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On Paps and Pelvics

Posted Jul 26 2008 10:18am 1 Comment

This guest blog written byfemmes femmes.

While it may be true that many doctors will not prescribe hormonal birth control without a pap test and/or pelvic exam, the reality is that there is no medical basis for such a restriction. Pap tests are for cancer screening: the result of the pap test doesn’t determine whether the patient can use birth control. Neither the US Food and Drug Administration, the World Health Organization,Planned Parenthood Association, or the American College of Obstetricians and Gynecologists believe that a pelvic exam or pap smear should be required for hormonal birth control. According to WHO, a pelvic exam for contraceptives (including monthly injectables) is a Category C. That is “does not contribute substantially to the safe and effective use of the contraceptive method.”The information that a doctor gets from a pelvic and a pap is not information that is needed to safely prescribe hormonal birth control.

From this article

Over the past decade, questions have been raised regarding the evidence-based need for pelvicexams and Pap smears, especially in regard to the initiation of oral contraceptives. There is consensus among several prominent healthcare organizations that thepelvicexam isnotrequired, at least during the initial visit. These organizations include the US Food and Drug Administration,[1] the World Health Organization,[2] Planned Parenthood Association,[3] and the American College of Obstetricians and Gynecologists.[4]

There are certainly many good reasons to do apelvicexamand Pap smear, but initiation of birth control,specifically oral contraceptives, isnotone of them.

See also this article:

Although hormonal contraceptives arenotrecommended for women with some serious medical conditions, the problems that make their use unwise are effectively identified through medical history and a simple blood pressure measurement. “Hormonal contraceptives can safely be started based on medical history review and a blood pressure check. For most women no further evaluation is needed before making a decision to use them,” said George F. Sawaya, MD, UCSF assistant professor of obstetrics, gynecology and reproductive sciences and research coordinator for the UCSF-Stanford Evidence-based Practice Center.

Furthermore, requiring pelvic exams for birth control prescriptions is both paternalistic and unethical. The decision to have a pelvic exam should be the client’s: she shouldn’t be coerced into it due to a need for contraception.

See also:

Heather S. Dixon, Pelvic Exam Prerequisite To Hormonal …

Comments (1)
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Good for you - you did your homework.

I'm an Australian lawyer...I'm afraid I don't just fall into line when I'm demanded to do something....30 years ago they started pushing pap smears.  I asked for risk information...What!?!

I did my own research and was shocked that such an unreliable test would be pushed and forced onto women.  At that time, many women wanting to use the Pill were forced to have a pap smear.

I refused to participate in cervical screening and still refuse - the risks FAR outweigh the benefits.

Forcing women to have unnecessary invasive exams and unreliable cancer screening (with the high possibility of harm) is unethical and disgraceful.

This has nothing to do with women's health - it's about power and control...and making lots of money.

American women have been brainwashed into thinking they need annual gynaecological exams - look at the medical journals - lots of evidence to say that these exams are unnecessary in asymptomatic women and can be harmful.

It always seems to be women who suffer at the hands of the medical profession - I suppose we are a captive audience - in the 1960's American brides were given State mandated pelvic exams to assess their suitability for marriage - how they coped with penetration....unbelievable, isn't it?  I know a lady who at 19 was held down while the pelvic was performed- she was severaly traumatized - I regard this as sexual assault - Iwould also, have taken action against the State for facilitating this abuse of bosy and rights.

Naturally, this appalling abuse was reserved for women.

Now it's the women who want the Pill - and scare and brainwash others into complying...

Men would never accept this sort of treatment.

The facts behind cervical screening have been deliberately withheld...

The pap smear is an unreliable test for an uncommon cancer - it results in lots of false positives and some false negatives...some studies show it's accuracy is less than 50%....

Research shows that with regular screening, 78% of women will have a colposcopy and biopsies and only a tiny number will have malignancy. (L. Koutsky, Cancer Prevention Fall 2004, Issue 4)

Also, 1000 women need to be screened for 35 years to save ONE woman from cervical cancer. (Dr Angela Raffles, UK cancer screening expert)

1000 women need to have mammograms for 15 years to save one woman from breast cancer....

These are the undisclosed facts....

Only 1.58% of Australian women would get cervical cancer in an unscreened population.

In America women are expected to have ANNUAL smears, this increases your chances again of having false positives and unnecessary follow-up...

Some countries don't start screening until 25 or 30 to contain the harm to young women, who naturally have changes to the cervix that resolve without medical treatment.  Some countries opt for 3,5,7 or 10 year intervals...

I rejected them altogether - far too much risk....

I've also, rejected mammograms - there is a lot of very worrying evidence - they may INCREASE your chance of getting breast cancer.  (bruising the tissue) Also, the false positives and unnecessary surgery - also, the discovery of ductal carcinoma in situ - a slow growing cancer that would never bother a woman, but once biopsied, can turn invasive and once discovered, the breast is usually removed (the Dr fears liability)

Is this situation disgraceful and disgusting?  I think so....

I'm almost 51 years old - in my lifetime, I've had one pelvic exam (symptoms, but turned out to be nothing) - I have a general check-up every year (blood pressure and blood tests) and at 45 I started to have a professional breast check.  I refused breast checks as a young woman - they are of little clinical value and breast cancer in young women is uncommon - yet Dr's routinely examine young women's breasts - Do they perform routine rectal exams on young men? - they also, carry a small risk of prostate cancer....

For your own protection and peace of mind, I urge all women to question the need for routine invasive exams and tests - demand risk information and refuse anything that doesn't meet your risk v benefit test.

Women need to be informed and stand up for themselves...

Also, never see a male Dr for invasive exams and tests unless it is YOUR choice.  Many women are traumatized by having male doctors forced on them for these exams.

If anyone would like to read up on mammograms - see Articles by Professor Michael Baum, a UK breast cancer surgeon - a man brave enough to tell us the truth about cervical and breast cancer screening.

The screening lobby are powerful....

Also, women who choose to have cancer screening should write to the Government demanding access to the new blood test for cervical cancer - it's almost 100% reliable and a simple blood test - it's called Cervical Specific Antigen....see Onconix website.

Pathologists and doctors will try and delay the introduction of this blood test - they'll lose the enormous revenue that flows from the unreliable pap smear.

 Good luck everyone....
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