To encourage my friend to have a smear test?

[ThatIsVerySilly]

She is 27 now and was called in for her first smear test at the standard age of 25, so two years ago now. However she refuses to have one.

I have told her than nobody likes smear tests, it doesn't hurt and that it's a couple of seconds of embarrasment but she still refuses to have one. She still refuses to have one and has told me that being scared it will hurt or that it will be embarrasing is not the reason why she won't have one but then won't tell me why she won't have one. But what other reason would a woman not want one if not for embarrassment or fear it will hurt?

She is now very upset as when she went to get a repeat prescription of the pill last week her GP told her that she will not be given any more unless she has a smear test. I think this is a good idea as they really are so important and save lives. My friend has told me her GP has nagged her about it in the past so I think they are doing this to push her to have one. Personally I think it's a good idea and sounds sensible.

My friend is still telling me that she doesn't want one though and is now feeling bullied into having one.

WIBU to tell her to just get it over and done with? I feel kind of bad for thinking this but I can't help but think just suck it up and stop being so irresponsible. Having a smear test is nowhere near as bad as having cancer or dying from it.

I'm 30 and haven't had one. I will be later this year though after I've had this baby and my postnatal. etc. (I have anxiety issues about things like that, makes me sick thinking about it buy I know I should)

my SIL is 37 and has cerebal palsy her doctors keep hounding MIL to book her in for one. MIL refuses, says it's completely unnecessary as she's never even kissed a bloke let alone done anything else.

I've had smear tests from a young age (20 I think) as in my home country women tend to have regular gyn checks (with gynaecologist not nurse) once a year anyhow. When I had them with the gynaecologist, in a gyn chair, I never felt a thing. In this country however, a nurse unceremoniously scratched my cervix out while I was lying flat on a trolley, and it hurt like hell.

I now tend to go back to home country and privately pay for a full gyn check every now and again.

I got hounded by my old gp surgery as I hadn't had one. I found it extremely upsetting as they kept reminding me despite I politely told them I didn't require one and if they read my notes they'd understand. I even told the receptionists outright the issue.
A few months later I got a letter to remind me to get the smear. Hubby got on the phone to them and gave them a right earful for causing upset.
I don't need a smear as I lack the cervix which is the whole point of the test and it was extremely upsetting due to the fact it was related to the whole reason why I couldn't have kids and was suffering depression due to it.
Terribly insensitive I felt but never had a letter since. Moved surgery due to moving and wonder if we will have the same rigamole here too.

I was also touched very inappropriately by a male GP when I was 5 or 6 - as was my mother, an Aunt, possibly my Gran and many others, by the same GP (thankfully he was struck off etc and I believe he is now dead) this is why I have anxiety issues about things like this.

Sorry, forgot to say this was commenting on some people saying smear tests don't hurt.

It's a very invasive and awkward procedure and I have full sympathy with women who refuse to undergo this test.

I'm in my 40s and have now opted out of the screening programme. I've done the research and there are way too many false positives leading to unnecessary treatment in comparison to the actual risks of it being a true positive. I believe they've now found similar issues with the prostate screening too.

If the OPs friend has decided against it then that's her choice as long as she is doing so with all the facts.

AFAIK the GP can't withhold hormone contraception for not having a smear test given you can opt out of the programme. They do need to do a general health review on a yearly basis for other issues (blood pressure, changes to migraines, etc) but that's standard with any drug treatment.

It is not your business, you can't judge other people on the basis of your experience.
And she needs to complain about the GP.

I opt out as well due to being at negligible risk of exposure to HPV and alarmed at the over treatment that is carried out following cervical screening. None of my friends seem the slightest bit interested in the state of my cervix, thankfully, as it's none of their business!

It's really difficult . I would leave it and hope that she finds a sensitive HCP to discuss it with one day .
It's difficult , and I say this as a HCP and someone who has had stage 3 changes ( with no symptoms ) found on a routine smear . I consider myself lucky to be here to bring up my children thanks to that screening programme.
When I come across patients who haven't had a smear I try to be sensitive in discussing it with them but it is ultimately their choice . I would never force them nor withold prescriptions .

If I was your friend, I'd be changing my GP. He / she is completely in the wrong to try and bribe her into it. Also, don't GPs get funding for every smear done at the surgery? So it may not just be her wellbeing that's motivating the GP. As long as she's aware of the facts etc, she has made an informed choice. I wouldn't be very pleased if one of my friends tried to talk me into a medical procedure I had already made up my mind about.

for many people, me included, it doesn't hurt. And of course it is 'invasive' given where your cervix is. For me it takes 5 minutes; not the most fun five minutes I ever spend but part of the deal.

this does NOT belittle the OP's problem, or that the test is painful for some. But I'd hate anyone to read this and refuse a possibly life-saving test because it is being presented as an agonising and blood-soaked experience for all.

checked NICE guidelines and contraceptive prescription is not conditional on smear tests. However the UK also now think that hormonal contraceptives give an increased risk of cervical cancer; it isn't just due to increased sexual activity.

be informed of the FACTS and then make a choice.

She is now very upset as when she went to get a repeat prescription of the pill last week her GP told her that she will not be given any more unless she has a smear test.

Tell her to report her GP to the GMC. The GP is using coercive behaviour to improve their smear test record. They get paid based on the percentage of their patients who have a smear. If they miss the target they don't get paid. Doctors are not allowed to withhold treatment on this basis as it breaks their ethical guidelines. The money they receive in this case illustrates the direct conflict of interest the GP has. If the GP is driving women away from their practice by saying this, its as bad as forcing them to have a smear in order to get the pill. So she shouldn't just change GP.

As for whether she wants to go for a smear. As a grown woman she is able to make informed decisions about her care without someone like you judging her and pressuring her.

There is a very respected doctor by the name of Margaret McCartney who writes about how biased the information about screening we are given is, and how it is presented in a deliberately emotive way to 'encourage' women to attend rather than treating them like adults and presenting figures about false positives and the benefits of screening in a balanced way. She herself makes the point that there is a massive difference in screening and investigative smears and she does not have the former. She stresses the importance of tests if there are symptoms or perhaps a family history but questions the fact that we 'have' to have one. She is very respected and does have a very valid point about how we have made the worried well.

You need to back the hell off your friend and give her some good advice about her doctor being completely unethical. If you respect your friend, you should treat her with some intelligence rather than trying to bully her in the same way as her unscrupulous GP.

Only 0.067% of women who undergo smear test actually get any health benefits from it. The rest go through it for absolutely nothing.

Perhaps she's just made a rational decision based on the facts.

And it goes without saying that you should mind your own bloody business.

I'd be encouraging her to complain about her GP actually.

100% this ^

It's her cervix, it is her choice, you should be supporting your friends decision not trying to talk her into something that she obviously does not want to do.

As as for her GP withholding contraception, that is very out of order and needs to be reported.

There are a multitude of reasons women decide not to have smear tests, some like myself even think smear tests can do more harm than good and do not agree with them at all.

I don't go because I have PTSD from rape. Reading or being told that it doesn't hurt most women and can save however many lives each year doesn't encourage or enable me to go: it just makes me feel worse about my inability to go. I have tried, but the panic attacks despite sedatives meant I can't get through the door. I think my gynaecologist did one while I was under GA for something else (as discussed in advance).

If a friend bugged and bullied me about not going and teased me about being frightened about the pain, I would want to punch her in her ignorant, smug mouth.

Why the fuckety fuck are people on here so obsessed with whether OTHER WOMEN have smear tests?

Want a smear? Great, have one. But back off other women.

There are many compelling arguments against having smears when no symptoms present. See RTB's excellent post above. Many women in this country get false positives, leading to further treatment which has its own risks.

The top causes of death for women in the UK in 2012 were Alzheimer's and coronary/ cardio diseases ONS link. Even if you look at cancer specifically, cervical cancer deaths don't feature in the top ten causes of death due to cancer.

It is obviously true that the cervical screening programme has been correlated with a decrease in mortality due to that cancer. But the evidence isn't unmixed and the test isn't uncontroversial. Margaret McCartney is a respected GP who argues against blanket smear tests because if the damage they do to women's health due to false positives.

IMO if we really cared about women's health we'd

• resource midwifery and labour wards a hell of a lot better
• put more money into researching effective contraception without unacceptable side effects, and pain relief for labour
• prioritise preventative health checks focussing on diet and lifestyle, as the biggest contributors to what actually kills us

But that would be complex and expensive. Easier to just guilt women into smears

trouble is that those preventative health checks - don't eat too much and move around more - seem to result in people on here complaining that 'GP said I was too fat'. Doctors really can't win.

glad to hear the incidence of cervical cancer is so low.

I suspect that there is no such thing as 'effective contraception without unacceptable side effects', although the condom plus spermicide and very careful use is pretty near.

I think you should respect your friends right to choose. If she has asked for your opinion, maybe encourage her to go and have a chat with her GP/a GP at the practice that seems approachable and explain to them that she wants to opt out. She could ask them for the reason for their policy.

This may not completely resolve the issue, as pp, but may help.

GPs in the main are motivated by wanting to help people be healthy. They may worry too much about the missing diagnoses, and not enough about over screening and intervention. It's a tough balance.

You will find many threads where people complain that they haven't had various tests, or that something was missed. Others where people feel they have been over investigated. It is a hard line to find. Tell your GPs how you feel and hopefully that will help them to personalise your healthcare better.

Special agreed they can't win! But if I ruled the NHS people would have access to qualified dietitians to help sort health conditions.

I have no idea about contraception but it can't hurt to try - women are expected to put up with all kinds of rubbish!

Personally, as someone in a low risk group for HPG infection, I opt for minimal medical interference and smears only if symptomatic. This makes sense to me as a balance of risk. I would be beyond fucked off if some "friend" took it upon herself to bully me into changing my mind.

*HPV

I'm a HCP & very pro cervical screening, however as long as she makes an informed choice she can opt out. She should let her GP practice know that she wishes to be taken off the register.
I'm sure you're trying to be a helpful friend but her medical history is private.

Fantastic post RevoltingPeasant

I agree with everything you said. When I did research of my own, I was astounded with how uncommon cervical cancer actually is. Everyone I have spoken to seems to believe it's at epidemic levels and I honestly don't understand why

Extra funding for GP practices should be abolished if it is encouraging doctors to blackmail patients into unwanted procedures

Well tbf cervical cancer deaths have declined by about one-fifth in the period covered by the screening programme (introduced 1988 in the NHS).

But as with all risks, it's about presenting them fairly!

In 2012 there were 919 deaths nationally from cervical cancer, according to Cancer Research. So you can see that the original number if deaths prior to the programme, whilst greater, cannot have been that big.

I am not against the screening prog per se, but I do feel there is a lot of misinformation.

And that is not fair on women, as follow up treatments for abnormal cells can make it harder to carry a pregnancy to term or cause infection. These risks should be set out more clearly instead of relying on guilt inducing ads and bully tactics.

I'm certainly not denying that the program saves lives, which is does, which is wonderful. But patients have a right to informed consent which is sometimes lacking. If a women decides for whatever reason she doesn't wish to take part, that decision should be respected and she should not be intimidated or bullied as described in the OP by medical professionals and other women who do wish to take part

Quite! My last GP practice threatened me with de registration for refusing smears which is when I got so hot under the collar about it! Informed consent is key and a big part of that is respect people who say NO.