Is it Time for your Annual Pap Test?
When that time of the year rolls around, many women shrink with
dread. Am I talking about Thanksgiving with the in-laws? Christmas
with the parents? No! I am talking about the annual gynecological
exam! While getting your routine Pap exam doesn’t exactly
make your day, there is often, at least for me a feeling of virtue
– like I’m glad I got that out of the way! Sort of
like the way you feel after you organize your closet…
Thin prep or traditional?
There are 2 types of Pap smears which are used to screen for
cervical dysplasia available these days. There is the old, original
smear where the practitioner takes cell samples from the vaginal
wall, cervix and endocervix ( inside the os, the hole in the middle
of the cervix) , smears them on a slide, sprays them with fixative
and sends it off to the lab for evaluation. The second more modern
type of Pap test is called a Thin Prep. The cell samples are taken
in much the same way, however instead of smearing on a slide the
sample is placed in a preservative solution. The advantage of
a Thin Prep is that it is more accurate as every single cell is
viewed and evaluated and a sample can even be taken during menstruation
or when vaginal bleeding is occurring. This is not the case with
the old style Pap smear. Much of the sample couldn’t be
evaluated if the cells were at all clumped together. Thus women
often had to return for a retest because of problems with the
sample. However , the old fashioned Pap smear is less expensive
than the Thin Prep. Many insurance companies, always eager to
cut costs ( and increase their profit margin) won’t cover
the thin prep, even though it is more accurate and therefore could
conceivably eliminate thousands of dollars in medical costs down
the road if a problem is detected early enough.
What does the annual exam entail?
The average gynecological exam consists of the Pap smear, a
manual pelvic exam to feel for cysts or other abnormal growths
of tissue in the ovarian / uterine area, a check for abnormal
vaginal discharge and a manual breast exam. STD screening may
also be available. A good practitioner often will take the time
to ask about diet / lifestyle factors and previous health history
( or history as the case may be). These exams may be performed
by a naturopathic physician, nurse practitioner, physician’s
assistant, licensed midwife, or a medical doctor who is either
in general practice or has a gynecological specialty.
Causes of an Abnormal Pap smear
Cervical dysplasia, abnormal cells which may be pre cancerous,
are often caused by the presence of HPV (human papilloma virus)
which may also cause genital warts. The biggest risk factor for
contracting HPV seems to be the number of sex partners one has
had, though HPV is now occurring in epidemic proportions. It was
once thought that circumcision in men reduced the risk of cervical
cancer in their female sex partners, though epidemiological research
now shows that to be false. One estimate says that 70% of all
women are exposed to this virus at some point during their lifetime.
Most women with HPV will never develop dysplasia at all. Some
strains of HPV are much more virulent , causing malignancy to
occur over a brief 18 month period. Most strains are not so virulent
, luckily.
My clinical experience has led me to believe that the state
of a woman’s immune system determines whether the virus
will cause cellular changes that will lead to dysplasia or not.
This is where good alternative medicine from well trained providers
excels over conventional medicine. Alternative health practitioners,
especially naturopathic physicians, homeopaths, herbalists, nutritionists
and acupuncturists have many successful methods for improving
immune function and helping to reverse cervical dysplasia. Certain
alternative medical protocols may be used alone or in conjunction
with allopathic methods of treatment such as LEEP ( laser surgery)
or cryosurgery (freezing) depending upon the severity, or grade
of the dysplasia.
How much will it cost? What if I have no insurance?
The cost of an annual exam varies greatly depending upon the
practitioner and clinic used as well as one’s insurance
plan’s reimbursement level. The top end of the spectrum
is if one goes to a gynecologist’s office and the test is
performed by a physician and no insurance reimbursement is available.
This can be as much as $210 not including the lab fee, which varies
greatly depending upon the lab used. Other lower cost alternatives
are available at the following clinics. Boulder Valley Women’s
Health Center ((303) 442-5160) in Boulder has a sliding scale
based on income and even their full fee services are much less
expensive than a private gynecological clinic. The Longmont Planned
Parenthood ((303) 772-3600) also has a sliding scale fee whereas
the Boulder branch does not. People’s Clinic ((303) 449-6050)
which serves a 60% uninsured population also has a sliding scale
fee based on income though one must be able to document one’s
income status before the appointment and must be screened by an
enrollment counselor.
Many women’s lives have been saved through the early detection
that screening exams offer, though screening for pathology is
only one small aspect of wellness care. One must also learn proper
self-care including good nutrition, proper exercise, and stress
management. At the minimum, women should be on a good multivitamin
and should take 1200 – 1500 mg of Calcium daily to help
prevent osteoporosis. The form of Calcium that I believe is best
absorbed through the digestive system is Calcium citrate. One
can also use the proper herbal , nutritional and homeopathic allies
to improve one’s health as necessary seeking help from a
qualified professional as needed. I urge all of the wonderful
women of Boulder to by all means routinely utilize health screening
exams but also take care of any imbalances in your life and body
early. Be well.
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