Pap Test CBA

[cw: medical talk, genitals talk, etc.]

Found some ace blogs recommending all folks w/ cervices get pap tests.

:/

“As far as I know, pap tests are still a good idea after the age of ~21 or so even if you haven’t had sex because they help catch cervical cancer early.”

“The newest recommendations say that if you are not sexually active you should be receiving one pap test every three years.”

“This makes me feel like you’re not seeing an OB/GYN at all, and you really should.”

“In my personal opinion, if you aren’t already having sex by the time you turn eighteen, you should be scoping out an OB/GYN.”

Okay, let me teach y’all a neat communication trick.  Watch this.

When talking about a course of action, you can think in terms of cost-benefit analysis.  If you don’t know what cost-benefit analysis is, you can think of it in terms of a table of “pros” and “cons.”

Claiming a course of action is a “good idea” or something everyone relevant “really should” do is presuming the results of that cost-benefit analysis.

Instead, check this out: you can describe the pros/benefits, and that’s it.  For example, “if you do X, the good things that can come of that include Y.”

This is a super neat trick because it allows you to be right without making (potentially inaccurate) assumptions about what each individual’s personal pro/con table looks like — not only what they consider to be costs and benefits, but also what value they assign to those costs and benefits.

In contrast, the quotes above are just kinda assuming that the health-checking benefits supersede all, without a trace of consideration that, for some people, the costs may outweigh those benefits.

Because it’s “health”!  And health always comes first!

This may surprise you, but no, it doesn’t.  Healthism can bite me.  Being “healthy” is great but there’s nothing wrong with people having more complex priorities, there’s nothing wrong with people not valuing their health in the same ways you do, and I’m honestly sick as sick gets of people telling me how to feel about the care and keeping of my flesh prison, okay.

The costs (financial costs, psychological costs, physical costs, whatever) of getting a pap test, or any medical test, are different for everyone.  You can’t know what the “good idea” is for everyone.  People face enough pressure on the subject as it is and I’m irritated at everyone who cosigned this.

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27 responses to “Pap Test CBA

  • Klaaraa

    Also they didn’t even mention the most obvious things, with how poking and Scratching on the Cervix also, ever so slightly, increase the risk of something growing there, in a way that is insignificantly small compared to what viruses do, but that “should” be considered when the risk of having sexually transmissible viruses there is near Zero…. Also, cervical cancer is almost unheard of in People who have never ever had genital contact with anyone else, but very much not so in People who were once sexually active but haven’t been for a Long time…

    • Coyote

      Hm, hadn’t heard that. Might do some googling on that later.

    • Alex Black

      Yep. Most cases cases of cervical cancer are caused by a few strains of HPV, which is an STI. If you have never had genital contact with anyone else, the chances of you having one of the strains of HPV that can cause cancer is very small. If you had sex before but only that one time/with that one person/in a monogamous relationship/whatever and you haven’t had sex in years and years… you still might have gotten one of those cancer-causing strains of HPV years ago and are currently at risk for the thing that pap tests screen for.

  • Klaaraa

    to be honest, I have not done any googling on that, it’s just what the doctor told me when I was a 22 year old virgin on my first visit to the gynecologist and she wanted to reassure me that we needn’t do a Pap test and apparently they don’t do that in her Office unless the Person has been sexually active.

    • luvtheheaven

      As a 22 year old virgin going to a general practitioner the doctor told me if I’m not sexually active I didn’t need to go to a gynecologist at all (“yet”, I’m sure was implied). Also I didn’t know I was ace at the time and… haven’t really been to any doctor since other than an eye-related emergency where it didn’t come up. :P

  • embodiedinlanguage

    Weighing costs and benefits is good from a personal AND a medical point of view. From the medical literature I’ve read, over 99% of all cervical cancers are caused by HPV, so there’s not much point in getting a Pap smear if you’ve never had sex of any kind. Better yet, my current doctor is of the opinion that pelvic exams in general aren’t worth it for those who menstruate regularly, have never been sexually active, and don’t have any worrying symptoms. So the benefits aren’t equal for everyone even if you’re NOT considering potential mental, emotional, physical, and financial costs. Which you absolutely should, but, you know, healthism…

  • TheUnmarkedPage

    If you have a family history of cervical cancer I think the risk is a little higher, even if you’ve never had sex. There’s still other considerations though, as this post says.

  • epochryphal

    also Yeah if you’re planning on having a hysterectomy anyway then! fuck! off!! oh my god!!! honestly all the coercive alarmist shit targeted at trans folks and ace folks with cervixes Infuriate me the most

  • Maris

    The most frustrating aspect for me is when people imply (or straight up say) that getting a pap smear is an easy choice and that if you choose incorrectly, it’s your fault if you get cancer. The other factors (cost, dysphoria, repulsion, anxiety) weigh so heavily against it for me that I can never actually consider it, so it’s endlessly frustrating to have people trivialize that and blame me for the Wrong Choice and insist that I’m somehow Giving Myself Cancer.

    The “it’s an easy choice, I weighed all your factors for you” rhetoric also makes huge assumptions about sex repulsion (mainly that it would never get triggered in medical situations) which are just. so wrong and so dismissive. I could 100% disprove that assumption (because I have had it show up during several medical procedures less invasive than pelvic exams) but sharing personal medical data is always hit and miss and I really don’t want to go another round of “if you feel these feelings when someone else hasn’t brought up sex it’s your fault for sexualizing human body features”. I just wish sometimes that everyone would spontaneously know these possibilities and consider them before making insistent rude posts about exactly what medical decisions I should make.

  • Alex Black

    I think part of the reason that they (the medical community) suggest getting pap tests past a certain age is that they assume most people are sexually active by then, whether they want to talk about it or not. And lots of people who are or have been sexually active don’t want to talk about it, even to a doctor in a private conversation when asked a direct question. And lots of other people have narrow definitions of ‘sex’ or ‘sexually active’ that don’t include certain sex acts which still carry a risk of spreading STI’s.

    Also, statistically speaking, if you have a very low chance of having a disease (like 0.1%), then even if the screening test for that disease is pretty accurate (say 99%), getting screened may actually do more harm than good, because a positive test would most likely be a false positive. (here is a relatively easy to understand explanation of why: http://brownmath.com/stat/falsepos.htm)

    I don’t know the numbers for cervical cancer screening (especially for people who have never had genital contact with another person), though, so I don’t know if that particular (and very counter-intuitive) bit of probability mathematics applies in this case. Personally, however, I have talked about it with my doctor, and she agreed that in my particular case it probably wasn’t worth doing the test (given my unusually low risk and unusually high discomfort with the procedure). Cost/benefit analysis will yield different conclusions for different people, though, so it’s something that’s worth talking to a doctor about. Especially if that doctor actually understands that asexuality is a thing.

  • Sunny

    I’m not sure about in other places, but in Alberta, they recommend starting pap tests at 21 or 3 years after first becoming sexually active, whichever comes later. (http://www.screeningforlife.ca/cervical).

  • Sunny

    I didn’t think it would? (In fact, I thought I was agreeing with you. Or, maybe more with Klaarraa and Alex Black’s earlier points. But still…) It just seems like a good idea for people to have access to accurate information when making their decisions. I was trying to be informative, not argumentative.

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  • Nicole

    Late comment, but I just wanted to say bless you for this post. Gynecological exams have been a major source of anxiety for me since I hit puberty, due to a combination of dysphoria, pain, and general anxiety about doctors. Luckily I managed to talk my parents out of it when I was a minor, and now that I’m an adult I’ve been putting it off every time doctors bring it up… but the implication seems to be that it’s an eventual inevitability, like death or taxes. After so many people telling me that I’m making the wrong decision and will regret it later, it’s nice to finally see a post that says my decision (whatever it is) is valid.

    On a semi-related note: I’m still coming to terms with the fact that doctors/relatives/etc cannot legally force me into medical procedures I do not consent to. That probably sounds like a given, but I had too many traumatic experiences with doctors when I was a minor, most of which were unnecessary and caused more harm than good.

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