What no one tells you about the dreaded pap smear

If you or your partner is promiscuous, this post is not for you. If you are in a long-term, completely monogamous relationship or celibate, read on.

For years I suffered through the annual torture of a pap smear. I was told that birth control pills upped my risk of cancer so I needed to be screened annually. I sort of looked at it as the price I had to pay-- I wanted the prescription so I had to take the test. Once I was off of birth control pills I no longer had to make the annual visit and the window between when I'd bother with a well woman exam kept spreading wider. I was feeling a bit guilty about not having a pap smear in a number of years, until we looked it up to see how often it was recommended... and then learned even more.

Honestly, I'm not even sure I knew which cancers a pap smear tested for-- just female part cancers. I'd just had it continually drummed in to me that it was a super important way to prevent cancer (and who doesn't want to prevent cancer, right?) The government said that I need this test. My insurance company said I need this test. I definitely didn't understand that it only tests for cervical cancer and I most certainly didn't know that a person had to had to be infected with HPV virus, a sexually transmitted disease, to get cervical cancer.  (According to the American Cancer Society "a woman must be infected with HPV in order to develop cervical cancer" link)

I have been happily married for 20+ years. My husband and I were both virgins when we married. I was aghast to find out I'd endured this uncomfortable test for a disease I had zero percent risk for! In this article it mentions a study of 13,000 nuns (not sexually active).  ZERO got cervical cancer.  Think about that next time someone quotes cancer risk statistics.  Zero in 13,000.  In another article clearly very pro testing for HPV it states, you can get HPV "unless you are both virgins and have never fooled around".  Love it when a very pro testing article makes the argument against testing for me :-)

Frankly it makes me angry. It comes down to the fact that doctors don't believe their patients' sexual history. They don't believe it is possible for someone to not sleep around and be married to someone who does not sleep around.  They don't take you seriously when you say that is the case. They do not create testing recommendations for a group they don't believe exists.  Or is it all about the money?

Pap smears are a huge industry. Think of how many tests the labs run and charge insurance for every year. Think how many annual exams are scheduled with gynecologists and family practitioners because of these recommended tests. Whatever the motivations, there is a bunch of unnecessary testing going on.

And some might say, better safe than sorry. What can it hurt to do too many tests?  You might say, well, if you really have no risk, your pap smear will always be negative. No worries. Unfortunately, pap smears are also wildly inaccurate--somewhere in the neighborhood of 70% accurate. So 30% of all pap smear readings are WRONG.  And due to our lawyer happy society if the results aren't clear they will error toward the conservative side, call the test irregular and order a cervical biopsy.

From Web MD link
"Paradoxically, increasing PAP smear sampling among low risk women actual increases your chance of getting a “false positive” one day. For example (DeMay, 2000), if you get a yearly PAP between the ages of 18 to 78, and one assumes a 5% incidence of false positives, you would have a 95% chance of getting a false positive report during that time."

From the NY times link
"In general, about 10% of Pap smears have abnormal results, but only about 0.1% of the women who have these results actually have cancer."

In other words, out of 100 women with abnormal pap smears 99 of them were scared out of their wits and likely had their cervix scarred because of an inaccurate pap test.

Biopsies are talked about as a simple test all the time, so I don't think many people register what they are. A biopsy equals cutting a decent sized chunk out of your cervix! To test for a disease which I would not have. So it is very possible that a person with no risk could have a false positive and have to undergo a cervical biopsy.  A biopsy which WILL cause scar tissue that will be there for life.  And can cause all kinds of side effects.  Not to mention the pain of the actual test.  All "just to be on the safe side"

Want to see what they do for a cevical biopsy.  Here is a video. VERY GRAPHIC.
Biopsy of Vaginal and Cervical Lesions   https://www.youtube.com/watch?v=1JgsW-HjtWs

Colposcopy Procedure (with biopsy)
At time 3:23 is when they take the biopsy.  https://www.youtube.com/watch?v=u7ld_JWH8tU

Biopsy is HIGHLY invasive "just to be safe" isn't good enough.


The other frightening aspect is the risk of cross-contamination. My husband and I both are HPV free. Zero risk there. I'm sure there are other patients that go to my gynecologist's office who have HPV. One sloppy moment-- cleaning equipment, changing gloves, etc.--and it could be transferred to me. Yes, it's not super common, but it does happen.  It is a risk.  Just like there is a risk of getting cancer. Having an exam and pap smear actually increases my risk of cervical cancer. But no doctor or nurse or goverment program will ever warn me of that!

Links to some articles about cross contamination.  Google and you'll find lots more.  Does unnecceary testing put people at risk?  Yes it does.

2010 in texas 70 speculums were not sterilized cross contaminating patients link
Discussion of several incidents link
Dangers of using reusable speculums link
Study finds HPV on spculums AFTER cleaning link

Another good article:
Top Five Reasons for Opting Out of Pap Tests link

Female urethral spasms and prolapsed uterus - Cure without surgery

After about 15 years of living with female urethral spasms (or bladder spasm) we did some big time internet searching and reading about all sorts of things.  Lots and lots of different things.  Some useful and some well..not so much.  And some just down right terrifying.  I forget how but somehow my husband ran across information on uterine prolapse and we started wondering if this might be part of what was causing my urethral spasms. I didn't have an obvious, extreme prolapse-- although recently I had a few days when my tampon felt like it was mysteriously trying to push itself out. The only things I knew about prolapse were that it happened after births and that lots of women couldn't hold their pee because of it. I had never had any issue holding in my urine, so I had never considered it an issue for me, and I'd certainly never had a doctor even suggest it as a possibility-- even though I'd had two very large babies.  More on my personal experience.

All the things we didn't know about the female body:
As we started to learn more, we found there were so many things we had never read or been told about female anatomy. Maybe you already know this stuff and we're just clueless, but I had no idea that the uterus moves around during the monthly cycle. I'd always thought of my internal organs as fixed points but its more a jumble of stuff shoved in together.

As the following diagram shows, the uterus changes orientation throughout the monthly cycle. It's density and texture also changes. This seems to be typically discussed in relation to pregnancy and ovulation.  But this movement will have an effect on what and how much a prolapsed uterus is pushing on.  Seems this is useful information that should be mentioned more.
Complete page

Looking at these diagrams, it made it clear how intimately related the female bladder and uterus really are. And it made sense that at certain times of month (when I would have urethral spasms) the orientation could cause the uterus to push on the bladder if the uterus shifted downward because the muscle walls were not strong enough to support things.

Physical therapy is available instead of surgery
We learned that there are actual physical therapists out there who specialize in pelvic therapy. We would have visited one, but we live in the middle of nowhere where such things are not available, so we decided to learn and try it ourselves. We found descriptions of how to measure the amount of uterine prolapse and tried to measure how low my uterus was. We found that it would slip downward at certain times of the month. And would, as described above, change orientation during the cycle.

As my husband got more experience with feeling inside me and how it would change, we learned that as the uterus would tip various ways it would cause bladder discomfort or alternately constipation, depending on it's orientation.  On the days I was having pain or discomfort, we learned that through a combination of external massage and internal pressure he could press gently up on the uterus to coax it back into a higher and more normal proper position. There were times when I was in extreme discomfort and he would shift it and I could feel this huge release of pressure from my bladder and urethra. It was the first thing I've ever found that actually relieved the pain! Anyone who has experienced chronic pain will understand how exciting that was.  On days when my husband/DIY therapist was not handy, laying in different orientations to help the uterus slide away from the bladder also was helpful in reducing discomfort.

While the pelvic adjustments had helped relieve the acute symptoms, our goal was to eliminate them starting in the first place. In researching ways to combat or cure prolapse the options seemed grim.  Most were surgical options and honestly their success rate was VERY low.  One day in reading about Dr. Kegel he suggested that increasing vaginal muscle tone could have positive effects.  And that some surgeries he had tried without exercise were only temporarily successful. I have done Kegel exercises at various times, but like many people, I think I'd mostly done them wrong. The instructions typically given are not very helpful. "Activate your muscles while urinating to stop the flow. Remember that feeling and then practice doing it later." I had activated and strengthened the muscles at the exit (which had probably saved me from incontinence)-- but that had done nothing for the muscles that make up the side walls of the vagina. They were completely weak.  The exercise described by Dr. Kegel specifically targeted strengthening the "pubococcygeus".  Muscles "of the proximal urethra, middle third of the vagina and rectum".  The "pubococcygeus" is not merely muscles around the orifices.  Something that somehow didn't get passed on clearly to the rest of us.

My summary of Dr. Kegels article

How does one strengthen their vaginal walls?
Ever hear of "Vagina Weightlifting"? Neither had did I. But check out this lady.

Complete article
Some medical folks (probably surgeons) argue that the muscles of the vagina can't hold up a uterus, even if they are in good condition. I have a hard time believing that since  the average uterus only weighs between 0.06 and 0.22 pounds. Check out this video of some average young women, with no strength training, and how much they can hold. A typical bottle of water is 1 lb for reference.  They are lifting 5 times the weight of a uterus.  Still think a vagina couldn't hold up a uterus?

 Sounded like it was worth a try.  Really didn't have anything to lose by trying.  After looking into different contraptions for pelvic strengthening, I bought a simple set of weights. There are tons of sizes and shapes available. I bought this set because I liked that I'd be able to easily increase the amount of weight.

Honestly, since I'd never had the urinary incontinence, that a lot of reviewers were fighting, I figured I'd be able to hold the heavier weights without too much trouble. First day I tried and was shocked to find that  I could only hold the very lightest weight, only .05 lbs for a few seconds before it would slip out. Those girls were holding 20 (twenty) times the weight I could.  Despite having typical pelvic exams over the years, no medical professional ever suggested my vaginal muscles were sub par and could use some strengthening.  But here was proof as I couldn't even do the lightest weight.

I started practicing twice a day-- working with a weight until I could easily hold it for 15 minutes and then moving up to the next weight. The progression happened fairly quickly, within a few weeks, I had worked my way up to the heaviest weight. Then I started holding it for longer periods of time-- 30-60 minutes and adding additional weight onto it.

And it has made a big difference! The muscles are obviously stronger than they were, and I've had fewer and fewer bad days. I rarely need my husband to do adjustments for me anymore because the uterus seems to be staying up higher where it belongs. It is so nice to finally, after years and years of discomfort, we have found a solution.  And much to our elation it didn't involve cutting on my body.  It frustrates me that no one-- not my primary care physician, not my gynecologist, not my urologist ever suggested anything like this. It makes me wonder how many other people are suffering needlessly.  This blog is my attempt to help those others out there.

And guess what, I can even lift a water bottle now.  Only for about 10 seconds, but that is still exciting. And no, I won't be posting a video of that. :-)


Some additional links:
A woman's experience strengthening her insides to relieve incontinence.  Great descriptions of how to find the correct muscles and some good humor Link

A physical therapist commenting on vaginal weight lifting.  Link

UPDATE 9/2017 If you're interested in how well this has worked for me