A couple of months ago, I went to my doctor for a papsmear. I dreaded this appointment. Everyone does. They ask me the usual questions, including “are you sexually active?” to which I thought of the Juno reply “What does it even mean? Am I gonna like deactivate some day or is it a permanent state of being?”
However, during this question period, she tells me that I no longer need to come in every year for paps and that I in fact did not need to proceed with this particular scheduled one.
She explains to me that if I have a normal result, which I have gotten for the past two years, that I only need to come in every three years, as per new pap practises. I tell her that I wanted to go through the pap because my aunt and my mom have a history of abnormal cells that have almost led to cancer. She tells me that she understands but that the risk is low at my age and reiterates that I’ve never had an abnormal test, but that if I wanted to go through the pap, she will still do it.
She then asks me to remove my clothes and put on the paper examining gown while she steps out for a moment. I awkwardly change and wait for her to return. I hope she doesn’t come back, but she does. She asks me to put my legs up and prepares her medical instruments.
There I was, the paper bag princess, sitting on the cold examine room table, with my legs up in stirrups. All I could think was “Ew. I hate this.” My heart was racing, anticipating the moment that she would stick that ungodly medical instrument (they call it a speculum) into my vagina. I cringe as it holds my vaginal walls apart while my doctor scrapes my cervix.
I not only consented to this entire horrible experience, but I insisted upon it, despite her assurance that I did not need to go through with it.
I didn’t need an abnormal test result to feel reassured, but an abnormal test result is what I got. I am now scheduled to go in for a second examination and I’m pretty freaked out. I don’t want to think about the possibilities of what could develop over the course of the year. My aunt waited a year after her abnormal test result and it led to her having a surgery to cut part of her cervix out because the abnormal cells were in their last stage before coming cancerous.
So what’s up with this new pap practice? The Canadian Medical Association Journal updated its guidelines regarding pap smear tests for the first time since 1994, in a report that they recently released on January 8.
It stated that, “In 2011, an estimated 1300 new cases of cervical cancer were diagnosed in Canada, with about 350 deaths,” but continued to say that incidences of cervical cancer and associated deaths have decreased in the last 50 years.
The report says that this positive change in Canada is due to papsmears, but that “early and frequent (often annual) cervical screening is unnecessary, [as] other countries have achieved similar outcomes with less frequent testing and starting screening at older ages.”
An alarming part of the report states that the “likelihood of abnormal Pap test results is highest for young women,” but that “the proportion of abnormal results that represent serious abnormalities is greater among older women.”
None the less, the report instructs:
“For women aged less than 20 years, we recommend not routinely screening for cervical cancer. (Strong recommendation; high-quality evidence.)
“For women aged 20–24 years, we recommend not routinely screening for cervical cancer. (Weak recommendation; moderate-quality evidence.)
“For women aged 25–29 years, we recommend routine screening for cervical cancer every three years. (Weak recommendation; moderate-quality evidence.)”
Why is there a recommendation given to women aged 20-24 years if it’s described as weak and only backed by moderate-quality evidence? Why was I almost convinced out of having my papsmear, especially when my family has had a history of abnormal cells? Aren’t paps also useful for the detection of STIs and STDs? Is this not a period of sexual experimentation, promiscuity, and learning?
The report states that 9.8% of women in Canada aged 20–29 years have had abnormal test results, but explains that they recommend foregoing the screening because of the low incidence of cervical cancer and associated death in this age group.
“The weak recommendation implies that, although most women would want to follow the recommended course of action, many would not. Women who place a relatively higher value on avoiding invasive cervical cancer and a relatively lower value on the potential harms of screening will be more likely to choose screening. Therefore, clinicians should discuss the potential benefits and harms of screening with their patients and help each woman make a decision that is consistent with her values, preferences and exposure to risk.”
Although this was the recommendation in the report, many doctors are not apt to explain everything and many people tend to just follow what they’re told.
I’m sure many of you would hear that you didn’t need to have a papsmear every year and jump for joy (and reasonably so, it’s invasive and sucky). That’s okay! However, you should be given all the relevant information before you’re expected to make this sort of judgment. You should be given the option to make an informed choice.
I will personally continue to have annual papsmear tests because I think it’s right and safe for me, and because I personally think that this is just another form of cutting costs and saving time for more immediate and important matters.
So please, stick your fingers up my vagina, doc. Not because I like it, but because I want it.