I know you love 'em, but you really don't need a PAP test every year.

I was delighted to get a link to this article from the Canadian Women's Health Network today. It explains pretty clearly why we need PAP tests, who needs them and when we need them. It also explains clearly that a PAP test is not in any way, shape or form a test for any STI and that those need to be done separately. Awesome! Great article! So glad I found it. My question is, why don't I know this already? Why don't doctors explain this stuff to us? I have run into some women - often friends of mine - who have fabulous doctors who explain everything to them and give them lots of options and choices around their sexual health care. Sadly, I've never had this. This is what I've had - tell me if any of this sounds familiar to you.

Somewhere in and around 1994, I had a doctor prescribe antihistamines for me for nasty nasty summer allergies. I later found out from a friend who worked at Planned Parenthood (now Options for Sexual Health) that those antihistamines could interfere with the effectiveness of the birth control pills that doctor had already prescribed for me. When I asked the doctor about this she said 'Oh'. No really, that's all she said.

In 2002, now with a completely different doctor, I got a call saying that my PAP test came back abnormal and that I needed another. That came back abnormal as well and the doctor called me in to discuss. I looked at the lab result and it said clearly - HPV effect. I asked if I had HPV. The doctor laughed and said 'no, no, no, of course not'. As if it was completely absurd that a nice girl like me could have HPV. I was not in the least offended by the idea, I just wanted to know if I had it. I called the STI centre and the info nurse said 'Oh yes, if you have that result, you only got it because you have HPV.' Nice. So they sent me for a colposcopy. I was, I think justifiably so, terrified. They were looking for cancer! Neither my doctor nor anyone at the colposcopy clinic would or perhaps could answer my questions about exactly what the procedure would involve, what I would find out, what might happen after that or how long it would take to get results. So I freaked out for almost a month before this appointment happened. When I got to the clinic for my appointment, they handed me a lovely brochure that answered every single one of my questions! Might have been nice to have that earlier! The procedure took about a nanosecond, involved a slight pinch, and the tech took the sample, looked at it right there in the room with me and told me there were no cancer cells. Would have been so nice to know that I was going to get results on the spot! Why doesn't anyone explain any of this to you? And doctors outright lying about what your results mean? What's up with that?

Now, just recently, about a month ago, I finally found a new doctor - I hadn't been to see a doctor since a year after that whole mess. She told me I didn't need a PAP test because I have never been pregnant. That seemed bizarro to me so I explained that I have had an abnormal result and a colposcopy several years before and would really like to just check. She did the PAP test but said that it was highly unusual for someone who has never had sex to have an abnormal PAP. She assumed that because I'm 43 and never been pregnant, I don't have sex. How can we even try to have the honest and open communication that's required for good sexual health with huge assumptions like that going on?

I include the timeline to be clear that this is not something that used to happen. This is my experience over almost 20 years with three different doctors.

So what's my point in all of this over-sharing? My point is that I agree with the author of the CWHN article - women do have a lot of misconceptions about what a PAP test is, when they need it, and when they are and are not being tested for STI's. I believe that responsibility lays squarely at the feet of the doctors. They need to do a much better job of asking the right questions, not making assumptions, and informing women of what tests they can get, what tests they need and why, what those tests will tell them, and what they are and are not being tested for. However, since I have little faith in most doctors to do this, until such time as it actually starts happening, it's really up to us to find the information ourselves and insist that our doctors, even if they might think we don't need them, give us the care and testing we believe we need.

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