Routine pelvic exams, PAP smear, etc?

[nubianamy]

I'm just going through the paperwork from my doctor's office to prepare for my first office visit. I learned today they usually do a PAP smear/chlymidia/gonnorhea test and pelvic exam, in addition to the blood work. I am feeling a bit uneasy about this! Somehow it doesn't sound like a good idea to be putting foreign objects into my cervix. Doesn't that increase the risk of introducing bacteria into the vulva?

Anyway, I'm looking for studies done on routine pelvics during pregnancy to help me make a good decision. My midwife says we don't need to do any pelvics at all, and the nurse at the clinic said I can decline most of the above ("It's negotiable," she said), but I want to have a well-reasoned decision, not just "It feels wrong!".

Anyone know of any?

[CaliMomof4]

How about - it's your body and you don't want or need to be poked and prodded? Unless you feel you have reason for the tests, it's your right to decline them. They have been hired by you - they can't tell you what to do.

[MamaChel]

I don't have any studies but we had the whole shebang with #1, but nothing with #2. The only time anything went near my vagina was for the GBS test and when I asked to be checked. That's how I'm planning on handling #3 as well.

Have you read Thinking Womens Guide to a BEtter Birth yet? She gives some good information on pretty much anything that is standard or not in pregnancy/labor care. That may help you make an informed decision. In the end you can always go with your gut, remember all these tests and interventions are a new thing. Our ancestors did not lie on a table so someone could take cultures of their cervix. If this was absolutely necessary, none of us would be here.

[scubamom]

the one thing i do think is very very important (not just when pg but all the time) are pap smears, but if you have had one recently then its ok.

But please dont skip pap smears even when life gets busy as its so so important (i treat many patients who regret not having them every day).

For the rest of the exams if you have a health professional you trust ask there honest opinion, as to whether necessary or not.

[Mallory]

I don't think pap smears are very risky in early pregnancy, but I don't think they give you much information either.

Many times if a women does have some abnormal cells at this point they will slough off during birth, and even if they are cancerous you probably wouldn't do anything about it until the baby is born anyway. I say wait until the 6 weeks postpardum visit for the Pap. You don't need that to worry about on top of pregnancy.

With the STD's, if you have any risk factors, get the tests, if not don't worry about it.

[MamaChel]

scubamom, I don't skip pap smears between pregnancies, I just prefer not to have them done while pg. I've known too many people who've had complications from pap smears/vag exams while pg, my SIL came very close to losing her baby this month over a vag exam/pap smear. While I agree that it is very important to consult with your health care provider, in the end they don't live with the decisions. I guess it really depends on your circumstances.

[Metasequoia]

I had a pap done with a pg at 7 wks & miscarried at 8 wks. Just afterwards, unsterile speculums were in the news, so I always wonder if that had anything to do with it??? I've never had a pap while pg since. Sometimes just being pg will cause a pap to come back abnormal & even if it was cervical dysplasia, you probably would wait until after birth to have anything done about it.

[kellykins]

a PAP while pg doesn't sound like a good idea to me either.. but I think I am one of the resident worryworts here :P

[nubianamy]

Have you read Thinking Womens Guide to a Better Birth yet? She gives some good information on pretty much anything that is standard or not in pregnancy/labor care.I love Henci Goer, and I just finished that book -- then passed it on to my mom, who asked to read it. (I actually liked Obstetric Myths vs Research Realities better, but it's pretty much the same stuff.) She doesn't say much about prenatal care. I will go back to <i>A Guide to Care in Pregnancy and Childbirth</i> to check what they have to say.

[nubianamy]

Scubamom, thanks for the encouragement to remember to have regular paps! I admit I sometimes forget to get my yearly exam, but I've never had an abnormal pap, so I guess I'm not too worried.

Thanks for the suggestions, everyone. I think I will wait until after the pg to have the pap. As for STDs, I had a recent (January?) complete screen of everything I could possibly think about, and since then haven't had any lovers except my bf (who is very monogamous!), so I think I am clear.

[etoilech]

Here is a thread all about pap smears and pregnancy. I believe it has reference articles as well.

http://mothering.com/discussions/showthread.php?t=218171&highlight=Pap+smear

My midwife doesn't recommend them for the reasons stated on the thread.

Olivia :thumb

[Ell-Bell]

I'm going in for my first pre-natal (at 10 weeks) tonight, and one of the things that they said they would do is a pap. Since I haven't had one in a little over a year, I thought "no problem!" but now I'm second guessing. I have always had normal paps, so perhaps there is no reason to get one until after baby is born. I will have to read those articles that Olivia posted... thanks!

One question, though. I've had brown discharge, and I was hoping that if they DO do a vaginal exam that they would know what is causing it, or that they could tell if something is up with my cervix. So is there a way for them to still peek inside without poking around too much? I know that I can ask for whatever I want, but I am looking for some vocabulary. Can they do a vaginal exam without a pap... or IS a pap a vaginal exam?

Did that make any sense? Thanks in advance! :o

[lilsishomemade]

a PAP is scraping some cells off the cervix. It's *part* of a vaginal exam. If you're having funny discharge, I think it's important to get a vaginal exam or whatever your provider feels is necessary. They can take a swab of the discharge without messing with the cervix too much.

I don't really believe that a PAP at the beg. of a pregnancy is really useful. Unless, it's your time for one anyway. Everytime I've had when while pg, they turned out abnormal, and I've had to have that cryo done twice, but they always wait until 6 weeks pp, since that can disappear after birth/during the healing.

[LisaG]

One question, though. I've had brown discharge, and I was hoping that if they DO do a vaginal exam that they would know what is causing it, or that they could tell if something is up with my cervix. So is there a way for them to still peek inside without poking around too much? I know that I can ask for whatever I want, but I am looking for some vocabulary. Can they do a vaginal exam without a pap... or IS a pap a vaginal exam?

Did that make any sense? Thanks in advance! :o

Yes they can do a pelvic without doing a pap. Last time I was prego I refused the pap, but let the ob/gyn get a look see. He was able to check out my cervix that way.

Good luck!

Lisa

[Ell-Bell]

Thanks! That's exxactly what I'll do if they want a peek- a vaginal exam is ok, no pap.

Man, so many decisions! And it's only just begun. :nut