Practise nurse withholding the pill without a smear test? (TITLE EDITED BY MNHQ)

[hoomans]

I've just been for a pill renewal appointment with the practise nurse at my GP. I turned 25 last month so have only just come onto the smear screening radar and she informed me that the new rules mean that she can only supply a weeks worth of contraception until I have a smear test and if I continue without having one they will refuse to prescribe it altogether. Surely they can't do this? I haven't declined and I've booked an appointment to get it done but surely this shouldn't be the case?

@hoomans

I probably wouldn't have gone for the smear voluntarily though tbh if I wasn't being made to . I have had the vaccination , I have only had unprotected sex with one partner and I'm not currently sexually active. I also have sometimes struggled In the past with penetrative sex being painful so I know it's going to be painful .

Not necessarily. Ask for a small speculum. They can try and make it easier for you

@godmum56

to add....I think its very easy for threads like these to get derailed into circumstances when such coercion is ok and circumstances when its not...and for adults, that is not right.

The thread is about more than whether it's okay to coerce.

That particular offshoot was about whether there were reasons other than "stubbornness" for women to refuse something that is generally medically recommended.

While it is within women's rights to be stubborn it's also well worth pointing out that women can use reason and take their cues from clinical evidence too.

This ties in directly with the monetary incentive that GP clinics have to increase uptake of smear tests and the need to see that their policies and recommendations are not all made in a vacuum and not necessarily entirely driven by clinical indications.

@NumberTheory

While it is within women's rights to be stubborn it's also well worth pointing out that women can use reason and take their cues from clinical evidence too.

In my case mine is based on clinical evidence, just not the evidence used in the UK. That is irrelevant though. A PP assumed I was stubborn.

Your suggestion of reasons is perfectly acceptable and you used it to back me up against the PP (and I thank you). I think @godmum56 makes the point that you shouldn't need to give reasons at all. If we really believe in bodily autonomy then a simple "no" should suffice.

[quote acatcalledjohn]@NumberTheory

While it is within women's rights to be stubborn it's also well worth pointing out that women can use reason and take their cues from clinical evidence too.

In my case mine is based on clinical evidence, just not the evidence used in the UK. That is irrelevant though. A PP assumed I was stubborn.

Your suggestion of reasons is perfectly acceptable and you used it to back me up against the PP (and I thank you). I think @godmum56 makes the point that you shouldn't need to give reasons at all. If we really believe in bodily autonomy then a simple "no" should suffice.

[/quote]
I don't disagree with this at all and have said so.

But it is relevant that policies are not always in women's best interests either individually or as a group and I object to godmum56 thread policing my contributions and trying to decide what is and isn't "on topic".

Didn’t read the full thread, so not sure if it's been mentioned: if the nurse at your local GP is being a bitch, consider getting your contraception sorted at the nearest sexual health clinic (assuming they're still running despite COVID!)

I find you're less likely to get weird unpleasant comments from the staff in these places, when it comes to personal choices around sexual health (they've seen it all, and I believe they're trained to be less judgemental, to avoid putting people off. They will treat people who would never see a GP)

we seem to be violently in agreement here. My point is, as @acatcalledjohn has stated, that its really easy (seen it before on here) for the point of the OP's post (coercion by an HCP) to get blurred by discussion of whether or not the health (or other) intervention is reasonable which, to me, is not relevant to whether or not its right to apply coercion. I saw a similar thing on here about putting a teenager's gifted money into a sealed till age 18 ISA without their consent. There was much chatter about how much money it is right for a teenager to have which kind of lost the principle of the action.......same here.....whether or not the OP has a "good" reason, a "hmmm" reason or a batshit reason is not relevant to the principle that that kind of coercion is wrong. Hence my comment about rationale being irrelevant.

Good Lord that is shocking and needs definite follow up.

Mandatory smear tests indeed..... there's a bit of a worrying trend towards the concept of "mandatory " being applied in many areas at present which is infantilising and liable to push people away from potentially beneficial things due to lack of trust and coercion.

It also strikes me as ironic that I personally know at least three older women who have been told potentially worrying and gynaecological symptoms have been told to change diet, lifestyle, reduce stress etc etc and then its been discovered that it was cancer down the line leading to fatal outcomes in two after utterly gruelling treatment.

So potential diagnostics that generate money for surgeries due to government initiatives lead to this scenario, women actually asking for investigation can be fobbed off....

Seems like womens health issues need a bit of an overhaul all round......

Just get the smear test. I had major cell changes aged 24 and now I'm 32 I often wonder if that saved my life..I had to have minor surgery

I’d contact the practice manager first, and ask what this is based on, and then put in a complaint to your HA.

You should have a smear test of course but it shouldn’t be forced upon anyone like this.

Rationale is irrelevant.

However, I will give my rationale because I believe the NHS guidelines are rubbish.

In my home country (affluent European country), women between 30 & 60 get the invite every 5 years. Women of 40 and over who are tested and no HPV is found then wait 10 years for the next invite. Added to that, women who struggle because of sexual abuse or other issues can request a HPV home test. And anyone who presents with symptoms outside of those time frames gets tested, regardless of age.

Both countries have a very similar cancer rate (around 0.00015%), as well as a very similar survival rate (around 75%).

So exactly why are we so keen on shaming women in to going through with this procedure? Why do HCP's think it's acceptable to withhold medication or treatment in order to coerce women? Why are we putting quotas ahead of the well-being of women?

If a woman says NO then please have the decency to simply accept it. We are capable of making our own decisions.

@godmum56

we seem to be violently in agreement here. My point is, as *@acatcalledjohn* has stated, that its really easy (seen it before on here) for the point of the OP's post (coercion by an HCP) to get blurred by discussion of whether or not the health (or other) intervention is reasonable which, to me, is not relevant to whether or not its right to apply coercion. I saw a similar thing on here about putting a teenager's gifted money into a sealed till age 18 ISA without their consent. There was much chatter about how much money it is right for a teenager to have which kind of lost the principle of the action.......same here.....whether or not the OP has a "good" reason, a "hmmm" reason or a batshit reason is not relevant to the principle that that kind of coercion is wrong. Hence my comment about rationale being irrelevant.

We are not in totally in agreement. I think the post and feminist response to attitudes around things like smear tests is about far more than simply whether or not you can refuse one without reason. OP specifically asks about what might drive the GP's practice to try to coerce her.

I don't think it's just about the right of women to say no. I did not simply supply a list of rationale I thought acceptable (because I agree you don't need a rationale). I deliberately referenced a rationale that someone might have that was clinical to highlight the fact that HCPs and health care policy does not necessarily reflect patients' best clinical interests and women can reasonably (and ideally should) consider recommendations for themselves even when they seem on the surface to be about best medical outcomes.

I also notice that you didn't have a go at the poster who mentioned rape as a reason for not wanting a smear. Is it just when women might be engaged in the scientific evidence behind recommendations that you think it's an inappropriate subject to raise?

I work in a GP surgery and this is utter bollocks. You cannot be forced to have a smear if you don't want to, they cannot withhold contraceptives from you because you have not had a smear test, their is no correlation between the 2. Unlike with blood pressure where they could say they want to see you first as the pill can cause you to have high blood pressure.
I would complain about this to the practice. In regards to the alcohol...was it misplaced joking??? She sounds a bit of an idiot tbh.

I would ask for an appointment with a different nurse. Or ask for a GP appointment, probably over the phone these days. Don't be railroaded into an invasive procedure if you're not ready for it yet.

If you are able to, please put a formal complaint in to stop this happening to other women. You won't be the only one they try this on.

Thinking about it I'm not comfortable with seeing this woman again. She also made me feel stupid when she asks me if I check my breasts for lumps and bumps, I said yes but I have implants, does that make a difference? Meaning does she need to know for extra checks/ would it make a difference to the prescription I wanted and she made me feel silly by saying well implants don't stop you getting cancer you know you still need to check them almost mocking me and completely misinterpreting what I said.

I got sick of patronising practice nurses so I now order the mini pill online from Superdrug. £30 for a 6 month prescription, well worth it in my opinion. There's a quick health questionnaire, but nothing mentioned about smear tests. It does ask for a recent blood pressure reading, I have a small monitor I use at home (can be picked up at most pharmacies).
It's always a good idea to get a smear done though.

hoomans it sounds like you have little faith in the nurse or the practice. Is it easy to change practice where you are? Failing that, is there a convenient sexual health clinic?

I would put in a formal complaint about the policy and the nurse's treatment of you if you feel up to it. But more importantly look to get healthcare from somewhere else if you can.

@Lovelymincepies

I work in a GP surgery and this is utter bollocks. You cannot be forced to have a smear if you don't want to, they cannot withhold contraceptives from you because you have not had a smear test, their is no correlation between the 2. Unlike with blood pressure where they could say they want to see you first as the pill can cause you to have high blood pressure. I would complain about this to the practice. In regards to the alcohol...was it misplaced joking??? She sounds a bit of an idiot tbh.

Exactly. It is only reasonable to withhold medication if the required monitoring has not been done according to manufacturer instructions or NHS guidance. There is no guidance that cervical smears must be done before prescription of the pill as it does not increase the risk of cervical cancer.

Out of interest OP, did you have an HPV vaccination as a younger teenager? If this was before sexual activity you probably have a much lower risk of cervical cancer than older women anyway,.

I do find it odd the attitude here to women during medical procedures, like we are still infants or wombs to be monitored.

I chose not to remove excess body hair. I’m comfortable with that, partly as I grew up somewhere where it was more common not to. My last smear the nurse huffed and puffed. She tend said TWICE during the appointment ‘it’s far more difficult when woman don’t groom themselves’, the second time acting like she was wading through a fucking jungle to find a needle with drama and a screwed up nose.

For context whilst I have a natural bush it’s hardly matted closed and impenetrable! It’s pretty standard, I don’t even have thigh hair for gods sake. I had showered just before also if anyone wants to imply that was the issue. It wasn’t, I was freshly showered and neatly turned out in work clothes, make up- the lot!

I was so cross, it could really really damage the self esteem of a younger and less confident woman. She acted like I was dirty.

Bella, yes I had the three vaccines when I was around 13 .

@TheViewFromTheCheapSeats

I do find it odd the attitude here to women during medical procedures, like we are still infants or wombs to be monitored.

I chose not to remove excess body hair. I’m comfortable with that, partly as I grew up somewhere where it was more common not to. My last smear the nurse huffed and puffed. She tend said TWICE during the appointment ‘it’s far more difficult when woman don’t groom themselves’, the second time acting like she was wading through a fucking jungle to find a needle with drama and a screwed up nose.

For context whilst I have a natural bush it’s hardly matted closed and impenetrable! It’s pretty standard, I don’t even have thigh hair for gods sake. I had showered just before also if anyone wants to imply that was the issue. It wasn’t, I was freshly showered and neatly turned out in work clothes, make up- the lot!

I was so cross, it could really really damage the self esteem of a younger and less confident woman. She acted like I was dirty.

I would definitely complain about that.

Well I went and it didn't go well. As soon as she tried to put the speculum in I said ouch and winced as it was hurting me. I assumed she would try and use some lube or a smaller speculum but she just carried on. She got halfway despite me being in pain then said she could see some white discharge and this is why it was hurting me and therefore she couldn't continue until I have taken some swabs to test for infection. It is clear\whiteish discharge which I have always had, it's not loads, a tiny bit on my pants sometimes I assumed it was quite.normal, it doesn't smell. I said I haven't had sex since my last sti test and she said well it will come back negative then won't it if you're not sexually active. When I got off the bed I was shaking a bit and she said 'you can stop shaking now'. I came away feeling awful and I can't face going back to see her. I'm going to go back and try again but I'm going to insist I don't want to see this particular woman.

You ought to complain in writing to the practise manager. Her attitude is terrible, I have a lot of fear around smears but my local nurse is fantastic, very reassuring and careful. Your smear experience should not be like that at all

I am absolutely shocked about this. Access to contraception should not be tied to anything (except blood pressure readings where relevant).

Yes women need to go for smear tests - or better, they need to have their HPV status checked. But home HPV tests are a credible alternative and should be rolled out nationwide - now. Rather than trying to coerce women into having an unpleasant procedure.