Refusal for Pap at health department

[gavinsmommy84.livejournal.com]

I had this experience happen yesterday morning, but have still be so disgusted that I haven't been able to think about it much.

Where to start...I'm recently married (got married in June), and I haven't had a past test since before I began sleeping with my husband (February 2010). I went for my yearly appointment in January 2011 and was told that I didn't need a pap because the guidelines had changed for women in their 20's only needing a pap every two years if there hadn't been an abnormal one in so many years. So, I decided not to get one and save the trouble of it. Well, fast forward to a few weeks ago when a friend of mine says that she has cervical cancer. Upsetting news for her (she's also pregnant), but my husband has slept with this friend before he and I began dating in 2010. I know that the HPV virus can cause cervical cancer, so, naturally, I figure that I should have this checked out for myself , if anything just for piece of mind. Plus, I've been wanting to change my birth control anyway. So, I made an appointment at my local health department, where I've been going for years for my birth control needs (they have always been helpful) since I'm still a student and don't have insurance yet.

I get into the exam room with the nurse practitioner, and she looks over my chart and medical history and says that I don't need a pap since it hasn't been two years since my last one (it was in February of 2009). I tell it that I don't care, that I want one anyway. She still insists that I don't need one. I explain to her why I want one...that a friend of mine has found out she has cervical cancer, and she has slept with my husband, therefore, I want the pap test to see if I have abnormal cervical cells. She proceeds to act like I have no idea what I'm talking about...that they don't do the kind of test that would show HPV since I'm only in my twenties (I'm 27), and they only do those for women in their 30's, and that even if I was exposed to HPV that if I am healthy, my immune system would automatically fight off the virus without needing to have intervention. 

I was shocked. I mean, I know many women in their 20's (especially for reading here on VP) that have had to have intervention due to paps coming back abnormal. I think I was more offended with the fact that this woman acted like I had no idea what I was talking about, and then refused to give me a test that I would have to pay more for. So what if it proved to be worthless, and only helped my piece of mind? I was paying for it, and I think she provided me with misinformation anyway.

I also told her that I thought I may have a case of BV or yeast. I suspected BV, but she came back saying that I had a minimal amount of yeast that didn't even necessarily need treatment and because I'd just gotten off my period, it was normal to show that some yeast (but I thought that being on your period usually made yeast disappear??). But I know I still have some sort of infection, but don't know what to do about it.

And I don't know what to do from this point on. I had tears in my eyes the entire rest of the exam, and on my way home to talk to my husband. I don't think I've ever been treated this way at a doctor's appointment. But I guess I just need some advice on where to go from here. I am lost. Also, sorry for the length of this post.

Comments

[somniumdraconae.livejournal.com]

What she told you wasn't entirely true.

The "pap smear" test collects cells and looks at them under a microscope, and compares them to a standard of normalcy, to look for precancerous changes. This test is the same for everyone - there is no "over 30s" version.

There are also DNA screenings for HPV that you can have done to test whether you have been exposed to HPV. The one used most screens for all the high-risk HPV subtypes in one test. It is a separate test from the pap.

She might have meant they only do the HPV DNA test on women over 30 "normally". However, I am SHOCKED AND DISTURBED that someone who came in presenting a specific situation of concern was denied the tests that they requested.

Write a letter of complaint to the department.

[gavinsmommy84.livejournal.com]

I wouldn't even worry about the HPV test if the pap came back completely normal. I figured a pap would be the best place to start and go from there.

And thank you for the suggestion. I just wish I knew what I could do *now* to ease my concerns besides trying to find an actual gynecologist that I know I can't afford...

[makale-83.livejournal.com]

I agree with this.

[realt-stea.livejournal.com]

i second what the above poster said.

and if your last pap was in 2/2009, wouldn't you be due for another one? it has been more than 2 years, right? (i'm only saying it like that because i've been sick and on cold meds, just want to make sure i'm not hallucinating :) )

eta: can you get an appointment with another provider at the office? or is there a planned parenthood around or something you could try instead?

[gavinsmommy84.livejournal.com]

It was in Feb. 2010, sorry. Got my dates confused :) But essentially that still means that I was only short of the two years by a couple months...Sorry for the confusion.

There's no Planned Parenthood close to my area of Kentucky. There is one about an hour away in Southern Indiana, but I'm not sure how that would work since it would be in another state and all.

[somniumdraconae.livejournal.com]

If you're paying out of pocket anyway, it shouldn't matter that you're coming from out of state. It would make paperwork a bitch if you were using insurance but that's about it.

Give them a call first, let them know they're the closest one to you, and ask if they have any specific policies you should know about for coming from a different state. They'll help you figure it out.

[gavinsmommy84.livejournal.com]

Thanks. I'll try and give them a call :)

[sashafarce.livejournal.com]

Second this. I'm in northern AL and my closest PPs are in TN. I haven't used them but I have contacted them and was told that there was no residency requirement. Where I'm from in the south, where women's services are constantly under attack, sometimes going out of state to PP is the only kind of care you can get.

[marionravenwood.livejournal.com]

I'm sorry the NP was disrespectful, but I've got to say that I agree with her recommendation, if not her delivery of it.

they don't do the kind of test that would show HPV since I'm only in my twenties (I'm 27), and they only do those for women in their 30's, and that even if I was exposed to HPV that if I am healthy, my immune system would automatically fight off the virus without needing to have intervention.

This is true, more or less. HPV testing is only routinely used if you are over 30 or following up on an abnormal pap. Most people who test positive for HPV clear it without intervention in two years. It sounds to me like the NP may have been trying to address your concerns (rudely, it sounds like, but still) without overtesting you. Also, even if you have been exposed to HPV via your husband, if you've only been with him since 2010 it's too soon for any abnormalities that might develop (and they most likely wouldn't) to become serious, and if you'd ever been sexually active before your husband, it's highly likely you were exposed to HPV then. However, if you're informed and paying out of pocket they should absolutely respect your wishes. It's your body and your choice.

I know many women in their 20's (especially for reading here on VP) that have had to have intervention due to paps coming back abnormal.

Yes, but that is exactly the argument against testing people too early and too often: that they are more likely to have interventions for abnormalities that would have resolved without treatment.

Finally, are you absolutely certain that your friend has full-blown, honest-to-god cancer? Not just an abnormal pap, dysplasia, CIN 1-3, etc. but fighting it with chemotherapy and having a hysterectomy cancer? The only reason why I question this is often people get an abnormal pap back and due to bad communication or lack of communication from their doctors they end up terrified that they have cancer and are at risk of death. Only 11,000 people are diagnosed with cervical cancer annually in the US. Which of course means nothing if you're one of the 11,000--please don't think I'm trying to belittle your concern or your friend's situation, however.

[gavinsmommy84.livejournal.com]

I was just going off what she said. She is pregnant at the moment, so no treatments have occured yet.

I think the entire test mattered more for me for my own piece of mind, I guess. I just don't want something to accidentally get out of hand. Plus, I went in there mentally prepared for a pap, and now I might have to prepare myself all over again :)

How long is too long to wait for this?

[eta-carinae-311.livejournal.com]

Also, even if you have been exposed to HPV via your husband, if you've only been with him since 2010 it's too soon for any abnormalities that might develop (and they most likely wouldn't) to become serious

wow, really? I didn't realize it took so long after exposure for anything to show up. even HIV shows up after like, 6 months, right? do you happen to know why HPV takes so long? (please forgive my ignorance! ^_^)

[atalanta0jess.livejournal.com]

The abnormal cells can develop that quickly - I think what Marionravenwood meant was that they would not progress to cancer that quickly.

The idea behind the less-often screening is not necessarily that it's pointless because you wouldn't find abnormalities anyway. The point is that most abnormalities will resolve themselves given time, and that less screening is safe (because it takes time for abnormalities to become serious enough that immediate treatment is necessary) and helps you avoid unnecessary procedures.

[marionravenwood.livejournal.com]

Yes, I meant that it usually takes a decade for abnormalities caused by HPV to progress into cancer, not that you couldn't have an abnormal pap within two years of being exposed to HPV. Sorry I was unclear.

[atalanta0jess.livejournal.com]

In fact (sorry, I can never collect my thoughts!) one reason they are moving away from starting screening so young is that it is SO COMMON for very young people to have abnormal cells! They definitely occur! But they typically don't develop into something requiring treatment, so too much screening can lead to over-treatment, which has dangers of its own.

[marionravenwood.livejournal.com]

It's not that you couldn't test positive for HPV within six months or two years or etc. of exposure, but that in the unlikely event that HPV causes serious abnormalities, it almost always takes a very, very long time for them to develop--usually a decade or more for abnormalities caused by HPV to develop into cancer, if they ever do (most of them regress). Most people who have ever been sexually active with another person have been exposed to HPV, so testing positive for HPV without abnormal cells really isn't the best way to determine risk of cancer for young people.

[atalanta0jess.livejournal.com]

You can have honest to goodness cervical cancer without a hysterectomy. A friend of mine has it, and has been treated with radiation. She still has her cervix and uterus.

I do agree that knowing you've been exposed to HPV is not necessarily a reason to get a pap ahead of schedule. OP, the nurses recommendation was a good one in the sense that getting paps too often can lead to over-treatment, which can be harmful. That said, anxiety can also be harmful! If this is going to be really getting to you over the next year, I would search for someone to do a pap. If not, then it's really fine to wait. The every-two-years guideline basically assumes that you HAVE been exposed to HPV, I'm sure, because most people have. It wouldn't make sense if it was only for folks who had never been exposed.

I know that for ME, yeast can occur more during/immediately after my period. Don't know why, but the doc isn't necessarily super wrong about that. However, if you're in discomfort, than treatment is warranted! Who would want to walk around feeling infectioney! :/

[marionravenwood.livejournal.com]

You can have honest to goodness cervical cancer without a hysterectomy.

My apologies again; I know that cervical cancer isn't always treated with hysterectomy any more than breast cancer is always treated with mastectomy. I was just trying to differentiate between a pap test coming back abnormal and full-blown cancer.

[elialshadowpine.livejournal.com]

"The only reason why I question this is often people get an abnormal pap back and due to bad communication or lack of communication from their doctors they end up terrified that they have cancer and are at risk of death"

I had a doctor tell me I was going to get cancer and die if I didn't get intervention immediately for my abnormal pap. I spent the next eight months or so terrified, because I wasn't able to get to see a doctor because I moved and didn't have access due to lack of a car. When I finally got in to see another doctor, they did another pap and found that my body had fought off whatever was going on, and the doctor told me it wasn't likely anything more than a passing abnormality that they would have kept an eye on.

Needless to say, I always tell people to get more information about what's going on, because fucking hell.

[atalanta0jess.livejournal.com]

Holy hell, that's terrible.

Thank you

[gavinsmommy84.livejournal.com]

I guess I will just wait it all out and try not to worry about anything. They will probably make me have a pap when I go back for a refill on birth control in three months anyway. But, of course, when I go back then I won't want one, and won't be prepared, but I think I've come to terms with the fact that nothing should get worse.