What Do the New Cervical Cancer Screening Guidelines Mean for American Women?

Many might imagine that only women “of a certain age” get cervical cancer, but that’s not true — women of all ages must be screened. Now, some women will have access to a new option for screening.

New government guidelines developed by an expert panel — the U.S. Preventive Services Task Force (USPSTF) — state women between 30 and 65 may undergo screening for cervical cancer by getting tested for high-risk strains of human papillomavirus (HPV) every five years. This frees the patient from having to have a Pap test too.

The USPSTF previously recommended the use of both tests every five years for the age range. The co-testing method is less-preferred since it requires women to undergo more procedures and tests, compared to Pap testing alone or HPV testing alone. Another alternative exists, per the guidelines — getting the Pap test done every three years. The guidelines haven’t changed for women under 30 and over 65.

Keeping Screening Necessary

Women now have more choices to screen for cervical cancer, but the primary concern remains encouraging women to get screened in the first place. The USPSTF stresses the need to focus on adequate screening, no matter the method chosen, since regular screening will ultimately lead to lowering cervical cancer rates.

The findings have come a long way in terms of protection and detection. In a 1989 study, papillomavirus DNA was found in the vapor of warts that were treated by carbon dioxide laser. The study revealed the dangers of possible inhalation exposure to papillomavirus. This essentially meant that the risk of exposure to this disease is even higher than wehad  initially believed, although high-risk HPV strains spread via sexual contact still cause nearly 90 percent of cervical cancers.

Many HPV infections do clear up by themselves, but the virus can linger and lead to an eventual diagnosis of cervical cancer. Both the Pap and HPV tests analyze a woman’s cervical cells, but the Pap test looks at whether or not they’re cancerous while the HPV test searches for HPV infection. Co-testing itself takes one swab, but doing both tests can heighten women’s nerves.

Why Update the Guidelines?

The update has come as a result of revelations from current studies. It was discovered that testing for high-risk HPV strains, rather than using Pap tests, led to an increased rate of discovery of precancerous lesions within the cervix . The study proved the strong effectiveness of high-risk HPV testing utilized alone to screen for cervical cancer.

Both co-testing and HPV testing alone proved a little more effective to reduce cervical cancer mortality rates than Pap tests alone, per a recent study in JAMA. A simulation model found that 830 in 100,000 women died of the cancer if they went without screening, and the model also found:

  • If women screened with only the Pap test, the mortality rate decreased to 76 deaths for every 100,000.
  • The death rate dropped to 30 deaths for every 100,000 women with co-testing starting at age 30.
  • If women screened every five years with HPV testing, starting at age 30, the mortality rate decreased to 29 for every 100,000 women.

Any Downsides to Choosing the HPV Test?

Co-testing and HPV testing alone both maintain increased rates of false positives than using the Pap test. Co-testing holds the highest rate of false-positive results, but the USPSTF states that each of the recommended screening methods — co-testing, Pap testing alone and HPV testing alone — offer reasonable balance between harms and benefits.

The guidelines suggest that women could possibly conduct HPV testing for high-risk strains effectively at home. Women would provide their sample and mail it to a lab for analyzing — much like modern ancestral DNA testing. This would also increase screening rates while decreasing mortalities from cervical cancer thanks to prevention. This method also could potentially make women feel more comfortable about the procedure since they’re doing it themselves, especially women who have fears related to gynaecological exams.

Additional studies will determine if HPV vaccinations, which lower HPV infection risk, might affect how HPV testing functions in cervical cancer screening. However, this could be a great shift for many women — time will tell, but we’re hopeful.

The Fight for Legal Abortions Continues in Latin America

450,000 clandestine and unsafe abortions take place in Argentina every year, according to Amnesty International.

Currently, Argentina only allows abortions in cases where a pregnancy is the result of rape, if the mother is mentally ill, or if her own life is at risk. On August 8 2018, Argentina came very close to legalizing abortion. The Senate narrowly rejected a bill that would have made abortions legal within the first 14 weeks of pregnancy, with 38 votes against, 31 in favor and 2 abstentions.

On the streets, thousands of people gathered to show their support or opposition for the bill, divided in two different sides in front of the Congress building.

It was a disappointing result for many women, not just within the country but in Latin America as a whole. Activists planned demonstrations in support of the legislation in several countries like Mexico, Chile, Peru and Uruguay – as well as around the rest of the world too, like in New York City.

Photo credit: Maria Rendo

Currently in Latin America, only Uruguay, Cuba, Guyana and Mexico City allow women legally to have early-term abortions. This means that 97% of women in the region live in countries that ban abortion or allow it only in rare instances.

Since the bill in Argentina passed in the Congressional vote, similar projects to legalize abortions have been energized throughout Latin America. These movements have not been discouraged by the end result in Argentina this month. Right after the final vote in Argentina, a bill to legalize abortion was introduced in Chile, where abortions are currently legal only under 3 circumstances:  when the mother’s life is at risk, when the pregnancy is the result of rape, or when the fetus is non-viable.

Around the same time, Brazil’s supreme court began to consider decriminalizing abortion through the 12th week of pregnancy. Women wearing red robes resembling those worn on the television adaptation of The Handmaid’s Tale gathered outside the supreme court to show their support for decriminalization. Meanwhile, the church sounded its bells as a sign of protest.

Argentine activists and lawmakers haven’t given up either. They are determined to introduce the bill again next year and make sure that this time, it goes through. Most of the Senators who voted against the law argued that it was too broad and missing relevant details that still needed to be debated. One example is the issue of parental consent when the pregnant woman is a minor.

Photo credit: Maria Rendo

In the meantime, the federal government is considering decriminalization of abortion in the penal codeThis wouldn’t give women access to safe abortions, but it would save them from the threat of being imprisoned as a result of an abortion. This is yet to be presented and debated, but it would do part of what the proposed law intended to do (leaving out the need for better sex education, access to contraceptives and safe abortions in hospitals and under the care of health professionals).

On a personal note, it was incredibly moving for me to have the opportunity to join the women who had gathered in front of Congress to show their support for the law. I saw women of all ages and all sectors of society together, supporting the same cause. The air was filled with hope and solidarity.

Photo credit: Maria Rendo

These women spent a cold night out in the rain, sharing umbrellas and blankets while they waited for the decision, encouraging each other even though they knew the law was very unlikely to pass. Their strength is what keeps this movement going, and it’s the reason this law will be approved, sooner or later.

If you want to support Argentinian activists, they have created The Young Feminist Fund for Argentina to support projects designed and led by young women’s rights defenders until abortion is legal in the country. You can find them on Twitter as @FondoFeminista.

Share their work and encourage others to donate!

Vestibulodynia? I’d Never Heard of it Either

If you don’t know how to pronounce Vestibulodynia, let alone have any idea what it is, don’t worry – for a long time, I didn’t either.

You may have heard of another term – Vulvodynia – though you’re probably not sure what that means either. This is the term given to generalised, unidentified pain in the vulva. Women are often diagnosed with Vulvodynia when their doctor is unsure of why they are in pain.

There are also scenarios – which I have personally experienced – where doctors don’t offer any diagnosis at all, and instead see pain in the vulva as something psychological.

When this happened to me, I was told to go and see a Psychosexual Counsellor to deal with the pain I experienced during sex. But I was so confused – if I’m physically in pain, how is this going to help me? I did my best to go to my appointment with an open mind, as no other doctor could seem to give me any further insight.

It was suggested that I had Vaginismus – a condition that causes the vaginal muscles to tighten involuntarily during penetration, or even when inserting a tampon. The idea behind attending counselling to deal with vaginismus was that I could talk about any mental worries to do with sex, practice mindfulness, and hopefully then feel more relaxed so my ‘involuntary tightness’ would fade away.

I remained convinced, however, that my pain was very much physical and I felt sure that I just hadn’t found the correct diagnosis yet. I was trying to be as open minded as possible, in the hope that I could ‘talk’ my way out of the last 8 years of pain, but after 10 Psychosexual Counselling sessions I decided that it wasn’t for me.

My counsellor was a wonderful and empathetic man, but I really couldn’t shift my belief that I did not, in fact, have some deep-rooted traumatic issue that I related to sex. My search for help continued.

Endometriosis, irritable bowel syndrome (IBS), severe period pain, internal cysts – I was scanned and tested for so many things. It was a long, arduous, frustrating process with which I know many other women can identify. I’ve spoken to women who felt they were being ‘passed around the system’, as well as others who felt as though they’d been completely given up on.

I’d done a huge amount of research on my own about what I was experiencing, but after a while I realised that I hadn’t actually researched individual professionals working in the field of vulval pain.

I finally booked an appointment with a well-researched specialist, who confirmed within 15 minutes of talking to me that I had Vestibulodynia – a condition that causes severe pain around the vestibule, the entrance of the vagina. This pain can occur from vaginal entry such as intercourse or using a tampon – which is how I was affected, but some women experience pain purely from pressure around the area, such as from wearing tight fitting clothes, or riding a bike. My heart truly goes out to any woman experiencing this.  

The symptoms and the level of pain vary greatly amongst sufferers, and as there seem to be so many varieties, I can understand why it can be hard for medical professionals to diagnose the condition. There’s a difference between provoked and unprovoked Vestibulodynia, for example, which means that the pain can occur with or without touch. Some women physically tear during sex, while others have red irritated skin.

The experience that all women suffering from the condition seem to share is the burning sensation, likened to being cut with a razor or having acid poured on the skin. I am amazed, and horrified, that so many women have to experience this level and intensity of pain and yet the rate of diagnosis remains so low. Many gynaecologists are still completely unfamiliar with the term.

Since my diagnosis, I have had surgery to try to improve my condition. After countless other treatments, I decided this was the best option for me, but most women aren’t even given surgery as an option. Most women have to deal with this condition – and countless other vulval disorders – with such a complete lack of support, for so many years, before coming anywhere close to a diagnosis.

Why, as women, are we so ill-informed about this element of our health? Why is our pain so often dismissed and de-validated? Why is the silence surrounding women’s bodies and sexual health still so stifling? 

Personally, I found reading blogs from other sufferers incredibly important. Reading other people’s words gave me an insight into their pain and ideas of things I could try for myself. Most importantly, reading blogs made me feel – for the first time – that I really wasn’t alone.

Unfortunately, there’s no guarantee that one person’s experience will be exactly the same as the next’s, so there’s no assurance that you will find all of your answers in another woman’s blog post. But from my own experience, what you will find is a community and support network that is doing its very best to provide the answers that the medical professionals can’t or won’t. 

To anyone who is suffering and to anyone who is currently in pain: keep strong, keep searching – your answer will be out there. And in the meantime, I promise you that support from other women experiencing a similar thing is far more comforting than going it alone.

The Vulnerabilities of Being Pregnant

Women face unique challenges throughout their lives. For some, one such challenge can be pregnancy. It is an exciting and beautiful time, but it can also be a major test on the strength of a woman’s body and mind.

Did you know a woman’s socioeconomic status has a surprising amount of influence, not just on her baby, but also on how her pregnancy goes? Childbirth outcomes are heavily tied to socioeconomics, with women in more impoverished regions experiencing a wide range of additional challenges.

While some of these challenges are health-related, others are not. Many factors combine for a successful pregnancy and birth, and an individual’s financial situation has a huge impact. Of course, most people can’t just change their financial standing quickly, and so we need to examine ways we can change the culture around pregnancy.

In countries that lack universal health care, financial status has a significant impact on prenatal outcomes. Merely being able to afford regular medical checkups, prenatal vitamins and any additional medications can significantly increase the chances of a healthy pregnancy and baby. It’s impossible to understate how important prenatal care is.

Access to medical care goes beyond prenatal care, though. Women in lower socioeconomic classes tend to be less likely to be able to access health care before becoming pregnant, which also contributes to the health outcomes of the child. Even with socialized health care, the risks remain, because money affects every aspect of our lives.

Women can also suffer in countries without socialized health care. One U.S. case, for example, shows how insurance companies took advantage of pregnant women who qualified for government-funded Medicaid. The companies claimed to give the women coverage, then denied their claims while still collecting the money from the government. This is just one case that demonstrates how willing people and companies can be to take advantage of those in ‘vulnerable’ positions.

There are many countries where access to quality prenatal care should not be an issue. Universal health care should eliminate the barrier, but it doesn’t stop women from having problems. As some studies have demonstrated, even with socialized health care, pregnant women in lower income brackets tend to have more challenging pregnancies, including problems like preeclampsia, premature birth and obstetrical hemorrhage.

Lower incomes make women more vulnerable to things like stress, domestic violence, poor personal health choices and drug use. It has been shown that stress is one of the precursors to birth issues like premature birth and low birth weight.

Studies also show that women experiencing poverty are more likely to experience abuse from their partner. This abuse often occurs alongside other issues, like financial dependence on the abuser and isolation from a support network. The stress, isolation and risk of hospitalization all take a serious toll. Women who are pregnant and have been in the relationship for a while may see violence escalate during their pregnancy.

The problems related to having a new baby don’t just impact the mom and baby. They’re a serious issue for everyone in society as well. Pregnant women are certainly in a place of high vulnerability, but they are not weak links. Women make up half of the population, so we need to address the gendered issues at play.

Addressing the reasons behind the systemic problems that women and new moms face will undeniably lead us to a better and healthier tomorrow for everyone.