for a long time before the failed one??)
    This is why women don’t get these things done: we are patronised and slut-shamed.

  32. To make it clear (for those who might infer that the need for a sexual health checkup results from having a wide range of sexual partners, which can increase your risk of cervical cancer) I have had only two partners in the last six years.

    Yes, agree with you 100%, but did you see what you did there?

  33. Well, having said that, I do disagree with you on the explaining-the-cost thing. I went for a more invasive test when in my early 20s and didn’t have the cost explained adequately at all. The test in question required an anaesthetist and a brief period of surgery time and the cost breakdown was not explained – only the price of the procedure itself was quoted so of course when I got the day surgery bill I was in tears, it was ruinous. And they could have pointed me to less expensive options i.e. day surgeries which I use now. So I like it when people explain cost.

  34. Helen, exactly – and informed financial consent is now a legal requirement, to the best of my understanding, as well as an ethical one. In Australia particularly, many people are accustomed to having no or minimal gap payments on pathology testing, so explanations of the Thinprep cost are essential to avoid unpleasant surprises.
    Also, yes. No need to carefully explain that you’ve had few sexual partners, as if having more would be some sort of negative.

  35. You’re right – an ironic fail on my behalf. I was trying to point out that I am not in fact, part of the high risk group for young women (which from my understanding, comes from an increased risk of exposure to STIs).
    On the informed insent of cost – I have had had the thin smears explained to me before – without being told how to budget in a tone that implies that I am unable/unwilling to budget for my health needs.

  36. Rebekka,
    Here is a link to the financial incentives paid to doctors to reach screening targets, only paid for cervical smears, not mammograms or prostate screening. The latter cancer are common, cervical cancer has always been uncommon.
    You can also look at the Financial incentives Legislation on line.
    http://www.medicareaustralia.gov.au/provider/budget-2010/cervical-cancer.jsp
    I don’t mean to be rude, but the chances of getting cervical cancer at 19 is one or two women in a million, but the chance of a false positive and totally unnecessary treatment is sky high – 1 in 3 smears will be abnormal, some highly abnormal.
    Young women produce lots of false positives due to natural changes in the cervix that occur at that age. Some women assume an abnormal pap, LEEP or biopsy means cancer, it rarely does…
    Also, it’s not testing 1000 women to save one woman, it’s testing 1000 women regularly for 35 YEARS to save one woman, that’s a huge number of tests.

  37. On what are you basing your statement that cervical cancer is uncommon?

  38. Hi all
    i’ve just discovered a horrific practice whereby training medical students perform practice pap smears and pelvic floor exams on unconscious patients (under anaesthetic) without their consent. This practice is well known in Canada and the US (and who knows where else.)
    I think there is an urgent need for a conversation on institutional/ medical rape. I’m really glad to see people begining to talk about these issues. Thanks again for the post. xxx
    nina

  39. Thanks for the link, Honestinfo.
    Seems to me that when it affects someone you know and care about, it doesn’t really matter whether their chances of getting it were 1/100 or 1/1000000, what matters is that they did get it, and not a false positive.

  40. Oh and by the way, one of the reasons why cervical cancer is now comparitively rare is because of screening. It’s still quite common in developing countries
    http://www.aafp.org/afp/20000301/1369.html

  41. Actually the rates of cc in the developing world have always and will always be higher due to their unique set of risk factors. You can’t compare our rates with their rates…women for instance don’t have access to sanitary items and use all sorts of things like mud caps, they start having sex and having children VERY early etc.
    It’s an argument that is often used by cancer screening groups to mislead women.
    Your 19 year old friend should get her pathology and get another opinion, many women in that age group get false positives and never know…you shouldn’t have to live thinking you’re a cancer survivor if that’s not true.
    Of course, LEEP destroys all cells and there is nothing for pathology, so women never know whether they had a false positive or not. If she had a cone biopsy or hysterectomy there should be pathology.
    CC has always been uncommon, even rare – it affects 1.9 women per 100,000 in Australia…it occurs in roughly the same numbers as testicular cancer. (before screening it occurred as often as mouth cancer) Isn’t it strange how a screening program amplifies risk, not many women worry about mouth cancer or even bowel cancer? (the latter is much more common)
    Anyone interested might like to look at Dr Joel Sherman’s medical privacy blog and under women’s privacy issues you’ll find all the references – I’d recommend anything by Dr Raffle and Richard DeMay.
    Off to a conference in Singapore now…

  42. Of course, LEEP destroys all cells and there is nothing for pathology, so women never know whether they had a false positive or not. If she had a cone biopsy or hysterectomy there should be pathology.

    That’s… not true at all. They send what’s removed to pathology and let you know at your next checkup where the cells were staged. I supposed if you were having a truly tiny amount of tissue removed then your statement might be accurate, but the lesion I had removed the second time I went in for surgery wasn’t particularly large and I got a very definite “Yep, still cancer” from the lovely pathology people.
    Cervical cancer is the second most common female cancer. The fact that women don’t worry about mouth or bowel cancer isn’t exactly a GOOD thing.

  43. Thanks for all the information, hexy. “Honestinfo”, LEEP (or LLETZ) is a loop excision of the transformation zone; it’s designed to remove material that can be sent for full pathological examination, not just cytology like a Pap smear. Everyone else here, please read all “scientific” information you see on the web (and everywhere else!) with a critical eye. Not that you didn’t know that already…

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