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Is the Smear just PAP?

2/7/2014

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To be a woman in this day and age it seems is to be constantly poked and prodded. Or torequest to be poked and prodded and denied. Even though few women look forward to their smear test, so you'd think a request for a smear would either be welcomed (welcome to the prodding and poking era of your life!) or raise suspicion that something must seem very wrong. Either way, when it comes to the vulva invasive prodding and poking is apparently regularly required. However the Annals of Internal Medicine (you shh, this is SCIENCE) has reported that in gynaecologists in America, where those with a vulva are informed they should have an annual pelvic examination, are perhaps getting a little too rigorous and that an annual check up is not necessary. 

In the UK women aged between 25 and 64 are invited to attend their GP's clinic for a cervical screening every three years. According to the NHS site since introducing the screening programme in the 1980s the number of cervical cancer cases has reduced by 7% every year. It is clearly saving lives.

I don't need to tell you, whether or not you have a cervix, that the smear is what sadists and medical professionals might call 'uncomfortable'. For those with a traumatic sexual history they can be triggering. The idea that people might be having more exams than strictly necessary is therefore worth taking note of. 

In 2010 in America doctors performed 62.8 million routine pelvic examinations and the cost of gynaecological screenings cost 2.6 billion dollars annually. Women on birth control pills in the US peculiarly have to go in for a routine examination before they can renew their prescription. This probably puts off many women from using this method of contraception. 
The study published in the Annals examined 70 years worth of pelvic exams and found that annual check ups had no impact "morbidity or mortality of any condition"

In light of this to refuse to open wide for doctor seems a reasonable response. 

The American College of Physicians has responded by updating the guidelines on the subject of symptomless women, reminding physicians that to: "subject patients to unnecessary worry and follow-up" and can "cause anxiety, discomfort, pain, and embarrassment, especially in women who have a history of sexual abuse."

Rather alarmingly internists at the University of California-San Francisco George Sawaya and Vanessa Jacoby wrote in an editorial for the Annals that pelvic examinations have "become more of a ritual than an evidence-based practice."  

Is it surprising though? There is some discussion over whether the PAP smear is necessary and talk that it could be replaced with an HPV test. Women's health and how to deal with it seems to constantly be under discussion. 

In light of this to refuse to open wide for doctor seems a reasonable response. 

Squeamish Kate
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