Regular

nextstepcake:

metapianycist:

has the medical profession decided yet whether persons with a cervix who have never had any genital sexual activity actually need pap smears as frequently as recommended for everyone else?

asking because I’m almost 30 and want to be taking care of my body without putting myself through unnecessary dysphoria if it’s not considered medically necessary

no reblogs telling me to tough it out and get a pap smear. I want to know what actual legit medical research is saying specifically about people like me, with a cervix and no sexual history at all, so i can share that knowledge with my doctors.

I looked this question up for someone else recently, and there’s no research or guidelines that have actually calculated out the risk vs. benefit ratios for this population. (We can speculate a lot on why – is it lack of interest? lack of funding? Is it seen as too niche of a population to worry about? Or is reported virginity seen as too unreliable to base research on?)

Many “standard” guidelines (and the research behind them) were modeled on the expectation that most people have been sexually active at some point by their mid twenties, and don’t really include or address the issue of whether those guidelines also apply to individuals who have never been sexually active.

However, among the few more reputable sources like the NHS and Mayo Clinic that do address the issue, the advice boils down to basically “well you could choose not to get one, or you could choose to get one”: basically, make your own best guestimate of how you weight the potential risks and benefits (potentially with the help of a medical professional, although IMO they tend to be winging it just as much themselves).

The main factors to consider are basically: 

  • Your level of comfort/discomfort with the pap smear procedure itself 
  • Your risk factors for cervical cancer – if you have never been sexually active, you’ve likely never been exposed to HPV, and are therefore at a much lower risk for cervical cancer. On the other hand, someone with a family history of cervical cancer might be at greater risk.
  • The very real risk of false positives, which can lead to unnecessary biopsies or other medical interventions that can lead to both mental and physical discomfort as well as actual serious medical complications. These risks may be a larger decision factor for someone who is at low risk for detecting actual HPV related cervical cancer.
  • Whether you have been experiencing any actual symptoms recently that could be indicative of cervical cancer or other potential gynecological health issues (like irregular vaginal bleeding, intermenstrual bleeding or recurrent atypical vaginal discharge) 

(More anecdotally, most of the medical professionals I’ve talked to in person have said that it’s totally fine to put off pap smears so long as you are not sexually active, but I suspect they also assume that my status will change in a few years and I can just do one then so….take that as you will. My impression from speaking to other medical professionals in a non-patient capacity is that they don’t know any more about this issue than probably most of the people on this post, and that they just make an educated guess using the same kinds of thought processes here)

Personally, after my first attempt at a pap smear several years ago that was incredibly painful, I’ve decided to hold off any getting any more in the near future as the risk of cervical cancer is imo lower for me atm than the combined risk of false positives and the certainty of intense discomfort. (pending any further unexpected changes to my current complete lack of sexual activity). That said, it does mean I will also make a point of keeping an eye out for potential symptoms.

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In terms of actual research, the closest I can find is (mostly older) research showing that cervical cancer risk in nuns and unmarried women may not be that much lower than in married women, contrary to some assumptions – but it’s not clear whether that’s a result of non-HPV related cervical cancer risks, or that assumptions that religious nuns and single women are virginal are false assumptions and not relevent in the first place. There’s a long (and non-paywalled) overview here: http://www.obgyn.net/gynecological-oncology/nuns-virgins-and-spinsters-rigoni-stern-and-cervical-cancer-revisited)

(it should be noted that while the post says 2011, though, it’s actual just a repost of content from a paper from 1991 – I haven’t really been able to find anything more current yet than this nearly 20-year-old review, and I know that general screening advice has changed a lot since then)