I’m wondering, is a yearly really necessary? I’m 24, and in a (hopefully) permanent lesbian relationship, which is ATM long-distance so there’s no sexual interactions at all. I have had probably..a dozen paps (Pregnancies: They do one when you first go in, and at 6 wk checkup, plus between pregnancies) and not one has been abnormal. I’m pretty low-risk for any of the cancers or problems. My fiance has no STDs that she would possibly be sharing with me when we’re together in a few months, and while we’re in an open relationship at this moment (But again, I’m not having sex with anyone) in the future we plan to be monogamous except for when she conceives the child(ren) we want together. When that happens of course she plans on getting checked for STDs, and paps and all.

But there’s a little problem: While back when I had my tubal in February, the doc had success in family planning medicaid paying for patients post-tubal to have yearlies, NOW it doesn’t. And I *cannot* afford 80 dollars a year for a pap smear, I just can’t. Planned parenthood is out of the question–the nearest one is in Asheville, I have no way to travel 2 hours for a yearly. The health department only does free yearlies if you have family planning medicaid too, so that’s out. The only thing my medicaid will cover now is emergency gynecological care. Otherwise, it doesn’t cover anything.

So I’m kind of at a loss as to what to do. Is it really necessary to have a yearly when I’m low-risk (except my grandma having uterine cancer), and have never had an abnormal pap? Aside from cervical cancer (and really, how would I get HPV when I’m not having sex except with a woman–and that’s a few months away, that doesn’t have HPV?), and ovarian cancer aren’t there signs to look out for with the other cancers?

And another question: I had ridiculous weight gain with my tubal, and despite chasing 4 kids around the house, cleaning a lot, dancing, pilates for exercise, and eating pretty much nothing but protein and fresh veggies, I have NOT lost it. Is that normal post-tubal?

Edited for clarification

ETA: Also, isn’t ovarian cancer genetic and rare? And isn’t non-HPV cervical cancer genetic, or really rare one?

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25 Responses to Possibly an odd question…but I still need to ask it!

  1. 711body says:

    Someone can correct me if I’m wrong, but most young women can elect to not have a yearly pap these days. As long a everything has come back normal before, there is no reasons to suspect anything… I think it’s fine to go every other year. Obviously, some doctors may tell you otherwise. But this is what I have read before (I love reading health stuff).

  2. 78aNope says:

    I’ve read that too…I also read in last month’s Cosmo Gyno section that you can even go as far as every 3 years, if you’ve had no abnormal paps. Thanks.

  3. SseNope says:

    A pelvic exam and a pap are two different things.
    A pelvic exam includes a bimanual check for PID and other things, a peek at your discharge, vagina and vulva, and a pap. Sometimes the doc also does an STI test or a breast exam.

    A pap smear is when the doc takes a sample of your cervical cells to test for changes probably due to HPV. (There can be other reasons for cervical cell changes, like irritation or a mild infection by something else, but those usually come back as “abnormal not hpv” or something. Paps do NOT check for STIs!)

    ACOG recently changed their guidelines for pap smears, so that you go every 2 years instead of every year, and when you hit 30, you go ever 3 years. This assumes that you have normal paps each time; if you get an abnormal one, you may have to go more often even after it has been deemed cleared.

    I’m 29 and when I went to PP for my most recent exam, it was just a fully clothed chat with the doc. Because I had a concern about something external, I did end up changing into a gown and spreading my legs on the exam table, but there was no speculum involved. If I had brought up strange discharge or other vaginal concerns, I would have had a pelvic exam, but not a pap.

    The exam still falls under my local PP’s “free pap smears and bc” umbrella, because even the clothed discussion falls under preventative care. For my next annual visit, I will probably have a pap, but then I will be free until I’m 33.

  4. SseNope says:

    Also, when I was in a relationship that did not involve PIV (was dating a cis guy at the time but usually dated cis gals), my doc recommended three years in between paps. This was before the ACOG recommendation change, and I was 25, so most other docs would have advised yearly paps.

    Basically, if you’ve ever been sexually active with anyone, you should consider yourself exposed to HPV. Being sexually active with women doesn’t make you exempt from pap smears. On the other hand, HPV-created cervical changes happen so slowly that a yearly pap isn’t necessary. If you’ve never had an abnormal pap, then you can probably wait 2-3 years for your next one. Preventative care for your entire body is definitely useful, and if you’re in an open relationship it doesn’t hurt to be checked regularly for STIs. (Remember to ask the doc which tests they’re running, as no two clinics run the same gamut of tests.) But a pap? Less necessary.

  5. 78aNope says:

    Thanks. I’ve had a pap since I was last sexually active with anyone, prior to my tubal, and there was no detection of HPV. We’re in an open relationship for now due to the fact we’re distanced, and it actually brings us closer since it forces us to be even more open and honest with each other than we already were (As if we even HAD secrets :P) but, I’m not seeing anybody at all, and have no desire to see anyone or sleep with anyone unless it’s her. The open relationship mostly benefits her, until she breaks up with her boyfriend which she’s been trying to do for 2 months.

  6. 78aNope says:

    Yeah I know they are two different things, but here when you call to schedule a pap, they schedule the full shebang. Pap, breast, pelvic, etc. Honestly, my vulva looks the same as it has for the past at least 6 years since I had my second child, the way it looks hasn’t really changed any that I or any doctor would notice…and I’m meticulous about keeping check on myself, so I don’t really see how having a doctor peek would be different as I know my body better than any doctor would. My current doc has only done one exam on me, so he doesn’t know my body that well at all. As far as things I know the symptoms for as I’ve had them in the past, that includes: PID, chlamydia (No sex, so not getting that anyways), yeast infections (I get them every month during and after my period, and have been getting yeast infections since I was a baby so I’m used to them–and no it’s just my body being weird, no real problems) and I’ve had BV twice-once in jail and when my youngest was 3 weeks old.

    My thing is, how am I supposed to go to the doc when I cannot afford them? I can’t go to PP–They are 2 hours away. I have issues trusting doctors as well, so it’d be a big deal for me to change doctors just to get a free yearly…

  7. TreNo says:

    In the UK the NHS only call you for your first pap when you’re 25 – which you can refuse, if you’ve never been sexually active (or if you just don’t want one, but they’ll try to talk you into it). You’re then called once every 3 years, providing your results are normal, until you’re 49, when they reduce this to once every 5 years until you’re 65, after which, provided you’ve had three normal tests in a row, you won’t be called again.

    Obviously, the way our health system is set up it costs them money to test you, whereas in the states they earn money for testing you – so I don’t know how much of a factor that is in the difference! But I’m personally entirely happy to only go once every 3 years, providing my samples are normal each time.

  8. 78aNope says:

    Thanks!

    Honestly, most of the stuff in the US Health care system is money oriented, there’s so much stuff docs do/recommend here, that is not recommended or done in any other country, and that’s only because they want the money from it!

  9. Hteall says:

    On the weight loss… I would suggest a thyroid check. My thyroid wasn’t working right for years, but after I had my kid, it went to Bermuda (Triangle…) without me. Full-time breastfeeding, and I was gaining weight…

    I would say that as long as you are not being sexually active with someone who is/has been active with other people, you would likely be fine at the 2 or 3 year mark for pap smears, which hopefully will give you some time to look into the resources in your area and see if there are any decent doctors around. (But HPV /can/ be transmitted from vagina-to-vagina, if the vagina-equipped people in question are not ultra-careful about not touching more than one set of genitals without washing, or using toys/vibes on one set of genitals likewise. And of course direct contact of the genitals would be a risk factor in transmitting HPV. Stuff’s like the common cold that way.)

    Are there any free health clinics in your area, or at least closer than 2 hours away? You might also want to google on /free std clinic/, since even if they can’t do paps themselves, they may know of resources for you.

    And, in the end, it is about your risk tolerances and your mental health. You /can/ choose to accept the risk that you might get HPV that your body could not clear on its own. I would urge you to research the risks, so you can make an informed decision, but pap smears are a matter of personal health, not a moral requirement to be a good person.

    Good luck!

  10. 78aNope says:

    Thanks. I’ve thought about my thyroid possibly being the culprit–I mean geeze, I eat like at most twice a day, and it’s usually just lean meat of some sort…but I’m chasing kids all day, and live off of coffee!

    Of course those would be risk factors…but if either of us aren’t seeing others, and she doesn’t have HPV…would that still be a risk? I mean, can it pop up out of nowhere, or is it just sexually transmitted?

    Not that I am aware of, there is one, but the doctors there from what I’ve heard are kind of rude, and don’t really have any sort of bedside manner. Plus the waiting list is a year and a half long. It’s in my town, but I wouldn’t want to go there from stories of how the doctors treat you, and the nurses treat you. They treat you like your crap because you are one of the free people on the sliding scale. An acquaintance of mine, they *slammed* the speculum into her, instead of inserting it gently.

    But I could look up any resources and all that..I don’t know of any that SC has (It’s a crappy state with crappy people!) but maybe there’s something federal or whatever…

    Again thanks, I’ll research as I think about things. XD

  11. Hteall says:

    Thyyyyyyyyroid test! It’s just a blood test, at least… (And while the tests are, well, tests, the levothyroxine itself is generally pretty cheap. It’s best to get a brand name, so they can’t swap a generic for another generic out from under you (all brands/generics tend to be absorbed slightly differently, so being stable on one levothyroxine brand/generic doesn’t mean the “same” dose of another would actually be the same for you necessarily), but if you’re hypothyroid, any dose is probably somewhat better than none. …if you’re living off coffee to stave off a constant fatigue, like a black pit of Sleep that is constantly behind your eyes, then I definitely suspect thyroid. (Iron may be another one to consider, though; low iron is very like hypothyroid fatigue.)

    HPV is sexually transmitted — so two people who’re unicorn bait when they meet, who never have other partners, would not be at risk — but it’s not well understood how long a “dormancy” period HPV might have. Basically, if you’ve ever had any sex with someone who wasn’t a complete genital-contact virgin, you might be at risk. Maybe.

    Ugh, it’s awful that you’re in an area with crappy free “care.” O:( Might be worth the research to see if there’s anything available, though.

    Crossing fingers for ya!

  12. EohNet says:

    I have to point out that most people don’t feel like they’re doing something wrong by not having yearly exams or cancer screenings of most of their body parts. If you are asymptomatic and don’t have any risk factors, then I don’t see the big deal in spacing out exams and cancer screenings of your reproductive organs.

    You should ideally continue to get Pap smears every few years even if you never have a new partner, since the test is for cell changes that can take years to show up. (But it’s always your choice. You can weigh the pros and cons and decide what your comfort level is with various risks and costs.)

  13. 78aNope says:

    Thanks. Yeah, the only risk I have is uterine cancer..and my grandma had it, noone else in the family has.

    I probably will every few years, but as long as yearly isn’t needed, then I feel a lot better!

  14. Remoma says:

    My doctor told me that the guidelines have changed to allow for women who have no history of abnormal paps to go up to three years between visits.

  15. 78aNope says:

    Thanks!

  16. Sseyle says:

    Don’t forget that a pap is different from an HPV test. (Sorry if I missed that written somewhere.) So in your decision making process, you’ll want to make sure that you and your partner have both tested negative for HPV, not just had normal pap smears.

    It sounds like you would be fine to be on an every other or every three years schedule. A pelvic isn’t really necessary anyway, so that part kind of doesn’t matter.

    To answer your questions, the idea that ovarian cancer is detected during pelvics is not evidence based. You don’t need a pelvic unless you have symptoms. Non-HPV cervical cancer is indeed very rare, and I believe typically causes symptoms that would raise a red flag for you.

    I will share that I once had HPV, and now test negative for it. When I asked my doctor if that meant I couldn’t have anymore dysplasia unless I was exposed to a new strain, she said “probably.” So…my doctor at least seems to think that even if you and your partner both test negative for HPV, you should still have pap smears.

    80 sounds expensive to me though. I wonder if there would be a way to make it cheaper…I think when I’ve paid just for the lab work (and had the visit itself covered) it was about 30. I wonder if your insurance would cover a yearly physical, and if your GP could fold the pap into the visit so you’d only pay for the test itself. Might be something to check into.

  17. 78aNope says:

    Yeah, but docs here do NOT offer an HPV test UNLESS you have an abnormal pap. None do, not a single one. I’ve asked around. It doesn’t make much sense to me, TBH. But I have never had an HPV test done, ever. Just paps.

    Thanks.

    Ahhh, so ovarian cancer is detected based on symptoms like non-HPV cervical cancer? I don’t think my fiance’s doc even does HPV tests unless you have abnormal paps either…

    Nope, because I have family planning medicaid. I like our family doc, who the kids see though, and would trust him with my life. He’s also somewhat cheaper, but still too expensive for me to pay for. 🙁

  18. 78aNope says:

    I say I don’t think hers does because we were talking about HPV tests one day, and she said she’s never had one either…just a pap smear with 2 swabs…

  19. XaGirl says:

    As others have noted, it doesn’t sound like your fiancee has been or will be tested for HPV, which means that HPV is not something you can wholly rule out. That said, unless you’ve had an abnormal pap, every other year is the most frequent that current guidelines recommend.

    However, it sounds like this program might apply to you and/or be worth checking out? http://www.cdc.gov/cancer/nbccedp/about.htm

  20. 78aNope says:

    Yeah I haven’t been tested for HPV either, and like I said I don’t *think* she has been, I’m not 100% sure–but either way, right now (when I’m technically due for a yearly) we’re not even with each other. I could always ask her to be tested for HPV, and push the docs to test though. The docs around my area believe that if there isn’t any dysplasia or anything wrong with the cervix, then testing for HPV is unnecessary and can cause unnecessary panics since most cases go away by themselves and a lot of insurance companies (even medicaid) won’t pay for HPV testing unless there is a noted cervical problem or abnormal pap.

    Ahh the thing is, I think the only place that participates in it is the place I mentioned earlier…not my doctor, because i asked if they participate in any programs to help low income people, they just do medicaid. And I will not go to the office that *might* participate in that program, EVER…

  21. 78aNope says:

    But to me, asking her to be tested for HPV just seems like I don’t trust her…and I trust her with my life. I don’t want to get in a fight with her about this, at least not anytime soon since she has a lot of stress ATM…so I’ll probably wait until she comes here, and then take her to MY doctor, and have her push him to test for HPV.

  22. Sseyle says:

    Honestly, I find it concerning that she (or you) would take asking about HPV to be a sign of mistrust. HPV is something that the majority of people will get in their lifetime, and that you cannot know you have unless you have been tested. I’m not sure how asking about something incredibly common and undetectable is implying lack of trust.

    I trust my partner with my life too. We’ve been together almost ten years now, and he is the cats meow. He never lies to me, and is one of the most trustworthy people I know. He also gave me HPV. That’s just life…it’s not a character judgement and has absolutely nothing to do with trust.

    I hope your partner wouldn’t get angry at you for wanting to protect (or even have information about) your health.

  23. 78aNope says:

    I see it as a sign of mistrust for me, but I’ve never had it that I know of…but it’s also really common for it to just go away on it’s own, so I may have had it but it went away. Now asking about STDs is something different, but I have no need to since we tell each other every little detail of our lives just about. 🙂 So, I’m probably just a bit iffy about it, but I’ve had relationship issues in the past and it takes a lot for me or her to trust someone (Both of us had very sordid childhoods), so that we trust each other so much is a HUGE testament to the fact that we are honest with each other.

    I think it’s just me being paranoid, to be honest. I don’t think she’d have any issue with me asking her if A) She has/has had HPV or B) If she would be tested for me. She’s just that caring and sweet and kind, but she’d do anything for me pretty much (and I her) if it makes me happy and is harmless…I ask her about something, she’s like “Yeah, I’ll do it for you..” or “That’s fine”

  24. 78aNope says:

    Our local division only helps women between 47 and 65 I’m only 24

  25. XaGirl says:

    That sucks. 🙁 I saw that in the program listing but I wasn’t sure whether there might be more options they could tell you about if you called. I mean, I definitely agree with those who’ve said that medical guidelines indicate you have no need for a pap smear this year, and if your fiancee is currently nonmonogamous, it doesn’t seem like there’s a lot of reason to push her to get an HPV test until the two of you will be intimate, anyway.

    Mostly, I just wanted to be sure that in the future, once the two of you are physically together, either you would have both been tested for HPV, or you would hopefully both be able to find a way to get every-other-year pap smears, because otherwise, you could be at risk for developing cervical cancer.

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