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Readers Respond: Reasons women avoid Pap smears: Is it fair to require them for birth control?

Responses: 181


Updated October 14, 2010

Go to Mexico or HK or the UK...

It is coercion and I won't permit it. You can get birth control without exams either by using HOPE or picking them up in another country. (Mexico is close by for us) I travel for work as well and have used doctors in London and Hong Kong. I've never had any trouble at all. Like the previous poster, a blood pressure check and a few questions about my history is all that's required. I think women should speak to foreign doctors when you have the chance (not Germany, they are excessive as well) It's clear women are treated very differently in other countries. No gyn exams and although cervical screening is pushed...I've never been denied birth control when I refuse the test.
—Guest Anna

A woman is a disease

In this country women are diseases with no rights...well that is the way doctors treat us. We are not willing participants in our healthcare - we're victims. I don't see our doctors either. I travel to the UK every year on business and see a Dr there for birth control. A blood pressure check and I'm on my way. I told her how our doctors won't give you BC unless you agree to very invasive exams. She was shocked and couldn't understand that at all. She felt these exams should be confined to women with symptoms and screening is ultimately a matter for the woman. She said annual screening was excessive and leads to harmful outcomes. At the most, she recommends screening from 25 and 3 or 5 yearly to 50 or thereabouts. She readily agreed a low risk woman having no screening was only taking the tiniest of risks...crossing a busy street would be a much greater risk and it was even a very small risk for a high risk woman. I respect this doctor because she is respectful of my rights.
—Guest Yvonne

It's down to condoms

My husband and I have used condoms for years. (very carefully) I couldn't allow myself to be pressured into preventative health care. I firmly believe it should be my decision whether I have these exams. I could use HOPE at PP but my husband and I no longer trust or respect doctors. The way women are treated who just want to take a responsible approach to birth control disgusts me. I cannot understand why someone hasn't stopped this by now. We're not having children, my husband has 3 from a previous marriage and we've decided a vasectomy is the next best thing. If I'd been able to get more reliable birth control, we might have left that decision for a few more years.
—Guest Cindy

Are you kidding?

I don't mean to be rude, but how could you even ask that question? Obviously, the answer is no.. Cancer screening can never be required, it's an option that a patient can take up or not. I think the hallmarks of medicine as it applies to womens health are things like dishonesty, excess, lack of respect, paternalism and yes, coercion. Men would never be treated in this way. When a doctor put barriers in front of me, I went over his head and lodged a complaint. I got my script right away. Doctors know they couldn't justify this boycott in a court of law...it's a try-on...don't let them get away with it! It's clear doctors can't be trusted with the power to dispense birth control, so it should be handed to pharmacists. Doctors have all banded together to create this huge barrier to birth control. It's 2009 and we supposedly have all these birth control options. In fact, unless you want to hand over your body or you can stand up for yourself, you have few options. You're back in 1940
—Guest Jillian

No medical care

I was so traumatized by a Dr standing over me and stating I'd need rectal exams, pelvic exams, smear tests and breast exams every 12 months IF I wanted birth control, that I left and never went back. I could see that doctors had the power to do as they pleased with my young body. I had no rights if I wanted reliable birth control. I did some research and found none of these things are necessary in a healthy woman. I'd recommend all women spend a day in the medical library. I've managed over the years, it has put a strain on my marriage from time to time. My husband understood, I explained what the doctors would do to me if I wanted the Pill and he agreed picking up condoms was a better way. I think there is a principle at stake. My husband very kindly had a vasectomy last year. I think many men do that because they also disagree with the way their partners are treated or mistreated. Being a woman doesn't mean our bodies belong to doctors to do as they please.
—Guest Katie

I found another way

I was denied BCPs many years ago because I refused gyn exams and smears. My BF and I were not sexually active before we got together and I'd lived in the UK for a few years. I knew paps weren't necessary for me and I knew gyn exams were not done elsewhere. I studied the Billings Method. I've never had a routine gyn exam or pap smear. I don't believe I need either. I've never had an unplanned pregnancy and it's nice to be in control of my own fertility. My friends who gave in have been put through hell. LEEP, punch and cone biopsies. I felt sorry for them. None of them had cancer. I think the number of women who have treatments for pre-cancer is hard to understand. Before screening was introduced, approx 12,000 women a year died from this cancer, since screening about a million have pre-cancer. It doesn't make sense to me to do this to our healthy women. Most of my friends use HOPE now - Pills with no exams or test. They're all sick of smears, LEEP, biopsies etc... That's not living.
—Guest Deborah

Informed Consent

As an Australian lawyer, I'm unsure how doctors get away with "demanding" cancer screening in return for pills. That does amount to coercion and negates any consent. It's also unethical and a breach of professional standards. Cancer screening has risks and benefits and is offered to healthy people. It is therefore imperative that the patient chooses for herself whether she has screening. Every woman should be able to access reliable birth control; the risks of pregnancy are far greater than the risk of cervical cancer. Cervical cancer is uncommon and the test is unreliable and produces lots of false positives. Biopsies carry risks, mental and physical. When 99.35% of women won't benefit at all from smears and 95% of US women will have biopsies at some point, it's not surprising some low risk women may choose not to test. High risk - their decision. The risk of over-treatment goes up sharply if you have smears before 25 or are over-screened. Ref: R.M.DeMay, Jnl of Cl Path, 2000
—Guest Louise

Women and coercion

The situation in the States is abusive and women have no rights - you're all third class citizens. As an exchange student, I was shocked what they were demanding from women. Our doctors do not recommend rotuine pelvic and breast exams in asymptomatic women, ever...There is no sound clinical or medical evidence backing up the benefits, but there is evidence of harm. Cervical screening is a cancer screening test - can you imagine a man being told he can't get his Viagra until he has a colonoscopy? Yet that happens to women every day in some countries. The States is the worst in demanding unnecessary and optional testing and exams. Birth control has nothing to do with cancer screening. Some doctors even demand mammograms or refuse you the Pill. It is shameful to treat women in this way. Thousands of women have unnecessary biopsies and treatments and are left with health problems. I'm soooo pleased I live in a country where our doctors have our best interests at heart...
—Guest Heidi

should be illegal

I'm 19 years old and i have vaginismis. I am also a virgin, and i require birth control pills for hormonal reasons.. My doctor refused to give me the pills without the pelvic exam and pap... The exam in itself was the most painful thing I've ever experienced in my life, it wasn't just uncomfortable or embarrassing it was physically painful. I experienced vaginal bleeding and soreness for about a week after which the doctor said was typical of vaginal penetration. I felt degraded, and humiliated, and victimized.. i honestly feel like my virginity was taken from me.. after the exam the doctor let me know that to continue the pill and renew my prescription i would have to get paps regularly. I will not under any circumstances... Pap smears are supposed to be an elective preventative test, i think doctors should do their job and educate patients on benefits and make recommendations and leave the final decision to the patient. Requiring an invasive elective procedure should be illegal.
—Guest Anne

No choice

It's no fair whatsoever, No matter what way I choose I lose the stupid game. My foster mother is mad because I choose to be sexually active and now she's forcing me to get a pap test. I'm 17, turning 18 in 3 months. I refuse to have a pap test because I was forced to when I was 11. I HATED it AND I take birth-control pills for hormone reasons, not for the sexual purpose of it.(I bleed uncontrollably if I don't take them)I can't have any more pills if I don't take the pap test? That's bull, I'll end up in hospital&I'll still refuse, If I get cancer then I do, It's not like they can cure it and I'll find out sooner or later. Either that or I end up pregnant. Which I'm sure that they will just love. Well I'll just buy the damn pills. Problem solved. It's our life and our choice. We should be able to get pills WITHOUT a pap test. AND that we can choose to have a pap test. **From the Guide: Actually they can treat cervical cancer if they catch it with the pap smear.**
—Guest xVengancex

Hostage system waiting to explode

So, Hold the ability to self-regulate pregnancy hostage to enforce womens' reproductive health? Hypocritical! Today's medical system doesn't seem to know or care much about women's health unless a woman has cancer or is pregnant. And why force a woman to get pregnant to find out if she's sick? I'd rather a woman be sick and NOT pregant with the aid of birthcontrol, than pregnant and sick because she she couldn't afford a pap, or was scared of one, or what-ever the issue is.
—Guest Silly_Quiet


I don't/won't/can't get regular pap smears, so I don't use the pill. I wonder how many people there are like me, but who instead of using other forms of BC just go without. I have some issues here, but I have to say being on this side of it, it's like being told I don't deserve access. I'm broken or defiant or stupid (however you want to categorize it), and that's my punishment.
—Guest Leigh

Solves one problem but creates another

It is problematic that some women don't get Pap smears, but changing it by denying BC pills to those who don't? That policy creates its own problems. I wonder if there is any better way to provide incentive to get Pap smears. Maybe health insurance discounts, just like a good driving record gets you car insurance discounts? Personally, while I am not scared of the stirrups, I have gone without hormonal birth control before because I was uninsured and couldn't afford a Pap at Planned Parenthood -- around $150, IIRC. That just seemed... stupid. What, women with potentially cancerous crotches ought to run a higher risk of unintended pregnancy? You know, because we can't afford a Pap but we can totally afford an abortion. In any case, it is a complicated issue.
—Guest Jessica

Disservice to women

It is unfair and unethical. I was coerced into pap tests for birth control when I was a teen. A pap is for women who want cancer screening. When it is being forced on a woman in exchange for something unrelated to the test result, it a form of rape. The unspoken message was that having sex meant my body was no longer private or sacred. I cringe when I recall agreeing to lie with my legs braced open for strangers to shove hands and tools inside of me, beca The RN asked if I wanted her to stop. Of course I did! She also said if I didn't have a full exam, I could not have the Pill. I felt trapped. I had no interest in test's outcome. I threw away the test results, unopened. If I had cancer, I'd let it take its course rather than endure invasive treatment . I went through that for 3 years before finding out they had lied to me. I have never gone back. Had I not been put into that awful position, I might have chosen to start screening later in life.


I find the "it's for your own good" argument unsettling, personally. It's too easy to expand it into control over women and their reproductive health. People should be able to access the information available and make their own choices, not have them held hostage by medical professionals or the economics of actually being able to afford a doctor visit and a pap smear. You can't force people into being good or making perfect choices without taking away their right to choose.
—Guest Amanda

I could have died.

When I was younger, I really resisted getting a Pap smear. I hated going to the gynecologist, and if I hadn't had to get a smear to get my birth control pills, I probably would have skipped the pelvic exam entirely. I found it humiliating. When I was 26, though, the doctor found pre-cancerous changes on my cervix. He removed them, and three years later I'm doing fine. I can't imagine what might have happened to me if I hadn't been forced into getting regular Pap smears. It's annoying and it sucks, but I don't always make the best decisions for myself. Sometimes it takes help.

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