Why get a PAP as part of prenatal care?

[megviolet]

I have a midwife appointment tomorrow and i'm guessing she will have plans to do a physical/PAP smear. I don't want to, which i'm sure won't be a problem, but i was wondering WHY they do them at all?

My last one was after my DD was born, 2.5 yrs ago.

It should be no problem to decline it, right?

[snoopy5386]

well you are supposed to get one every year - they help diagnose cervical cancer.
I didn't have one as part of my prenatal care, but I did have one 3 months before as part of my annual exam.

[SeattleRain]

It should be no problem, but I don't know why you would. They're really important for female health.

[GuavaGirl]

They're checking for STD's, infections, any irregular cervical cells, size of uterus & pelvis, and any abnormallities of the uterus, ovaries, or fallopian tubes.

Is there a reason why you don't want to get one, other than they fact that they're not entirely fun?

[NSmomtobe]

My doctor did it at my first prenatal appointment because, he said, it would be a while before I would be able to get one again... I guess you can't get them later in pregnancy and i don't know how many weeks postpartum.

In any case, I tried to refuse because I had already had one a few months before, but it wasn't worth fighting over so in the end I just let him do it. It's funny because my last doctor refused to do it if it had been any less than a full year since my last one, but now I no longer feel the need to get one every year.

[moonInLion]

When I got pregnant Dec 2008, and had my first midwife appointment in Feb 2008, at that time my last pap had been sometime late 2005. Midwife suggested to schedule pap for my first postpartum visit with my family doctor (typically 8 weeks PP). The reason she gave: a pap disturbs the uterus, and you just don't want to do this.
(Well, that pregnancy ended in a m/c, so I got my pap done in June, so that's covered now.)

Interestingly, the reason why I had such a large gap in my paps was that from Feb 2006 until Summer 2008 I lived in the Netherlands. And the Dutch healthcare system foresees paps in healthy premenopausal women only every five years (my Dutch doctor laughed at me when I showed up in her office some time early 2007 for a pap.....), especially if all previous paps have been normal and there are no other symptoms. go figure.

[NicolleLynne]

Originally Posted by SeattleRain

It should be no problem, but I don't know why you would. They're really important for female health.

Just wanted to second this... A PAP caught a precancerous condition in my cervix very early on. I had it treated with cryosurgery and have been fine ever since. I know it sounds melodramatic but PAPs do save lives and unfortunately, you can just as easily get cervical cancer when you're pregnant as when you're not.

[katelove]

There is no reason to get a PAP smear as part of a *routine* antenatal assessment.

In Australia it is not done, as normal cervical changes during pregnancy make the tests less effective at detecting ominous changes. Women who are due for a PAP smear while pregnant (we only do them every two years here unless there are changes) are offered one at the 6 week postnatal visit.

ETA - bimanual pelvic examinations are also not routinely done as they are uncomfortable and invasive and there is nothing really to be gained from them. Women are offered full STI screening via blood and urine tests in early pregnancy. If they report signs/symptoms/lifestyle choices which warrant further investigation this is done on an individual basis by need.

[onelilguysmommy]

Originally Posted by GuavaGirl

They're checking for STD's, infections, any irregular cervical cells, size of uterus & pelvis, and any abnormallities of the uterus, ovaries, or fallopian tubes.

Is there a reason why you don't want to get one, other than they fact that they're not entirely fun?

All of that is not a PAP. Also, you can't tell much from the outside or even vaginally about a fallopian tube anyway.


Spotting and cervix irritability and that they can INTRODUCE infection, are some of the reasons that some people don't do it, especially in early pregnancy.

[expatmommy]

There is always the risk of introducing infection when hands & instruments are inserted into the vagina/cervix. I prefer not to have anyone messing down there & to just let my body do what it is designed to do when pregnant. Also, as mentioned previously, when pregnant there are normal cervical changes that make PAPs less effective.

I get my PAPs regularly when not pregnant, but there is no clinical reason and some risk to doing so when pregnant so I opt not to have them then as part of my prenatal care.

[GoBecGo]

I'm in the UK. No-one puts anything into your vagina routinely here until you're 40+ weeks (they might put the ultrasound wand in if you need an early ultrasound for some reason) and they NEVER do PAP's during pregnancy because the cervical changes of pregnacy make it unreliable and it's not actually a good idea to mess with a pregnant cervix because it is more friable and doing a more important job than the non-pregnant woman's. Here we have a PAP every 3 years and this is an evidence-based interval.

You are perfectly within your rights to decline.

[ann_of_loxley]

What she said lol! I am in the UK too and the only thing they mentioned was a 'good idea' was a checkup at 6 weeks post partum. So thats some ways to go!
I personally wouldn't dream of having a 'PAP' during pregnancy...thats a fragile area and not something I would be happy messing with.
You are within your rights to decline - and personally I would.

[rabbitmum]

Originally Posted by GoBecGo

Here we have a PAP every 3 years and this is an evidence-based interval.

Here too. BUT shortly before I was due to have one last year I had some irregular bleeding and went to see my doctor. I had a five centimeter tumour on my cervix, plus threads going out to the left and right... It was so large it was inoperable, and I had to have radiation treatment and chemo. It was horrible. Now it is gone, but I have to have regular checks for years, and live with the fear for it returning, plus the physical and psychological damage that I have suffered because of the illness and the treatment.

Cervical cancer is actually one of the most aggressive types of cancer there is. During my chemo treatment I met two other women my age who, like me, had had their paps every three years as recommended, never had any irregular cells previously, but now had tumours that were too big to be removed by surgery. The oncologist told me this is not all that rare, and he said he thought cervical cancer wasn't taken seriously enough in the Norwegian health care system.
A pap every five years, like in Holland, sounds downright irresponsible!

I am 44 years old and had never had an irregular pap result. I don't smoke, I eat healthy food, am not overweight, I have three children and a healthy lifestyle. The tumour most likely started growing during my last pregnancy four years ago. Pregnancies seem to be a risk period for cervical cancer. I wish my doctor had suggested a pap at least at the six weeks post-partum check-up, then I and my family wouldn't have had to go through this.

[Lauren31]

A lot of countries with government or socialized healthcare seem to give the Pap every 3-5 years bc it keeps the costs down, I guess. To the OP, if I were you I would get the Pap, especially since you last had it more then 2 years ago! Also, ask if they will do the more gentle form of the pap/pregnancy pap bc there is a difference. They swab the cells vs scraping them and it's more safe for the poor cervix who is already doing tons of work in pregnancy

[Bluegoat]

The new recommendation here is every two years for most people.

I got one when I got pregnant this time, but only because I had moved and been without a doctor and neglected it.

OTOH, as a note, if neither your nor your partner has had any other sex partners (ever), the reasons to get a pap are significantly reduced, which most doctors don't mention.

[GoBecGo]

Originally Posted by rabbitmum

Here too. BUT shortly before I was due to have one last year I had some irregular bleeding and went to see my doctor. I had a five centimeter tumour on my cervix, plus threads going out to the left and right... It was so large it was inoperable, and I had to have radiation treatment and chemo. It was horrible. Now it is gone, but I have to have regular checks for years, and live with the fear for it returning, plus the physical and psychological damage that I have suffered because of the illness and the treatment.

Cervical cancer is actually one of the most aggressive types of cancer there is. During my chemo treatment I met two other women my age who, like me, had had their paps every three years as recommended, never had any irregular cells previously, but now had tumours that were too big to be removed by surgery. The oncologist told me this is not all that rare, and he said he thought cervical cancer wasn't taken seriously enough in the Norwegian health care system.
A pap every five years, like in Holland, sounds downright irresponsible!

I am 44 years old and had never had an irregular pap result. I don't smoke, I eat healthy food, am not overweight, I have three children and a healthy lifestyle. The tumour most likely started growing during my last pregnancy four years ago. Pregnancies seem to be a risk period for cervical cancer. I wish my doctor had suggested a pap at least at the six weeks post-partum check-up, then I and my family wouldn't have had to go through this.

I am aware it is aggressive, my mother died of it. She had 7 PAP smears in the 2 years running up to her dx and they were all clear (she was post-menopausal but had irregular bleeding she kept going back to the doctor with), including the one she had 5 weeks before they discovered she had a grade 4 tumour up inside the os, just out of reach it would seem. By the time it was located (with ultrasound after a huge bleed) it was growing into her bladder and uterus and was in her nearby lymph nodes. She had a radical hysterectomy/lymph strip, radiotherapy, chemotherapy, a kidney removed (because a secondary tumour had cut off the artery to it) and then died. She was basically the same as you - normal weight, ate well, non-smoker.

PAP's are not always reliable when it comes to finding some cancers. Having them more frequently doesn't make them more reliable and does cause damage and potentially an in-road for infections to the cervix. There is a balance between catching cell-changes early and causing cell-changes by making the cervix more vulnerable to things like HPV by repeatedly damaging the mucus membrane designed to protect it. In general PAP's detect only about 55% of cell changes before other symptoms appear. I cannot speak in your case, i have not read your notes, but some cancers can advance from pre-malignant to advanced and terminal in 4-6 months, even annual PAP's cannot prevent them. And some, as in my mothers case, don't grow where one would expect and thus go undetected despite repeated PAPs.

It is routinely offered in the UK at the 6week PP check-up.

It's interesting to think of the perception of those in non-state-funded healthcare countries think our government is trying to save money. Cervical cancer is MUCH more expensive to treat than a pap smear is. It is the more common view here that in countries where individuals/insurance companies pay for healthcare a PAP smear is a nice quick way of making an easy buck.

[megviolet]

Thanks everyone for the answers

I was told at my postpartum checkup last time that the recommendation is 2 years, so if i wait until postpartum to have this next PAP that only pushes it to 3 years, and i'm comfortable with that this time.

I totally don't mind having an internal in late pregnancy, when the MW and i are curious how things are going

For the record, i have always found PAPs extremely painful, which the specialist i saw said is just normal for some women so it stresses me out to no end... and in early pregnancy i don't want cramping and spotting like i usually get from them, i can't handle the stress! So i'll be declining it today and get it after baby is born.

Thanks for all who contributed.

[SeattleRain]

Originally Posted by katelove

There is no reason to get a PAP smear as part of a *routine* antenatal assessment.

In Australia it is not done, as normal cervical changes during pregnancy make the tests less effective at detecting ominous changes. Women who are due for a PAP smear while pregnant (we only do them every two years here unless there are changes) are offered one at the 6 week postnatal visit.

ETA - bimanual pelvic examinations are also not routinely done as they are uncomfortable and invasive and there is nothing really to be gained from them. Women are offered full STI screening via blood and urine tests in early pregnancy. If they report signs/symptoms/lifestyle choices which warrant further investigation this is done on an individual basis by need.

I would love to say that only people who report promiscuous lifestyle choices are teh ones who end up with STI's but I think research shows that's just not true. Not to mention that women don't usually REPORT things they're embarassed about (like a cheating spouse!). Not to mention, cervical cancer is not an STI. I think especially if you're a woman who is having babies in their late 30's, you should especially be diligent about getting your paps every year. I actually found the pap to be MORE comfortable now that I'm pregnant.

[Astraia]

I have also heard that seeing abnormal cells during pregnancy is common- when, in fact, everything is normal. It's just that being pregnant can skew the results.

Also- so you have abnormal cells during your pregnancy. What are you going to do about it? Is there even much you CAN do during pregnancy if something funny is going on? I don't think they'd want to do biopsies, etc, during pregnancy (I've never had an abnormal pap result so IDK what happens if there is).

[pammysue]

They may not even do it. This is my second pregnancy with the same MW's and they have never even mentioned a PAP at prenatals and the only internal I had (outside of L&D) was my choice when I was 40+ weeks and wanted to "see" how things were coming along.