• "The fact that only half of all women aged 20-29 years in Victoria have a regular pap smear may say more about the test and those who conduct it." (AAP)
Declining pap smear rates in Victoria are being blamed on “slack” women. Is this language warranted or are does it cause women further harm?
By
Kate Young

22 Mar 2016 - 11:11 AM  UPDATED 22 Mar 2016 - 11:12 AM

Last week the Victoria State Government issued a media release titled, Young women urged not to be complacent as cervical cancer screening rates fall. The Minister for Health, Jill Hennessy, is quoted as calling for women to not become “complacent” about the “awkward” test. Echoing this language, local media outlets jumped on the release with headlines calling women “slack.”

Yes, the cervical cancer screening rates have declined in Victoria in recent years. But why assume it’s the result of women being complacent or slack? And in a government document, no less.

Most women are aware of the benefits of regular cervical cancer screening. Pap smears detect changes that occur prior to cervical cancer developing (which tends to do so at a slow rate). When caught at this early stage the disease is 100% treatable. However, once the disease progresses to cancer there is 5-year survival rate of 72%.

The fact that only half of all women aged 20-29 years in Victoria have a regular pap smear may say more about the test and those who conduct it than it does about women.

The test itself involves vaginal penetration making it invasive and uncomfortable or even painful for many women. Presumably in an effort to increase screening rates, the test is often described as only being “awkward” or “embarrassing.” It is likely to be more beneficial—not to mention respectful—to address women’s understandable concerns about the test with honest communication.

There are also important social factors to consider. Approximately 1 in 5 women in Australia have experienced sexual assault; it’s not surprising that many of these women find pap smears to be traumatic. There are also vaginal conditions such as vaginismus (when the vagina contracts in response to physical contact) and vaginitis (inflammation of the vagina) that can make pap smears painful for some women. Doctors can be poorly-trained to provide appropriate sensitive care in these circumstances.

Approximately 1 in 5 women in Australia have experienced sexual assault; it’s not surprising that many of these women find pap smears to be traumatic. 

Women have reported encountering doctors with poor bedside manner, rough physical manner (to the point of causing bleeding), and who do not engage in informed consent procedures when conducting a pap smear. Further, those in full-time paid employment or with full-time caring responsibilities may find it difficult to attend a clinic during practice hours. Many women understandably prefer to have the test conducted by a female doctor but this may not always be possible.

These are just some of the many factors that may explain low cervical cancer screening rates. Given the complexity of the situation, how is it helpful to blame women for supposedly being complacent or slack?

Such language is rarely used when discussing low screening rates for prostate cancer or GP attendance rates in men. For example, the government run website, Better Health Channel, has a whole section on men’s health that explores the many possible factors explaining their low use of health services. At no point are men called complacent or slack.

When women are perceived as not looking after their supposed most important asset, their body, they are personally condemned.

When women are perceived as not looking after their supposed most important asset, their body, they are personally condemned. In contrast, men’s health choices appear to be largely viewed with respect to the external factors that may have influenced them.

Government health resources and information have a significant influence on the public and on medical professionals. The language they use reflects the views of the society within which they are circulated. Ignoring the complexities of women’s health and instead blaming them for unsatisfactory public health statistics is not only offensive but likely to be harmful.

If all women are to experience the benefits of cervical cancer screening, health authorities must use respectful language, acknowledge the complexities of women’s lives, and tailor care to women’s needs.

Kate Young is a PhD candidate in the School of Public Health and Preventive Medicine, Monash University. You can follow her on Twitter at @Researcher_Kate.

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