Why get a PAP as part of prenatal care? - Page 2

[GuavaGirl]

onelilguysmommy: I was just going off the info on webmd that says was happens during a prenatal pelvic exam.

http://www.webmd.com/baby/guide/first-doctor-visit

(it's towards the bottom on that page)

[busymama77]

I had mine done at my 8 week prenatal appt. I had to because I was already two months past due for getting one. No big deal and I don't mind getting them at all.

[Bluegoat]

Originally Posted by SeattleRain

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.

Cervical cancer has a very clear relationship to HPV. Which is common enough to have most women get a routine pap. But many women who are not, and have never been, sexually active are told they should get paps, which is pretty questionable.

[katelove]

Originally Posted by SeattleRain

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.

Perhaps I wasn't very clear. The section you bolded was in response to the person who suggested that a bimanual pelvic examination was indicated to check for STIs. Physical examination of the genitalia is not a great way of diagnosing STIs as many of them don't have signs which are visible to the naked eye. Or have remitting/relapsing signs.

*All* women here are offered routine screening for STIs in the form of blood and/or urine tests (whichever is the most reliable for each STI). *If* they report any abnormality then a physical examination may be warranted. If they choose not to report that is up to them - personal responsibility for health. My experience as a midwife is that women often will report symptoms although, of course, this is not always the case. Again, their body, their choice.

As to cervical cancer not being an STI, that is true but HPV is an STI.

I am in my mid 30s and until I see any evidence to support it I will not be having PAP smears during pregnancy and I won't be having them more frequently that every 2 years.

[nia82]

I scheduled mine in my pre-conception visit. This way it wasn't important to do it while pregnant, as I had it done in November 2007 and got pregnant 3 weeks later... I didn't want internal exams during pregnancy for reasons mentioned by previous posters.
As for how often, I do them once a year, back in Germany it's once a year too, but while I was taking the pill my ob insisted on paps every 6 months and one ultrasound per year to check for cysts or tumors. I don't know if that is the norm though. I was with government insurance and not private (which is available too there and has much more to offer).

[coffeegirl]

I really don't think that anyone needs to be messing with a woman's cervix in early pregnancy. And I don't believe you need a pap every single year if you aren't sexually promiscuous and don't have any abnormal symptoms. Like others have mentioned, the US is one of the only countries that seems to mandate this and it seems a bit excessive and needlessly invasive.

[soso-lynn]

Originally Posted by Bluegoat

Cervical cancer has a very clear relationship to HPV. Which is common enough to have most women get a routine pap. But many women who are not, and have never been, sexually active are told they should get paps, which is pretty questionable.

While HPV does cause cervical cancer, it is definitely not the only cause and there are many subtleties to diagnosing it. Women who have never been sexually active do get abnormal pap smears too.

To answer the OP's question, while 3 years is in the upper limit of what is advisable in terms of time in between paps, it is still perfectly reasonnable to wait after the birth to get a pap if you are not comfortable getting it while pregnant. Many HCPs push for doing them during pregnancy mainly because many women do not get them regularly otherwise and many of them will forget if told to do it after the birth (you have to wait for the bleeding to stop in order to get an accurate result). The consequences of not getting them for a while can be really dramatic, ending up with a deadly cancer rather than pre-cancerous cells that can be removed easily. Also to be noted is the fact that there are many different kinds of pap tests and that they are definitely not all equal. Make sure that your doctor/midwfe is using the latest technology when you do get a pap.

[megviolet]

OP here, for anyone who is curious, at my MW appointment she asked when my last was and then said she would do the PAPA and other swabs at my postpartum checkup. So, i didn't even have to request it, their practice doesn't do any internal exams until the end (or, obviously, if needed).

[thefreckledmama]

OP: Good deal! I was going to comment that paps during pregnancy aren't recommended, because they're notorious for being inaccurate.

Glad to hear it wasn't an issue for you.

[NataliaD]

Originally Posted by 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).

I had abnormal cells during my first pregnancy. Yes, the doctor could not do anything about it, however it is always good to know if anything is wrong with your health especially during pregnancy. Later, I miscarried, and after the DNC the doctor was able to perform a cryotherapy and eventually treat my condition. I am now pregnant for the second time, and so far things are going well. I see no problem in having a pap during your first prenatal visit. It was worth it for me.

[MiaMama]

When I got pregnant, I'd had a PAP done less than three months prior. The midwives still insisted on doing one. I lost that baby at 10 wks. Two cycles later, I got pregnant again. Another PAP. I was 22.

This is ridiculous. I asked why, and they said something about "getting a baseline."

ACOG recently put out new guidelines. They only recommend a pap every two years for a healthy 22 yr old. NOT 3 every 6 months.

http://www.acog.org/from_home/public...nr11-20-09.cfm

I understand cervical cancer is serious, and that paps save lives. But, I decline if I have had one recently.

The fact that I find them painful when I usually can not feel anything touching my cervix makes me a bit nervous. Just how much tissue are they scraping off?

[SeattleRain]

I agree, it does not make sense to have one done if you've had one in the recommended guidelines.

[NataliaD]

Originally Posted by MiaMama

When I got pregnant, I'd had a PAP done less than three months prior. The midwives still insisted on doing one. I lost that baby at 10 wks. Two cycles later, I got pregnant again. Another PAP. I was 22.

This is ridiculous. I asked why, and they said something about "getting a baseline."

ACOG recently put out new guidelines. They only recommend a pap every two years for a healthy 22 yr old. NOT 3 every 6 months.

http://www.acog.org/from_home/public...nr11-20-09.cfm

I understand cervical cancer is serious, and that paps save lives. But, I decline if I have had one recently.

The fact that I find them painful when I usually can not feel anything touching my cervix makes me a bit nervous. Just how much tissue are they scraping off?

I agree that 3-6 months is unreasonable. However, I also think that 2 years in my case could have killed me. I was only 21 then. I guess I was not one of the "guidelines" cases. At this point of my life, I rather be safe than sorry, and chose to have one done once a year.

[Pinoikoi]

Originally Posted by Bluegoat

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

The change in recommendations, as I understand it, have a lot of controversy..

I have an annual pap test pregnant or no.. I had one last spring, so when I went to see the midwife, she noted it in my record and asked me if I have ever had an irregular pap (nope). She hasn't done one yet with me and I don't think she does them "regularly" at prenatal visits.

I expect one at 6weeks pp and that's it.

[finnegansmom]

When i was pregnant with #1 and going to a procedure-loving ObGyn, I had a pap even though I was super anal about getting them every single year (I had precancer cells 10+ years ago, was treated had paps every 3 months for 1-2 years, etc).
So my pap comes back abnormal. My ObGyn tells me, "Oh, well that happens all the times - the cervix changes during pregnancy - we won't do anything about it now anyways..."
Ummm so what was the POINT of the procedure? I'm assuming just to have something else to bill to my insurance company....

I had a pap post partum and it was normal....I have since changed to a midwife who does not do paps while pregnant.

[MiaMama]

Natalia,
I am not sure of all the details of your situation, and I am sorry you experienced that.

However, the reason the ACOG revised those recommendations is not because they were not finding precancerous cells in young women, but because most young, healthy women were recovering from those precancerous cells without ever developing cancer.

The article says they are concerned that excessive treatment is damaging young women's cervixes when their immune systems would have dealt with the abnormality on its own. They are intentionally trying to catch fewer cases, because agressive treatment has its own risks, and the evidence does not indicate that it is reducing fully developed cases.

This is not necessarily my own opinion, I am not the biggest fan of ACOG. I am just saying what the new guidelines are. I usually get a pap every year, I was just saying that getting pregnant tends to increase the frequency of my paps WAY above the recommendations.