(Vent) Why is the pap test treated like it's the most important/magical screening test ever invented?

[gloomtownbratz]

I am 24, never been sexually active, never had any form of sexual contact with another person, never smoked, have no family history of cervical cancer, and I received both GARDASIL vaccines in my preteen years. I never plan on becoming sexually active because I am a full blown asexual who has never experienced sexual attraction and also has no interest in sex point blank period. All of these factors put me at a very low risk of developing cervical cancer, but no one ever seems to care about that. My grandmother died from breast cancer before the age of 40 and my mother had thyroid cancer when she was 21. No doctor has ever offered me any sort of screening or check in regards to those cancers, but oh my god they straight up harass me over getting a pap.

Last November I went to get a regular physical for the first time since high school. I figured it had been long enough and I wanted to get into the habit of going every year again. The appointment was going well until we got onto the topic of reproductive health. She asked me when my last pap test was, and when I said I had never had a successful one her entire demeanor changed. She went from talking to me very normally to suddenly sounding really accusatory and lowkey mean. She asked why I hadn't had one, and I tried to explain what happened. I had seen a gynecologist for the first time earlier that year and she wanted to do a pap test. I just went along with it since I thought I was supposed to and said okay. When she went to insert the speculum (before anyone says anything: yes I asked her to use a pediatric one), she could barely get it in before I felt a huge wave of pain. The best way I can describe it would be like a little ring surrounded by a wall of fire inside of my vagina. It hurt so bad I kinda jolted in the chair a bit and she immediately stopped before I even said "ow." My gynecologist then said she was just going to try to do a manual exam with one finger and I said okay. I thought it was just the speculum that was hurting me. She tried to insert her finger and the same thing happened again, so she stopped. She told me I had a very very tight hymenal ring, that she couldn't even get the tip of her finger through it, and recommended I start doing dilator therapy. The doctor I saw for my physical didn't seem to believe what I told her for some reason (???), and just replied in a very nasty tone "well, you better have it done before you see me next." I kinda froze and didn't know how to respond. I felt really really upset after that appointment. I already felt like I was broken and like a failure for not being able to get the pap done in the first place, so having this doctor be so weird/mean about it just made me feel even worse.

Online everything seems to be similar. I have been trying really hard to work with the dilators and do the pelvic floor exercises over the last year, but I haven't made much progress at all. I have the intimate rose set and I can really only use size 1 consistently without pain. I will occasionally do some ill-advised googling about reproductive health care when I'm feeling really down and scared about my situation since I really don't have anyone to talk to about it, and it honestly just makes me feel worse. Every single f***ing article or reddit comment about going to the gynecologist cannot fail to mention how absolutely vital it is to your survival as a human being to get a pap.

"You think that speculum hurt? Guess what? Cancer hurts even more! Suck it up, buttercup!"

"You need one even if you are a virgin and even if your risk for HPV/cervical cancer is super low because... whatever! Just get it already and stop whining!"

"Do you have a death wish? Do you want to die? Because by not getting a pap you're signing yourself up for an early death that will be all your fault."

What is with all the shaming!? What is with all the belittling behavior!? Why are people so obsessed with moralizing a medical procedure!? Where is this energy for other cancer screenings!? Why is everyone so obsessed with the pap!? I understand that cervical cancer is deadly, and I understand that within the general population it can and does save lives through early detection. But how is this energy and this behavior helping anyone? How does saying it can detect types of cancer it can't helping anyone (ex: I often see people claim it can detect ovarian and uterine cancers. No it can't??? It only tests for abnormal cells on your cervix! Nothing else!)? I'm not trying to downplay its importance but seriously why is there so much pressure put on people over this one screening?

I can say from my own experience that I put off going to a gynecologist in the first place because of similar shame-y behavior to this, and this energy also made me failing to complete the procedure so much harder. I felt like a failure. I felt like I wasted everyone's time and that I was broken. The only person who doesn't seem concerned about my inability to complete the pap is my actual gynecologist! I saw her again today, told her about my lack of progress with the dilators, asked to skip attempting the pap/speculum exam today, and apologized for wasting her time. She cut me off, looked me directly in the eyes, and said "you would not be wasting my time! You run the show here, not me! If you wanted to try to do the exam and it didn't work, that's fine. If you wanted to skip it entirely and just do the breast exam, that's fine. We only do what you're comfortable with." I felt like I was going to burst into tears. She's the only person who has shown me any compassion regarding my situation, which is wild because according to everyone else she should be the person most disappointed in me/worried about my life being on the line. I just don't understand why everyone else can't be more like her. I don't mean like brush off the test entirely, either. I just mean I wish more people and doctors would meet patients where they are at. I wish they would go over risk factors and help people make informed choices regarding their situations instead of making others feel like me.

I'm just frustrated about this and I feel like some of the emotions I have regarding the pap are hindering my progress with the dilators. I feel like I'm developing vaginismus or something on top of my existing condition as a result of all the pressure and fear mongering. I literally apologized to my gynecologist today out of guilt. I can't be the only person out there who feels this way, can I? Am I overreacting? Am I even making sense? I just feel kind of crazy

[amber]

Hi gloomtownbratz and welcome to the boards!

I am so sorry that you experienced that from a doctor. That behavior is never ok. I am glad that you've found a caring provider in your gynecologist. It may be worth it to ask her if she has a recommendation for a new primary care provider to see.

You are certainly not alone in your struggles with a pap or pelvic exam. I will not say they are not important, because they are, but for most people the exams should be more uncomfortable than painful and so they are worth the benefits. I'm glad you trust your doctor because I bet that she sees how the benefits for you do not outweigh the pain.

I think a lot of those comments online come from well-intentioned people trying to fight the plethora of misinformation and fearmongering online about paps and pelvic exams. Still, I hear how these thoughts are making it harder for you . I think staying away for pap 'discourse' online would be beneficial moving forward. Online, people often ignore the diversity of situations/experiences.

I do think the possibility of a mental-block, as you mentioned, can be contributing. Besides staying away form conversations online, what do you think would be most helpful to you in working on this?

[gloomtownbratz]

Hello, and thank you! I've been a long time lurker but this is my first time posting. Thank you for responding!

I am glad I found my gynecologist, too. As I'm sure is the case for many of us, I have always been a bit nervous about seeking reproductive care but she has made it a lot less scary. I have been looking for a new pcp since that visit so I might do as you mentioned and ask her if she has any recommendations. It can't hurt to ask!

And yes, I do not mean to demonize pelvic exams or pap tests as they are incredibly important! I was feeling quite emotional last night when I wrote the post and I think I came off as more aggressive than I needed to be. I was doing some research into people's experiences with pelvic floor physical therapy and hymenectomy surgery as my doctor suggested both to me, and people in the comments of the posts were making remarks that I think triggered this reaction in me. Like you said, the people saying those things were well-intentioned, but I kinda took their statements personally and freaked out a little bit. I think the expectation that everyone with a vagina should desire and be open and able to handle penetration at all times weighs on me a lot, and things I hear online or even in person from people like my pcp or my mom have all added up to make me feel very inadequate. Instead of dealing with those emotions in a healthy way, I tend to bottle them all up until one small thing I see pushes me over the edge and I explode.

I spoke with my therapist today about everything, and I think I am going to look into starting physical therapy soon. A lot of the spaces online that are for people with conditions like vaginismus tend to focus on things that fall outside of my goals (ex: piv sex) and they often have people in them who make comments that kind of stress me out. My therapist agreed with me that starting physical therapy might be good not only for my physical problems but for my mental blocks, too, as I will have a person I can talk to in real life about my problems and goals specifically and that I can get advice from. I think removing myself from these spaces until I can get a better hang on my emotions regarding this topic is probably the best idea, so my next goal is going to be to set up a pt appointment and go from there. I'm also going to try and shift my mindset a bit to be more neutral about everything. I want to try to make things like going to a gynecologist appointment for a pelvic exam or working with dilators at home feel like a more neutral and mundane experience, if that makes sense? I think I have too many emotions wrapped up in this topic, which is probably contributing to creating that mental block. If I can switch my mindset from "this hurts and everything sucks and I hate the world" to "yes, this hurts, but I am working with my doctor to make it hurt less for me. It will just take some time, patience, and practice" I think things will get easier.

Thank you again for entertaining my late night frustration rambles. I hope you have a good day!

[mikky]

hey gloomtownbratz,

This is a totally okay space to vent some frustrations around all of this, but I am also glad you are feeling more grounded today. I think you have some really great reflection on what may be best for you- neutrality is great, and that mindset statement (yes, this hurts, but I am working with my doctor to make it hurt less for me. It will just take some time, patience, and practice) is lovely. Thanks for coming back to share these thoughts and reflections.

I don’t think you were demonizing pelvic exams. I completely understand your frustration. The way I see it, the all-or-nothing attitude you’ve been getting from both providers and seeing other people exhibiting is pretty dangerous– it scared you off of seeking healthcare for a long time, and with that provider, created a barrier to accessing other care! I think a lot of people who exhibit that type of attitude around seeking gynecologic care– or really, any specific care or procedure– can project that their personal experience is probably everyone’s. Sure, nobody “likes” a speculum, but I’ve learned that others will assume the discomfort or minor pain they experience during a pelvic exam is what other people are referring to when they say PAINFUL.

I’ve also noticed the focus on the goal of PIV sex in forums around pelvic pain. I think, for people who do put a lot of value on PIV sex, it can feel extremely encompassing and defining- so those experiences and stories get amplified. And I can totally understand how hard it must be for people who feel like PIV intercourse is the only real sex and also are finding that really painful, and also feel like they need to be having that type of sex to affirm their role in a relationship, or gender, or maturity, so on. But it also can absolutely eclipse other experiences and stories. If it helps to know, all the pelvic PTs I have been to, including one who was downright awful, did not assume any specific goals and didn’t ask for any justification or explanation of why PIV is not a goal. Instead, my therapeutic goals have been oriented around reducing general pain and truly whatever is important to me. Sometimes intake forms can be a little rigid, but a PT worth their salt will go wayyy beyond the intake form when figuring out approach and goals.