Minimising women's feelings re: smear tests

[Gisla]

On local radio this morning they were talking about the importance of smear tests, due to rising numbers of women dying from cervical cancer.

However as part of the discussion they featured a cancer survivor who said the smears were important (fine) and that women should just "close their eyes until it's over".

I understand that the speaker was talking about something very important to them and it's obviously a very important issue, but it struck me that the language used was not very sympathetic to the very valid feelings and emotions that can be involved with such an intimate exam.

Besides the obvious 'lie back and think of England' connoctation, it also reminded me of the way women have often been treated during pregnancy or birth, and the idea that we just have to put up with invasive treatments and get over it. Silly women that we are.

*connotation

I agree with your post. I have put off a smear for some time now because I can no longer cope with them

I find this particularly irritating. I refuse smear tests. I went for a while, and then looked in detail at the stats. I decided that (for me personally) the risk was so low that I'm not prepared to put myself through an invasive procedure every three years. I would never try to persuade a woman to either go or not go, I think it is a personal decision.

women should just "close their eyes until it's over".
This really rankles. Women should, in fact, make their own decisions about medical procedures based on medical advice and any further study they choose to do themselves. "Put up and shut up" is what women are expected to do about so many things, its not at all surprising that this is what is expected when it comes to smear tests.

I agree with this too. I do go for smears when asked (although I began at age 19 so have had extra ones I didnt 'need' according to current guidance, which massively annoys me) although I hate the experience. It makes me feel some undefinable sense of shame- that this is my punishment for daring to have sex, or something. None of the medical professionals involved have said anything to make me feel that way- I can't explain why I do, really- suppose I feel somewhat guilty about some of my sexual history, and it really links in to that.

I never liked them. At the more extreme end I insisted on a general for a LLETZ treatment. Funnily enough I didn't fancy lying there while they lasered my cervix and I wasn't going to be stoic about it.

I heard this on the radio this morning too. They had a young woman on, who was diagnosed at just 25, talking about how vital it was to go and the whole tone was get on with it you silly ungrateful girls.

Every so often there's a thread in chat telling those of us with sexual trauma or abuse in our past that we just need to be big brave girls and get on with it. It fucks me right off.

Why are there not big campaigns to get men to regularly go for prostate exams?

The language used to convince women to attend screening is "must" and "should". There is an assumption that some woman are unable to review the facts and decide themselves if screening is for them. Women are scolded by other women for declining the test. " It's only five minutes", " it's painless" or "it could save your life".

GPs are paid to round up as many un-screened women as possible. Every under screened woman has a flag on her record so that every time she makes contact with her doctor, she is asked about screening. Woman are treated like outlaws. There seems little room for informed consent when there is a bounty to be paid.

Perhaps the reason why screening rates are falling is that women don't want the test? Perhaps they have made an informed decision not to screen. I respect that.

toads, I've had about 5 gp appointments since I've been overdue for screening, but never once been asked about it. My gp practice is particularly awesome tho.

I agree about the "women can make their own decisions", and I've been scolded a million times by other women. Like its a shock that a well educated woman can assess the benefits against the risks / discomfort and come to her own decision. It all feels very 'we know what's best, nothing to worry your pretty little head about dear'.

I've been scolded by other women for not having them. Apart from seeing the practice nurse for injections for foreign travel I haven't been at my gp for years. The practice nurse didn't mention it. They seem to have stopped writing to me.

No great trauma about it for me I just can't be bothered.

That's crap

I don't have any trauma that makes them unpleasant. Mine just always are very painful. As it happens I do go through with it but every time I think "isn't it time that bit of kit was redesigned to cope with soft human bodies?"

But then our pain and our opinion about pain is mainly just hysteria so why bother.

I remember a friend doing his nursing degree dissertation on the statistics of cervical testing/prostate testing, looking at the false-alarm rate, and medical downsides of unecessary treatment. The reason there isn't a routine prostate testing programme is because by the time the tests became available, "evidence based medicine" had come into fashion and someone actually did the sums and worked out that the damage done by unecessary treatment for false positives outweighed the benefits from early treatment due to screening. Now for the interesting bit: if people had been applying the same standards of evidence based medicine back in the day when cervical screening was first mooted, it would never have been introduced either, because again, the damage caused by unecessary treatment actually outweighs the benefits. (Important disclaimer - I don't have access to Pub Med Sci and can't check the veracity of this, but he did seem to be studying the literature very carefully and thoroughly when he did his dissertation).

Incidentally, why are there so many HCPs who won't listen to women? Last time I went for a smear the conversation went like this:

Me: "I know I'm post-partum, but I had an ELCS and last smear we discovered I still needed the smallest speculum."

HCP: "Nonsense, you've had a baby we'll start with a medium sized one."

Me: Thinks: "argh fuck it that hurts take it out now and write it on my goddam notes - I need the smallest fucking size I am only 5'3" and a small build and I had an ELCS." Says: "Ouch, please stop and get the smaller one. Like I asked you to in the first place. Because I do actually know what size my own vag is."

(Actually there's about a 2/3 1/3 split in my experience - 2/3 respect your dignity,take making it as painless as possible seriously, and listen to it. The other 1/3 shouldn't be let near a cunt because they are one.)

I had my first smear about 6 months ago, I was incredibly nervous but my mum had to have treatment for pre-cancerous cells so I wanted to have the test for my own peace of mind, however I am aware of how traumatizing they can be as my mum had experienced sexual abuse and really struggled with smear tests.

She was a wreck trying to psych herself up for the appointments. It also didn't help that there was an attitude that the pre-cancerous cells were a "sex disease" from certain older members of her family, which added to the stigma.

Being told to close your eyes and put up with it is the last thing she would have needed to be told.

Meg, they let you have a general for that? I'm just interested because they normally hate doing a general.

interesti g to hear I'm not the only person who has made that decision not to screen. I really hate the attitude around this.

lurcio that way pretty much what I could gather from the research too. Hence my personal decision not to have screening despite no abuse issues. I don't like it and I'm not convinced there's and significant advantage to it. It's always worth comparing death rates with survival rates if you want a picture of false-positives / unnecessary treatments. As I said, I don't want to persuade other people to not go, but in the grand scheme of things, I save my energy for seriously risky things (like driving) rather than attending screening. It's not an uneducated decision; it's not one I need scolding about. So people who disagree should keep quiet about what I should do an focus on their own medical choices.

This topic came up once before and someone recommended a great book called The Patient Paradox, Why sexed-up medicine is bad for your health by a GP Margaret McCartney, which sets out the position vis a vis cost benefit - it's a really good read and the Kindle edition didn't cost much.

Hmmm - i am in two minds about this. I do think that you have to put up with unpleasant medical procedures, there's not getting away from it. The medical profession are doing what they believe is best, the same thing happens to men with prostrate exams, although they are less frequent. I don't imagine there is much sympathy with men who refuse to get a finger up the bum because they don't like it very much.

I also think of course that you should be free to refuse such tests, but someone encouraging other women to put up with it so that they don't almost die like she did is hardly "scolding" anyone.

Bowel cancer is probably the most interesting screening programme to look at as it's the only national one delivered to men and women. Uptake is very variable and, let's be honest, sticking a cotton bud in a turd is better than having a smear. Not much better I will grant you, but it is better.

I have yet to hear the language of 'should' used about it in the same way, nor (to pick a non-cancer, male-only example) AAA.

So I think it is part of the challenge of how to engage with the public on public health issues. I think women would respond better to an evidence-based campaign, which acknowledged there is certainly a body of evidence that suggests that to the population as a whole cervical screening does more harm than good. It's more complicated than 'lie back and stop complaining or else you'll die'. (I've never missed a smear, btw, and personally never would, but I also know people who've had extreme difficulty in removing themselves from the screening list even if they no longer possess a cervix due to aforementioned cervical cancer).

For those who avoid smears as they cannot cope with it or find it embarrassing - how will you feel if you had cervical cancer and you had to have multiple painful, invasive, thorough medical examinations? For the sake of literally a minute, I do think you should just get on with it. We are very fortunate to receive smears for free, no one enjoys it but it saves life.

I consider myself to be a feminist AND have encouraged other women to have smear tests - I don't see that the two are in opposition. Having said that, I agree that language surrounding procedures specific to women (birth, smear etc) is oppressive.

That doesn't change the fact that I really don't think that smear tests/ pregnancy testing procedures are difficult at all.

Quite agree, Finally. I don't think anyone is saying that encouraging women to participate in any of the screening programmes is unfeminist. But the language used to do so may be.

Whatdoido, I think people's reasons for avoiding their smear tests range from squeamishness to genuine fear and distress, and many choosing not to attend do so because they don't believe the odds (esp in their particular case) warrant the risk of intrusive intervention in the case of a false positive.

Woman's Hour tackled the upcoming change to the cervical screening programme which will lead to changes in the frequency with which we are called for screening based on the presence (or not) of HPV in the sample, something which some of those who currently object to the programme may find more appropriate. The interview is at the end of the programme, head to about 50 minutes, although the rest of the programme is very interesting too.

How about we tell gynecologists to be more sensitive instead?
I was bullied into a smear test despite not being sexually active. This makes me very angry, in retrospect. It was a highly unpleasant experience, and may have caused me harm instead of preventing it.

Yeah, there's no way to make a pap smear a pleasant experience, but a gynecologist who is a bully just makes it worse than it has to be. I mean, people bullying us into letting them stick things into our bodies ... that sounds familiar, doesn't it? We don't need more of that. Nope.

Vestal "It was a highly unpleasant experience, and may have caused me harm instead of preventing it"

do you know, I used to have a link to some info about harm caused by smear tests and I can't find it. (I have been looking because I fully expect to be asked about this again soon).

the irony is, if you google for this, there's just mountains of the usual PR about how essential it is.

I'm not sure that I agree. Most medical tests are invasive and/or uncomfortable but you seem to be taking an issue with this one because it's for women only. If someone had said to close your eyes until it's over about a blood test for example would you still have an issue.

It is everyones right to refuse screening but is it so wrong that GPs remind you about it. Personally a smear is offered to me so I take it. I would hate to get cervical cancer later down the line having had refused the test. Yes, it's a speculum inserted into you but really it's no different than examine your breasts every month or giving a poo sample to test for faecal blood. It's the only way Cancer cells can be detected in the cervix. It was hardly designed to cause trauma and upset women.

Vestal - so sorry to hear this happened to you. It happened to a friend of mine too when she was working in America - despite her telling them that in the UK women who weren't yet sexually active weren't routinely screened because they were at next to no risk.

QueenC

"It is everyones right to refuse screening but is it so wrong that GPs remind you about it."

being reminded is one thing - being harangued is quite another. I filled in a form that had an option for me having opted out, fully consented to this etc, and it took a very firm conversation with another GP (not mine) to get this message across. She looked like she would fall off her chair when I mentioned the financial incentives as well.

I also notice they've recently added to the NHS page that "some women find it painful" - about 20 years after I found how bad it was for myself! Then it's a bit like childbirth - a bizarre culture around not telling women what might happen. I like the full whack of information myself.