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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.