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New York, 8:16 AM
Fri Dec 4
68 posts in the last 24 hours
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11/20/09
And yeah, I had my first pap smear before becoming sexually active because I wanted to regulate my periods and I was getting more serious with my then-bf and wanted to be safe.
11/20/09
The trick is the guidelines still provide for women to go in every other year between the ages of 21 and 30, unless they have prior abnormal results or other issues. The thinking behind a lot of this is that biopsies (and other invasive procedures) are overused by practitioners because they guidelines tell them that the proper follow up is a colpo, LEEP, etc. (depending on your Pap results). So practioners often order them up when, really, things would clear up on their own.
ACOG would answer the last sentiment in your first paragraph as: well, never finding it because it cleared up on its own is better. No biopsy, no invasive procedures.
11/20/09
Americans usually think more=better but other countries, especially Canada focus more on procedures that are most effective. These recommendations are a step in that direction.
11/20/09
I think this is a measured approach reflecting scientific research which will, in theory, reduce the number of these kinds of procedures that women go through.
11/20/09
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11/20/09
I agree with this so much. I'm 24 years old, never had sex, and on birth control because my uterus once tried to bleed me to death when I was 19. I hate that I'm forced to go through what is for me an incredibly comfortable (at best) test that I have absolutely zero reason to take.
Usually my doctors say "oh, well just in case." Yeah, just in case I'm lying. Thanks, guys.
11/20/09
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11/20/09
Seems reasonable, contains exceptions based upon previous history, some issues are a little sticky, but ok.
That being said - I stick by my - "what? No HPV testing in between?"
If anyone has a full copy of the guidelines and can let us know how HPV testing is discussed, that would be marvelous.
11/20/09
The recommenders did talk about how the incidence of cervical cancer has been declining and even women who have the cancer-causing strain are still relatively unlikely to ever develop cervical cancer. I thought that was interesting, though I don't know if it answers your ?
11/20/09
Technically, a Pap is a screening of abnormal cells - not a test for HPV. While yes, HPV can cause your cells to become abnormal - so its effect would be reflected on a smear - I don't think that a cytotech will look at a smear and know that HPV specifically has caused it and what strain it is. They just aren't trained for that, I believe.
Cervical cancer is on the decline and I think a lot of experts would, in part, attribute it to the HPV reflex use - so women can be monitored and their abnormal results can be carefully monitored depending on the strain.
11/20/09
I have friends who had abnormal paps and soon enough it was LEAP and biopsy time. All turned out just fine.
11/20/09
So glad to hear you have a good one!
11/20/09
That was like, 8 years ago. I have had pelvics now, but I still won't go on hormonal birth control. I have never used it, and I don't plan to. Instead, I'm pushing for a tubal ligation, but they don't like to do that to people of my age.
I do medical studies, and I won't do one for hormonal birth control, despite the fact that they pay scads of money for them. My sister made $5000 off one of those. It was a hard study, though.
To me, the biggest problem I've had in gynelogical health is that the doctors don't listen to me. I've been having the same, disgusting problem for about 3.5 years now, and they still insist it's normal.
TMI ALERT WOOO WOOO
When you have thick, yellowy discharge leaking out of you that smells like rotting... something... kinda like sour milk, that's not normal.
I have been to 6 or 7 gynos who insist because it's not a yeast infection or bacterial vaginosis, it's fine. Never mind how it's affecting me, or what I think it might be, or that no one knows of anyone else who had these symptoms and it was normal, it's normal "for me". Oh, joy of joys!
Thanks, doctors, it's not like I didn't have a whole pile of issues with that area of my body before. Now I have a few more to pile on. It's hard to not hate a part of your body that is behaving so fucking disgustingly.
Okay, end rant. I wish that doctors would actually listen to patients. That would be fabulous.
11/20/09
11/20/09
I'm not sexually active and have never been (partially because of this issue and partially because I have issues), so the only ones they've tested me for are chlamydia and gonorrhea, which are standard for testing at my university. I asked them if I should get tested for anything else, and they said no, because I'm not sexually active.
Other doctors just don't believe me, but they don't give me tests, either.
The only thing they do is a wet mount, then send me on my way when it comes back negative. Each time they see the symptoms, they say something along the lines of, "Oh, yeah, that doesn't look normal." I had a pap smear at my university (thank god for that doctor, she was awesome, but she said she can't do anything other than what she did, and I respect that), which came back normal.
I've gone to talk to my primary care doctor and gotten a referral to get an ultrasound to try to figure out what it is. I'm wondering if it's leaky cysts or something?
#tips
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#tips
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11/20/09
[www.cancer.gov]
11/20/09
11/20/09
If you have not done so already, you may want to contact a group such as [www.facingourrisk.org] to help you understand and deal with the results of your test. Best of luck with it.
11/20/09
11/20/09
The FORCE site has links to support groups and a message board. Talking to others can help you overcome, or at least manage, your fear.
11/20/09
The American Society for Colposcopy and Cervical Pathology website has some info that relates to questions raised here.
11/20/09
It would be one thing if it were just the bean counters pushing these recommendations, but scientists and health researchers are the ones putting them out there. The fact that it could ultimately save money is a bonus.
11/20/09
Given the paternalistic approach to medicine, it is not surprising that researchers are just now getting around to updating recommendations for mammography and pap smears.
11/20/09
I contrast this with what I saw while working at a women's health clinic. A woman with two abnormal paps in a row could expect to go through all sorts of fun procedures, starting with colpos and possibly including punch biopsies, cryocautery, LEEP cones and a mess of other fun things, all meant to make sure she doesn't develop cervical cancer. I wonder how much of that was necessary and how much was preventative. I also wonder how expensive that stuff all was.
And then there was the emotional toll such things took on the women, who believed they were just a step away from having cancer. A friend of mine, who had cryocautery done when she was 18, cried for days leading up to the procedure because she thought she was going to die from cancer. She ended up being fine, but whether or not that was due to the procedure, I don't know enough to say.
It's tough to say, because I am sure there are some women who were prevented from having cervical cancer as a result of all of these procedures, but I am also certain that there has got to be a better way to determine these things that doesn't involve putting lots of women through traumatic procedures that may ultimately be unnecessary.
11/20/09
11/20/09
traumatic (and expensive) experience aside, it gave me a huge wake up call that i wasn't invincible and that i needed to be more cautious. and it would have been way more traumatic and expensive if i didn't go for regular screenings and came back with cervical cancer.
11/20/09
Just out of curiosity, did you just have one abnormal pap before they scraped you?
11/20/09
i made an appointment with the local planned parenthood and when i walked in the doctor said, "ok, you're here because you have HPV." i burst in to tears because even though i had googled it, i was not prepared at all to hear that!
then after he performed the test, it turned out that my body had already eliminated the virus, or i was misdiagnosed by the original doctor.
so i guess the point is that women need to be given more information about the procedures in advance and also be made aware of the possible meanings of test results, not just automatically say "Hey, you have a virus and it will probably turn in to cancer. Now spread your legs while I pour some salad dressing in your vagina and then cut pieces of your skin out."
11/21/09
I think your point is so right on, that doctors need to do a better job of accurately conveying what is going on with something, rather than trying to scare the crap out of women in hopes of making them take things seriously. It reeks of paternalism, like you can't possibly handle the nuance of the situation so I'm just going to tell you that your ladyflower will rot from the inside out if you don't do as I tell you.
11/20/09
The problem is that they spent years trying to convince you to do certain tests to prevent cancer when actually they had little to no evidence that the tests actually worked. Because the breast cancer prevention juggernaut is so effective, they convinced everybody.
Turns out they were wrong. It is called science. And unfortunately, doctors don't use it very much. Just ask your parents about all the things they told them to do to prevent SIDS 20 years ago. First babies had to sleep on their stomachs, which is actually far more dangerous. Then their sides. It's only now that they know to do backs. And for a long time no one believed them when they were told to switch because they'd been indoctrinated with something else. It's the same thing here and until doctors actually practice evidence-based medicine, this kind of thing will just keep happening.
11/20/09
11/20/09
Our understanding of these things evolves over time. I'd be MORE alarmed if they never changed.
11/20/09
just thinking about all the things that women could do when they were pregnant as little as 30 years ago is proof that true evidence-based medicine is rarely practiced because fear-mongering-based medicine is far more profitable.