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Dawn Stacey M.Ed, LMHC

Why Do I Need a Pap Smear to Get Birth Control Pills?

By May 11, 2009

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In order to receive a prescription for birth control pills, the NuvaRing, or the Ortho Evra patch, most doctors will require that you have a Pap smear. Letís face it, how many women actually enjoy going to the gynecologist? Some may view the requirement of having a Pap smear in order to obtain oral contraceptives as being a subjective decision by the medical community, and may feel as if this procedure constitutes unnecessary intrusiveness. The Pap smear requirement actually does serve a very good purpose.

Dr. Elizabeth Boskey, About.comís Guide to Sexually Transmitted Diseases, explains: Why Do I Need a Pap Smear to Get Birth Control Pills?

Photo Reprinted with permission from J. Scott.

Comments
June 24, 2009 at 12:46 am
(1) Valirae says:

I read her article. My main problem with it (and the attitude in general) is this:

We are not children. We are grown women who can see and understand the risks involved and make our own choices. How dare our doctors refuse us birth control if we won’t submit to a costly and unneeded (and unreliable) pap smear?

It’s disgusting. I thought we’d progressed further than this.

August 14, 2009 at 3:05 am
(2) Deborah says:

You need to challenge the US health care system.
A pap smear requires informed consent BECAUSE IT HAS RISKS.
No one but the woman involved can accept that risk to her healthy body.
NEVER agree to a smear unless it’s YOUR decision.
Making a smear a pre-requisite for birth control is unethical and I suspect, a violation of your civil rights.
Doctors could not support this practice in the Courts.
It amounts to coercion, which negates consent.
Routine gyn exams are NOT recommended in other countries – in fact, my doctor believes they can be harmful (leading to further unnecessary and possibly harmful testing)
Annual smears and smears before 30 means LOTS of false positives and over-treatment that can leave you with permanent damage to your cervix (infertility, problems during pregnancy) and psychological problems.
If you wish to have smears (and this cancer is uncommon, so look at the risk factors) to minimize the chance of unnecessary biopsies for false positives – look at the Finnish program.
The Finns have the lowest rates of cervical cancer in the world and the lowest rates of biopsies and false positives. (55% of women will have biopsies – in the States, it’s 95% – most will be false positives – this is such an unreliable test)
The Finns don’t start screening until women are 30 and then only 5 yearly stopping at 50, 55 or 60 (depending on past results and medical history)
I’m low risk and was openly told that I’d be most unlikely to benefit, but very likely to face a false positive and biopsies – so I chose no screening.
Every woman should make her OWN health decisions.
Breast exams before 40 are also a bad idea and lead to biopsies….which are a risk factor for cancer. (If you have family history, you should seek advice from a specialist breast physician)
Mammograms before 50 are a bad idea and often lead to biopsies and other problems.
I won’t be having mammograms as the risks are very worrying – new research suggests they may increase the risk of cancer thanks to the radiation and bruising of the breast tissue.
US women are over-examined, over-tested and over-treated to their detriment.
Protect yourselves from harm – know your rights and make your own decisions.
Go to Planned Parenthood and use the HOPE program – you’ll get your Pills without the need for exams and testing.

August 14, 2009 at 3:32 am
(3) Sam says:

The risk of cervical cancer…
Dr Angela Raffles (UK cervical cancer screening expert) released data, published in the British Medical Journal – 1000 women need regular screening for 35 years to save ONE woman from cervical cancer!
Look at the tiny number of women actually helped by this testing AND the thousands of women harmed by false positives and biopsies.(and false negatives)
Andrew Rouse, a lecturer in public health at Birmingham University, published some figures in a letter to the BMJ – VERY few women are helped by this testing. (Google his name to see the figures)
This test was pushed into general practice BEFORE it was properly evaluated – whenever you have an unreliable test for an uncommon cancer, you end up hurting many, many more women than you help….
This test wouldn’t make it over the line today – it fails all three critical components for an effective screening test.
Is it a test acceptable to most women? No
Is it a common cancer? No
Is it a reliable test? No
My best friend is a pathologist and she has never had a pap smear – for her…the risks of testing far exceed the benefits.
If women were aware of the low chance of benefiting from this testing and the high chance of an inaccurate result – only very high risk women would take the gamble (and many of those might choose instead to accept the very small risk of this cancer)
I think this testing has meant women have lost their bodily autonomy – many women don’t feel they can see their Dr for anything without being hassled about pap smears.
The claim made that this testing has dramatically reduced the death toll from cancer is also debatable…one in three women in the States has had a complete hysterectomy for non-cancerous conditions – yet this HUGE group are left out of statistics – they MUST have an impact on the number of women dying from cervical cancer – yet the doctors conveniently ignore this huge group….any reduction is put down to screening.
Also, the small number of women helped by this test – at what cost to healthy women?

August 14, 2009 at 5:15 am
(4) Lucy says:

A doctor knows best…
What an arrogant attitude!
Are doctors also prepared to take full responsibility for the women hurt by this testing? -I didn’t think so…doctor running for cover!

September 7, 2009 at 10:03 pm
(5) JD says:

I almost went deaf because a doctor chose to push an unneeded pap smear on me rather than focusing on my five ear infections and closed ear canal. Doctors don’t listen to women!

October 12, 2009 at 3:04 pm
(6) nancy says:

you don’t need a pap smear to get birth control. planned parenthood will prescribe birth control without a pelvic exam.

Either go there or keep looking for a doctor who won’t try to force you to do an exam you don’t want and you don’t need.

Before I learned about planned parenthood’s program I went to numerous doctors and forced myself to undergo a traumatizing exam. I regret it every day because it has made me mis-trust all those doctors who never told me there were other options even though they knew of my discomfort.

It’s unfortunate, but sometimes you have to force your doctor to listen to you – and don’t give up until someone does listen. Most of all, be strong when you know you have made the right decision for yourself – don’t let anyone scare you into changing your mind.

October 22, 2009 at 5:34 am
(7) Lucy says:

I think that’s right – keep looking until you find a doctor who’ll accept your decision and treat you respectfully.
I presented a gentle and kind female doctor I liked with my reasons for refusing cervical screening.
Our doctors don’t recommend routine pelvic exams (thank goodness!)
I explained that my research (confirmed by a family friend who is a pathologist) showed this was a rare cancer and I was low risk.
I mentioned that I’d find the test confronting, but my main worry was the unreliability of the test.
Could she guarantee I would not face an unnecessary and harmful colposcopy and biopsies for a false positive?
Of course, she couldn’t and admitted a lot of her patients were referred for colposcopy and it was a matter of concern.
She said I had obviously made an educated decision and she would respect that…
My risk of cancer is tiny, and the risk of over-treatment very high. I found it an easy decision.
The risk of dying from almost every other form of cancer is higher…
All of my female ancestors died from heart attacks in their 80′s…so I’ll watch my blood pressure and cholesterol.
It saddens me that so many women focus, worry and obsess about this rare cancer.
I know women who never miss a smear test, but smoke two packets of cigarettes a week.
They have been misled to their detriment…and don’t understand the real risk of this cancer.

My Dr admitted to having doubts about this testing and felt Australia over-screened which led to high levels of unnecessary treatment. She had a few patients that were now refusing 2 yearly testing and she was happy for them to do 3 or 5 yearly testing. (and quite a few had declined altogether)
She felt women were becoming more aware and that was a good thing and made her job easier. She felt there was a need for greater honesty and disclosure and wasn’t sure why that hadn’t happened at the start of the program.
It’s a FACT:
This cancer is rare and the test often leds healthy women for distressing follow-up and a few end up with continuing health problems as a result.

There are ethical doctors out there, but remember from a liability point of view, it’s safer for doctors to simply follow the recommendations from their medical associations. Few are sued for false positives and harm arising from unnecessary colposcopy and biopsies, because few women understand the high risks and the unnecessary nature of their treatment. The greater risk from a doctor’s point of view, is missing the rare woman with cancer.
If you make an informed decision and make that clear, you’ll find a doctor. Doctors are concerned they may be accused of not warning you of the tiny/small risk or of you being the rare woman.
I’ve never had cervical screening and my kind doctor is still my doctor 20 years later!
I think women are misled as to the risk of this cancer and have no idea of the risks and limitations and that is totally unacceptable.

We are adults and quite capable of making our own decisions. Using scare tactics and misleading and manipulating us is just disgraceful.
High risk women should even be careful…even prostitutes in the Netherlands only have 5 yearly screening from age 30….(and stop at 60)
If you choose to have screening, don’t let doctors over-screen you.
Doctors have a conflict of interest and will rarely give you an honest and balanced assessment of this test. They get bonuses for recruiting new women or testing underscreened women and get a financial incentive for reaching screening targets.
This is very unethical, in my opinion.
Sadly, these programs are the enemy and threaten our health and rights…but keep looking, there are good doctors out there who put their patients and ethics first and respect their patient’s right to choose and make informed decisions about their health.

February 4, 2010 at 6:38 pm
(8) kleigh says:

it is up to the woman weather or not she wants any procedger informed consent is requierd for any meadical procedger I am 25 and choose not to have gyn exams at all If a doctor tried to tell me that I could not have birth control without a papsmer or pelvic I whould get a lawyer involved papsmers are an unreliable test for an uncommon cancer that was never comon no doctor hase has the right to push or force anyone into any tests u can get bc at planed parenthood thru the hope program without any pelvic exams or papsmer stand up for your rights ladies

May 19, 2010 at 11:28 pm
(9) Caren says:

Other posters have it exactly right- keep looking until you find a doctor who will respect your refusal. You just have to be willing to get up and walk out of the office. There is no justification for trying to force such a thing on women- the requirement does not serve a purpose, and as grown women we have the right to take control of our medical care. The more of us who stand up and say, “No!” the better. I refused a pap/pelvic exam and when the practitioner saw that I was ready to leave and find a new clinic, they relented and gave my the shot. Ladies, don’t let them bully you into this exam if you don’t want it. They don’t have the right to violate you like that.

June 28, 2010 at 6:35 pm
(10) Laren says:

I read that article on the About STD page this morning and was disgusted by it. She may need some “expert”, expensive (usually male) goof to tell her how to take care of her body, but I don’t. I’ve had pap tests every year since I was 16 or 17 (I’m 23) and they’ve all been normal. I’ve had Gardasil and I’ve been in a monogamous relationship with my fiance for almost 3 yrs. Usually my doc tells me that I have to get one to get more refills on my bc, but I’m going to call his office tomorrow to ask him if this is actually a requirement and if so, WHY. The health center on campus also has that requirement on their website so I emailed them and asked them WHY. What’s the big deal, you may ask? Well, besides the personal sense of violation for no logical reason, pap smears are very painful, both physically and psychologically, for me. I’m always in tears and bleeding afterwards. My doc obviously knows this as he’s there but it doesn’t seem to bother him. Yes, I probably need to find a new doctor anyway.
Like many of these commenters I too was scared into having them because otherwise I was pretty much guaranteed to die of cervical cancer, but after reading these posts and doing other research I’ve decided that once every three years is enough for me. But then how would I get bc pills? They are not just a matter of contraception for me….I have PMDD and get severe, debilitating cramps every month and the only way these don’t happen is if I’m on the pill. Trust me, I’ve tried everything else. It’s rather ironic that I have to go through pain to get pain killers, huh? I’m gonna call Planned Parenthood tomorrow too to see if they can help me. This is ridiculous.
On another note, if they ever approve bc pills for men, will the require a man to have have a cold metal medical instrument shoved up his penis and samples taken in order for him to get the prescription? Somehow, I doubt it.

July 7, 2010 at 10:40 am
(11) M says:

This article ignores medical ethics and informed consent entirely. It’s not ethical to force unnecessary testing on people with no due cause, unless you consider birth control a symptom for cancer.

September 5, 2010 at 6:17 pm
(12) Mai says:

I recently been switched to a new doctor and before she even looked me in the face, she looked at my chart. Seeing I was on birth control at age 19 and never got a pap smear she demanded I get one. That was her first comment coming out of her mouth after just meeting me. My last doctor put me on birth control because she wanted me to have normal periods and I asked her too. She said I didnt need a pap smear unless I felt I needed one.

It disturbed me that the first thing my new doctor said was ” I dont care if your a virgin you are getting a pap smear or I’ll take you off your birth control” She was demanding me to go through something I already told her I was comfortable with.

My last doctor left practice after she had children. She knew why I was uncomfortable with my body. But this new doctor does not seem to care what I think is best for me. I read many article explaining about false positives and how people my size(large) get mistreated because we are larger and ‘disgusting’ to some doctors.

I believe it is our choice to get one or not and not be held against us. If we want to be on birth control, do we really need a pap smear? What if you suffer from vaginismus and you dont know it yet. Imagine the trauma and pain you’ll go through just so you can stay on a silly pill.

I believe its something that should be discussed several times with a doctor before they even hint at it. Doctors only know so much about you. If your not ready. you shouldnt be forced.

September 5, 2010 at 8:15 pm
(13) Mai says:

I recently been switched to a new doctor and before she even looked me in the face, she looked at my chart. Seeing I was on birth control at age 19 and never got a pap smear she demanded I get one. That was her first comment coming out of her mouth after just meeting me. My last doctor put me on birth control because she wanted me to have normal periods and I asked her too. She said I didnt need a pap smear unless I felt I needed one.

It disturbed me that the first thing my new doctor said was ” I dont care if your a virgin you are getting a pap smear or I’ll take you off your birth control” She was demanding me to go through something I already told her I wasn’t comfortable with.

My last doctor left practice after she had children. She knew why I was uncomfortable with my body. But this new doctor does not seem to care what I think is best for me. I read many article explaining about false positives and how people my size(large) get mistreated because we are larger and ‘disgusting’ to some doctors.

I believe it is our choice to get one or not and not be held against us. If we want to be on birth control, do we really need a pap smear? What if you suffer from vaginismus and you dont know it yet. Imagine the trauma and pain you’ll go through just so you can stay on a silly pill.

I believe its something that should be discussed several times with a doctor before they even hint at it. Doctors only know so much about you. If your not ready. you shouldnt be forced.

September 5, 2010 at 8:17 pm
(14) Mai says:

I meant to say wasn’t ** not was comfortable

November 28, 2010 at 6:47 am
(15) Deborah says:

A glimmer of hope for American women.
http://www.msnbc.msn.com/id/40323407/
Take this article with you when you next see a Dr for the Pill and ask why the exam is required. You don’t need a pelvic exam for the pill (or a breast or rectal exam, pap test or a visual inspection of your genitals) I only found out about that last creepy requirement of some American doctors, there is absolutely no clinical need for that exam or any clinical evidence to back up the need…
Breast exams are not recommended in symptom-free women of any age nor rectal exams and pap tests are your decision…if you want them, look at a program that produces the least false positives and over-treatment. It’s a rare cancer so don’t overdo it – 5 yearly from age 30 is heaps if you want them at all. Low risk women – be careful, your chance of benefiting from pap tests is tiny/remote, but the risks quite high…
I think this sort of media coverage is helpful and a positive step – it will make women more aware and make it easier to challenge your doctors. I think more women will refuse and even report their doctors. I’m hoping more of you will have free access to the pill in the future without these harmful and unnecessary requirements.
You should all fight for OTC access to the Pill, no scripts – sadly, your doctors can’t be trusted…

July 18, 2011 at 4:52 pm
(16) cottonlily says:

I haven’t had Paps in years and I find it wrong that they are used as a way to force us to come to the doctor’s just so we can get the birth control pill. I find it completely degrading. Don’t allow yourself to be coerced into a Pap for ANY reason f you don’t feel comfortable having this procedure done.
.

August 22, 2011 at 4:13 pm
(17) anonymous says:

A pap smear and cervical exam are incredibly painful to me. Being married and sexually active with only one man, my doctors automatically treated me like I was crazy and told me I was probably sexually abused and blocked the memory of it. This is completely untrue and I hated their condescending tone and insistence that I was abused when I wasn’t even sexually active until adulthood. This happens to SO MANY WOMEN! There are countless stories about it online and I know several women who have had this happen. I had to come back for three examinations and go through horrible pain before they could successfully do a pap smear. And guess what? Nothing wrong. All this trauma, the horrible treatment, the pain, all completely for nothing. I am happy to be healthy, but I find it insane that women who are sexually active with only one partner and no history of cervical cancer in their family are forced into this exam and then treated terribly by their doctors when they experience pain. I believe this in itself is a form of sexual abuse. All girls should be able to get to a prescription for birth control pills without a pap smear. I will not trust another gynecologist after my experience and the stories of several others experiences. We should not be punished for being responsible.

October 31, 2011 at 1:32 pm
(18) shalee says:
December 23, 2011 at 5:44 pm
(19) niki says:

If you read the whole article by Dr Boskey you see that she has retracted her statement and does not think forcing women to have pap smears to get birth control are a good idea.

March 27, 2012 at 2:21 pm
(20) Michaela says:

I have to go for one on 3/30/12. I am thinking of confronting my doctor about it. This is ridiculous! I’m on birth control because of very heavy and painful periods. Yet, when I had my FIRST Pap Smear, I was burned! Literally! The “doctor” pulled a light over and it burned me! I have had some since, but I do not like it and I don’t see why this is needed to get a prescription for birth control! This is stupid and I feel very unnecessary and intrusive. If my doctor refuses, then I’m walking out and finding a new one.

December 4, 2012 at 7:14 pm
(21) curiouser says:

looking at the sources of that article has taught me a valuable lesson, and that lesson is that even lesbians need birth control…..but i digress….why don’t they make men get their prostates checked everytime they want to buy a condom? why don’t they just make an over counter pill and keep anyone that doesn’t like it happy by carding whoever buys it? they don’t even do that for condoms though…..

February 12, 2013 at 1:12 am
(22) Anonymous says:

I was forced to have a pap smear in order to get birth control that I use for acne only. I was in a lot of pain for two weeks. I was also upset for months after and ended up loosing a lot of weight. I will never get a pap smear done again and I will be avoiding doctors as much as possible. I feel like the are only trying to get billable services and do not care about my health. I think it is unethical to deny me medicine I need in order to get a medical procedure done.

June 3, 2013 at 4:24 pm
(23) kayla says:

We have a right to our privacy and birth control!!! My doctor was really cool about things with me and gave me the shot without a pap because she said it was unnecessary till I was 21 but even then its still my choice! everyone keeps tell me its no big deal or its not that bad haha! Yes it is I didnt even want my husband down there before we were married let alone some random doctor! Its OUR choice ladys so lets them know our bodies our choice!!!

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