Older Virgins and Pap Smears

[mirielenfield.livejournal.com]

I've read comments here to the effect that people who've never been sexually active don't need routine pap smears, and that the recommendations for all female-bodied people to have one past a certain age are there to catch those who can't or won't be honest about their sexual histories. Then again, I've also read things saying otherwise, including the official recommendations of various medical organizations. Does anybody know of any reputable sources that specifically discuss this issue? It's been quite difficult for me to find information, beyond the standard statements about how everyone over a particular age should have one, none of which include a rationale for that.

I'm asking because I'm a 28-year-old asexual woman who's never had any sexual contact and doesn't plan to. I know this is something to discuss with my doctor, too (when I get a new doctor, anyway), but I'd like to be educated on my own.

Comments

[cheeseydreams.livejournal.com]

PAP smears mostly screen for abnormal cells that could turn into cancer. While HPV is a sexually transmitted disease that certain strains can cause cancer, sometimes cancer can spontaneously occur. No sex doesn't automatically mean you have no risks, so I would strongly suggest having a discussion with your medical provider about it. Based on your family history, you may not need one at all, but one may be suggested just to make sure everything is normal.

I don't have any sources to suggest, but you could probably search on pubmed.gov for articles or abstracts related to this.

[kuradi8.livejournal.com]

I Googled WHY PAP SMEAR IMPORTANT and it came up with a bunch of results, most of which say the test screens for various disorders, the worst of which is cervical cancer. Apparently having multiple partners increases your chances of catching HPV and other viruses that could make conditions favorable for those afflictions. But celibacy doesn't guarantee that you can't develop them on your own.

If you haven't had one yet or in X-number of years, bite the bullet and get a smear. If the results are all clear then discuss and come up with an interval for your next one that both you and your doctor can live with.

[vortal-cord.livejournal.com]

Official guidelines for all not-at-risk women has been bumped to every 2-3 years for pap smears anyways, so it shouldn't be too much of an inconvenience. :)

[paraxeni.livejournal.com]

You probably don't need one, no. I refuse to trust info about cervical smears from US-based websites as 1) I don't believe a for-profit system truly has the patient's interests at heart and 2) America has a bizarre attitude toward the health of people with vaginas, where every such person is treated as pre-sick rather than healthy, and not capable of making their own health decisions.

Here we start testing at 25 if the person has had sexual contact (then every three years), or three years after first sexual contact in people over 25. Our cervical cancer detection and survival rates virtually mirror those of the US. Current research suggests that smears done on those who are too young to have mature cervical cells return false positives, leading to unnecessary interventions, and the risk of complications in later life especially during pregnancy. The same is true of testing too often. The majority of healthy people with working immune systems will clear HPV on their own. Abnormalities caused by HPV that will result in cancer take a very long time to develop, so a testing interval of one or two years between tests is too close for groups not deemed 'at risk'.

There is a type of cervical cancer called adenocarcinoma that is not caused by HPV and can therefore occur in people who've never had sexual contact. If you develop irregular vaginal bleeding or a foul smelling discharge then this needs to be ruled out.

http://www.netdoctor.co.uk/ate/womenshealth/207351.html


http://www.screeningservices.org.uk/csw/pub/info/leaflets/virgins.asp

[fallconsmate.livejournal.com]

I can't say so much about the pap smears but... The internal exam is important. My grandfather died in 1964. My grandmother didn't see the need for any exam because she was now a permanent widow. She got her heart listened to, blood pressure, that's about it.

So when she off-handedly mentioned to my mama that she had belly pain in 1995, mama took her to the doctor. They ended up removing a five pound tumor from her right ovary. It was fortunately benign. But it could have been caught sooner if she had scheduled well-woman exams.

[atalanta0jess.livejournal.com]

There is actually evidence that the internal exam is NOT important, and doesn't catch abnormalities in women who are asymptomatic. I don't have time/energy to look for it at this exact moment, but maybe someone else will chime in. I understand that it may have been useful for your grandmother, and in symptomatic women it has been demonstrated statistically to improve outcomes. But as far as evidence based medicine goes, the pelvic is not well supported in asymptomatic women.

[marionravenwood.livejournal.com]

The grandmother was not asymptomatic.

But it could have been caught sooner if she had scheduled well-woman exams.

Even that is not necessarily true. It's normal to not be able to feel ovaries at all, let alone masses on them. (I would hope that 5 lbs of anything could be felt, but something in it's early stages might not have been.)

Here are some links:

http://articles.latimes.com/2011/feb/20/health/la-he-pelvic-exam-20110220

http://www.racgp.org.au/afp/200806/200806stewart.pdf

My post on this:
http://community.livejournal.com/vaginapagina/19477591.html

You don't walk around worrying about the health of your liver or pancreas, I hope, and we don't do routine "well-pancreas" checks.

[paraxeni.livejournal.com]

Sorry but that's incorrect. Pelvic exams can detect the presence of a vaginal and cervix, and not much else. I've had a bimanual pelvic exam while suffering with a huge ovarian cyst and been told "all clear". Pelvic exams cannot detect cancer, or infection.

Essentially half of the US population has been trained to believe that their health, life and well-being depends on a yearly pelvic exam. It's coercive, patronising, and makes the base assumption that people assigned female at birth are too stupid to monitor their own health. In the UK we do not have 'annuals'. You have a smear every three to five years after the age of 25, and that's it. BC is not conditional on pelvic or breast exams, you just ask for it.

Unless you have gynaecological or reproductive problems then your vagina will be left alone. Only when someone is pregnant can they expect a pelvic examination. Despite this we are not plagued by crotch-rot. Like I said above our disease detection and survival rates are incredibly similar to those in the US. We are not relying on the false security of disease or abnormalities being detected at an 'annual'. We are encouraged to know our own bodies and the patterns that occur, and to monitor and report any problems. Women aren't cows or cars, they're capable of being responsible for their own health.

[stavegirl27.livejournal.com]

Totally on board with everything you've mentioned- but for instance here in the US with my insurance provider (which is one of the largest in the country) they won't approve paying for birth control unless you have a yearly exam. Its just another way I'm forced to get one (unless I go to planned parenthood or pay out of pocket).

[frolicnaked.livejournal.com]

Do they specify that it needs to be a gynecological exam? I ask because my insurance provider and state law require yearly exams in order to prescribe medications. However, there's nothing that specifies what kind of exam it needs to be. So going for a non-gynecological visit and checking for general health issues (e.g., blood pressure, reviewing medical history, checking individually relevant bloodwork) fits the bill just fine. If there's something gyn-specific that makes an exam ungood for you, it might be worth checking into.

[marionravenwood.livejournal.com]

Exactly this--it's common to require a doctor to have physically seen someone within the past year in order for them to prescribe medication: any medication, not just birth control. I would be amazed if any insurance provider actually required a pelvic exam or pap test for birth control, since it would make it more expensive for them to cover it, not less.

[atalanta0jess.livejournal.com]

Yes - this document (http://caonline.amcancersoc.org/cgi/content/full/52/6/342) discusses the rationale, and is definitely from an authoritative source. It is from 2002, I'm not sure if there's a newer one or yet, but this should give you a sense of what to look for, and if you can't find a newer one, than this would be pretty authoritative.

Pap smears screen for cervical cancer. I believe there is some debate over whether cervical cancer can occur in the absence of HPV. this paper, published in the journal Vaccine in 2005 (http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TD4-4F7VNF1-7&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_version=1&_urlVersion=0&_userid=10&md5=aa55cd24bb1b5c71d8f7107b2fdb8b96) states that HPV is recognized as a NECESSARY cause of cervical cancer. I do believe that I've also seen good sources suggesting that it is not. In either case, the VAST majority of cervical cancer is the result of HPV. So while one could argue that you could still get cervical cancer and thus it is worth begin screened for it...it could also be argued similarly for say, colon cancer in very young people, or all kinds of other cancers. It would be such a rare occurrence that for the most part it's not something that people really screen for. If I were you, I wouldn't feel weird about not getting paps, because even if cervical cancer is a possibility, it is a small possibility, comparable to other small possiblities that we don't screen for. Of course that's just MY comfort zone, and yours may be different.

[paraxeni.livejournal.com]

Adenocarcinoma can cause cervical cancer but it's rarely asymptomatic. The recommendation here is that someone who's never had sexual contact need not have a smear as a preventative measure every 3-5 years, as long as they are aware of symptoms that could indicate a problem.

[marionravenwood.livejournal.com]

Yeah, specifically, in the document linked above, it says "An upper age limit for when to initiate screening is needed for providers who don’t ask patients about their sexual history and for adolescents who are unable or unwilling to disclose prior consensual and/or noncon-sensual intercourse. Such an upper age limit ensures that young women, including victims of sexual abuse, are protected[....]

Provider discretion and patient choice following counseling should be used to guide the initiation of cervical cytology screening in young women aged 21 and older who have never had vaginal sexual intercourse and for whom the absence of a history of sexual abuse is certain.

I would strongly recommend against pap testing for someone in your specific situation. Genital HPV infection is considered a necessary requirement for cervical cancer to develop, and you don't have a history of anything that would put you at risk. The pap test is not perfect, and you have a greater risk of a false-positive than a meaningful result.