Abuse and smear tests

[me2oo]

I'm posting this here as I don't want a questioning of the validity of abuse and subsequent reaction response, so value a feminist perspective.

I suffered sexual abuse in my teen years. As a result, I really really struggle with going for a smear test. The letter sends me into floods of tears, as do all the reminders, and the thought of going makes me physically recoil. So I avoid them, and I know it's not good.

Has anyone experienced anything similar? Is there anything you can suggest?

Hun I am sorry I also react very badly to them as I was raped many years ago and walked away refusing smears for years
I now make sure I have some one with me [my Mum/DP] and I INSIST they come in with me.
A Dr does it and I speak before hand to them they know I am stressed etc
I get a double appt so no pressure/rush
I don't take a relaxant I need to be in control
I will not tell you what you already know
Could you ask the GP to guide you and let you do it yourself? My Gyne produced a mirror a light and talked me through it, it was weird but gave me control but this was a very nice male who instantly understood my hell no reaction to him.

Do you have a family planning clinic where you could go instead of the doctor? That's where I go and always get a female doctor.

I'm sorry about what happened to you.

I hope somebody can come up with something of help to you as (as you know) smears are essential. I've pre-cancerous cells removed once so far and was very grateful to my smear test detecting them. Or else I would be dead now.

I'm sorry to hear what happened to you. I'm a practice nurse, I do smears, maybe I can offer you some advice from the 'other side'.

I have had a couple of women come to see me for smears who have told me they had been abused or raped. We had an initial appointment where we talked through her fears and I explained what would happen during a smear, and showed the women the equipment used and what I would be doing and looking for.

Then the women came back for their appointments (I made double length appts so we had more time) and obviously could bring a friend or family member with them. We took it slowly and carefully and I made it very clear that they were in charge, it was their body and they would tell me when/if to stop.

I hope you can find someone you feel comfortable with at either your surgery or a FPC and can have a smear; they're so valuable.

Good luck.

Thanks all.

Sidge that's useful to hear from the other side. I was worried that I'd get told off if I made a fuss about it. I think I'll see if I can make an appointment to explain the problem, and then make an appointment to get it done when they know. I suppose they would rather that than them just ignoring them. I do think they should put it on the leaflets or something though, as I find the letters get nastier and nastier and they never actually ask why you don't want to go, or suggest that you can discuss it with them. All the advice seems to focus around 'it's not painful' which is really the least of my worries.

me2oo, you are so not alone, your reaction is well known. I took part in a big study earlier this year that was trying to find out what specific fears might prevent women who have been abused from making/keeping appointments for smears, and how appointments and the system around them could be made safer-feeling. So it's understood by people who do the tests that many women who have been abused find even the thought of them unendurable. And they want to make it bearable if they can.

I think it's a great idea to make an information appointment first. It can also give you the chance to suss out the person who'd be doing the test - you can ask to see someone else if you want to. You can also take someone supportive to that pre-appointment if you want. If you're not able to speak about it easily you can write it instead.

I had one done a couple of weeks ago. I wish I'd had your idea before I went! But I did know I would be basically re-traumatised and I booked the whole of the rest of the day off for being protective of myself and my wounds - things I needed at the time of the abuse. Award yourself gold stars and treats and don't skimp on the self-praise for at least a week after every single step that it takes you to get it done.

I really feel for you, and I know exactly what you mean about the letters. They can start to feel like you're being blamed again, huh? 'If you do not make an appointment we will record you as having refused to have a test' kind of thing. I told the study they needed to get rid of that threatening tone - sorry they haven't followed through yet.

for you, because you're being brave.

Hopefully you will get someone as nice as Sidge!

me200, I have never been abused or raped but did have a bad experience with a smear test itself ( very young inexperienced doctor) As a result, when I needed another one, I was very fearful. I made two appointments and on both, I got the bus into town but once off the bus, couldn't face going into the clinic so walked the other way and went shopping instead. I hadn't explained my fears to anyone in the hospital so they didn't know how nervous I was and sent me a very stern letter about how important the smear was.

When I finally did manage to go in, I was lucky enough to get a lovely nurse. I explained what had happened before and she was brilliant! She knew exactly what to say to me and was so gentle, I didn't realise she had done it.

By the way, I am not at all comparing my initial experience to yours, having been abused must mean that your are 100 times more fearful than I was But I wanted to say, that IMO, you need to tell someone what you went through and to ask for a female nurse/doctor who is very experienced.

Good luck!

Now, I am not comparing my experience to yours at all

Sorry, last line shouldn't be there! Edit failure!

I've just been invited for my first smear after a traumatic birth experience. I cannot bring myself to go, and I realise that I will probably never have another smear test now.

I could possibly use the advice on this thread to get me through the smear itself. But if the screening test was negative, I would regret going, and having put myself through the trauma of the test. There is a 9 in 10 chance of this.

If I was one of that one in 10 women who had changes detected, I do not believe I would be able to face going to a hospital for a colposcopy.

It is not irrational to choose to take the tiny risk of having cervical cancer because the test would be too costly. We choose to take risks every day. I am about to drive to a supermarket in the snow, when we could just eat beans for the next few days. I am choosing to take a risk, and I don't think many would blame me for it. I don't like the idea that, as a mother, I have an obligation to endure invasive cervical screening for the sake of my family.

From here:

"Professor Peter Sasieni from the Wolfson Institute of Preventive Medicine in London, says women should view cervical screening not as a test for cancer, but as "a costly and imperfect insurance policy" against the "catastrophic" but unlikely event of cervical cancer."

Unwind, I'm really sorry about your traumatic experience and understand it must be very difficult for you. I don't know if you have had counselling, and hope it is available for you in your area.

But, I cannot let your comment stand unchallenged as it is dangerous. If you decide to not go for smears it is your decision, but please don't suggest that it is a reasonable thing for others to do.

The chance of cervical cancer is so low precicely because screening is done to catch pre-cancerous cells. That is what a smear test is for. As I and my sister have found, both having had pre-cancerous cells removed.

I've looked up Professor Peter Sasieni and he has said a lot about how the new HPV vaccine will reduce the need for smear tests. But he also says:

'Professor Sasieni said: " The UK cervical screening programme has done a fantastic job in reducing cervical cancer , but it is based on an old screening test. ...

Professor Sasieni says it is not that the old method is bad, more that it is now outdated and involves testing women many more times than necessary.'

www.bbc.co.uk/news/health-11717154

Anna Sayburn, the author of the article in Unwind's link above is a journalist. I would rather take medical advice from doctors rather than journalists.

You and your sister had cells removed, which must have been an ordeal - what are the odds that either of you would have developed cervical cancer if you had not had this procedure done?

Refusing cervical screening is an entirely reasonable thing for anyone to do - as with any other decision you weigh up the risk/reward. If the cost of having the "insurance" of this screening test is too high, it is rational to opt out. The cost will often be much higher to those who, like the OP, have been sexually abused.

I didn't find it that traumatic tbh Unwind. I find smears etc. unpleasant but somehow I manage to block out my rape and don't relate the two things. I suppose intent is part of it. I find the dentist far more invasive and traumatic.

The odds that I will develop cervical cancer whilst having smear tests and having pre-cancerous cells removed are very low. I can't say 0% as there are failures in screening which very sadly mean pre-cancerous cells are missed.

Do you mean you were not told what the risk was of you developing cancer, given that abnormal cells had been found? If so that is utterly outrageous. How can you give informed consent for a procedure without knowing the odds?

Since you don't find smears, or even colposcopy and excision traumatic - the rational decision for you is obviously to keep having them.

But it is a personal decision and it may not be the right choice for other women. Aside from those who dread smears for whatever reason, women who have had the HPV vaccine before becoming sexually active will be at much lower risk of developing cervical cancer. I wonder if the girls who are getting it now will even be offered the screening test when they reach their mid 20s.

I used to find smear tests very difficult due to childhood SA but then like Unwind, I had a traumatic birth and it was much worse. I am in tears because I have had 2 reminder letters now and I am too scared to go because of the pain and upset of it. My practice nurse is useless and I don't know if the GP - who is male but who has been very careful during the many fanjo examinations he has had to perform on me, poor man - is able to do it?

I am debating not going for smears again too. I have only ever slept with my DH and he with me. But my great aunt died of cervical cancer (I think it was that but may have been ovarian) so I don't know if that puts me at greater risk.

TheProvincialLady - smear tests shouldn't hurt if they are done properly. Have you got a family planning clinic near to you? You can go to them instead.

As I said above Unwind , it is indeed a personal choice. I would of been told the risks, but I wouldn't have been prepared to take any chance. I can't remember now as it was many years ago and I find it hard remembering my age these days! I didn't say I breeze through smears etc. but it is within me to be able to do them, as it is everyone. I'm not criticising you at all for your choice. But please don't put other people off with the opinion of journalists. It's too important.

They do though They hurt at the time and then I get period cramps for a couple of days afterwards. I am 35 and have been having them since age 21 with a different nurse each time so maybe I am just a freak of nature. I can't believe the FPC would be any better would they3?

And now I have the added bonus of a battered fanjo following two lots of internal birth trauma.

If men needed a similar test they would have invented a way of doing it that did not involve lying spreadeagled with a chu+nk of metal and a brush up their penis.

I'm sorry ProvincialLady, sometimes they hurt for me and sometimes not. I don't know how to compare the FPC with surgeries as I've always gone to a FPC for contraception and smears. Probably because my mother always did and we accompanied her as children.

TheButterflyEffect - I think it would be possible to write or email that you had suffered trauma in the past and find gyny procedures very hard.

Earwicga - if I was told I was at increased risk of developing cancer, I would never forget what that increased risk was.

The guardian article I linked to is the only place I could find statistics to help me make a decision, without having to access journals behind paywalls. That in itself is outrageous. It is factual and sensible, refraining from the usual daily mail style scaremongering about cancer. My NHS pamphlet, on front of me (a new one arrived today)does not mention the odds of developing cancer if abnormal cells are found. I respect the journalist for doing the research - I am almost certain that she will have read more on this than my own GP.

Yes, I could somehow bring myself to face the smear tests, but there is also that 40% chance of an abnormal result, meaning (for me) an utter nightmare of hospital tests with a still very low chance of actually developing cancer (something of the order of one in 156).

Just had my first smear (aged 27, been married for 5 years) and despite being tripped out on diazepam it was extremely traumatic and took over 50 minutes.
The doctors and nurses were lovely, but as others have said, after sexual abuse even the letter can be enough to reduce you to tears.
My consultant was incredibly apologetic and has recommended general anaesthesia for the next one. This is about the only circumstance where I'd agree to have it done again.
Could you request this?

General anaesthesia is far from risk free. You would need to weigh the (very small) chance of compliations from general anaesthetic against the (also very small) chance of anything being found in the pap smear.

Obviously, if there are symptoms of a problem, that is different. But that is not cervical screening.

Good for you and your superb memory Unwind! I was given genital warts from my rapists. Therefore the risk of developing cervical cancer is higher for me because I have HPV.

A quick google comes up with this info:

'# Genital HPV infections are very common and are sexually transmitted. Most HPV infections occur without any symptoms and go away without any treatment over the course of a few years

However, HPV infection sometimes persists for many years. Such infections are the primary cause of cervical cancer. HPVs may also play a role in cancers of the anus, vulva, vagina, penis, as well as oropharyngeal cancer.

www.cancer.gov/cancertopics/factsheet/Risk/HPV

As I said before, take a chance on your own life but please don't encourage others to do this on the word of a journalist.

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I have asked Sarah of CRASAC if she can offer some advice here on how to proceed with smear tests if you are a survivor of abuse/trauma.

Thinking about prostate cancer - why are digital rectal examinations not routine screening for men over a certain age? Surely lives could also be saved that way? Or is it just too invasive