

## The Truth

## About

# Smear Tests

'They'

### don't want

YOU to know

### Meet the authors

### Ada, Alex, Angela, Chrissy,

### Diane, Eliz, Kat, Linda, Su

### & join our lively

### discussion at

www.forwomenseyesonly.com

Published

December 2015

### Contents

Foreword by Hippocrates

Introduction

Fleas, Fiddles, Nazis &

the giant leap into Women's Vagina's

by Linda

The shameful history of the British Cervical

Screening Programme, by A. V. Wells

Diane's Story

Chrissy's Story

A Short Thesis on Bums by Linda

Ada's Story

Linda's Story

Unconventional Attacks &

Iatrogenic Assault, by Alex

Kat's Story

Suzanne's Story

Hit That Target! by Linda

Angela's Story

Eliz's Story

Bibliography

Foreword

Medicine is of all the arts the most noble; but, owing to the ignorance of those who practice it, and of those who, form a judgment of them, it is at present far behind all the other arts. Their mistake appears to me to arise principally from this, that in the cities there is no punishment connected with the practice of medicine except disgrace, and that does not hurt those who are familiar with it. Such persons are the figures which are introduced in tragedies, for as they have the shape, and dress, and personal appearance of an actor, but are not actors, so also physicians are many in title but very few in reality.

Hippocrates 460-370BC

Introduction

With the advent of the Internet and increasing access to once hidden away medical journals, women around the World are discovering for themselves that incidence of Cervical Cancer is extremely rare. Rare enough for us to begin questioning why doctors and nurses insist on having intimate access to our genitals on a frequent, ongoing, (in many countries, annual) basis for our entire adult lives.

For the past thirty years, in every country, around the globe, when a women makes an appointment to see her doctor, no matter what she presents with, whether it be anxiety, depression, headaches, coughs and colds, or any other ailment, if she is 'overdue' for her smear, the first thing a doctor will want to do, is for her to remove her underwear in order for them to look inside her vagina to check her cervix for cancer.

Their focus, is not on us as women, but entirely on a small part of our anatomy, which is barely two centimetres in diameter, and unfortunately for us, located far up within the most private place of our body. Yet this small, usually inconspicuous piece of flesh, totally dominates the conversation during every consult.

Forced smear testing of all adult women is an archaic, degrading and dehumanising ritual fostered on us by the outdated mindset of the medical profession. A profession that gave us Mercury to drink, used leeches to drain our blood, tied dead pigeons to our feet, inserted acid enemas to rot our guts.

This highly unreliable, virtually useless, and particularly invasive test invented nearly a century ago - in this modern, dynamic, vibrant world, has no place.

A consequence of this manner of testing has been the unnecessary harming of millions who trusted our doctors enough to hand over our bodies to them. Countless millions more have been tricked into believing the timely removal of suspicious looking cells actually saved their lives.

What follows is just a few of these women's accounts... Women who until now have had their comments and complaints scrubbed from many medical sites. Experiences effectively silenced. Silenced that is... until now...

### *

Fleas, Fiddles, Nazis

& the giant leap into Women **'** s Vagina **'** s

by Linda

Georgios Nikolaou Papanikolaou was the inventor of the 'Smear Test' or the 'Pap Smear' as it is more widely known.

He was born in **1883** , the third child of Nikolas and Maria Papanikolaou and raised with his two sisters and brother in a small town on the island of Euboea, Greece.

In his early twenties, he studied medicine at the University of Athens. Upon leaving, he was conscripted into the Greek army to work as a medic.

On discharge two years later, he faced a decision: practice medicine on Euboea or continue as a medic in the military. Having no interest in holding down a job, Papanikolaou convinced his wealthy father to finance additional education in Jena, Germany. In 1907 he began to study zoology under Ernest Haeckel.

Haeckel was an ardent supporter of white race supremacy, who earlier had conducted 'scientific' experiments on the feet of black people to show their 'opposable big toes' proved that they had 'come down from the trees' much later than white people, proving 'Negroes' were 'less civilised.' A great deal of this rogue professor's work was later utilised by the Nazis for their propaganda campaigns against 'non Aryan races.'

Despite studying in this backwards environment, Papanikolaou was awarded a PhD three years later for his thesis on fleas, "Sex differentiation of the Daphnia" which looked at the sexual determination of the water flea. (What makes them male or female and how they have sex.) _Yes, that's right a - PhD on fleas._

Returning to Greece to pursue a career in biologic research, while on the journey home, he met Andromache 'Mary' Mavroyeni. They married on Sept. 25, 1910.

A few years later they decided to emigrate to America. When Papanikolaou and Mary landed at Ellis Island in 1913 the couple did what they could to survive in New York City. During the day he was a salesman, selling mats, rugs and carpets at a well known department store and of an evening he earned extra money playing his fiddle at local restaurants to entertain diners. Mary took a job working as a seamstress to create extra income.

Within a year of arriving, somehow he managed to secure a position at New York Hospital as an assistant in the Pathology Department. He stayed there for a short time before moving to the Department of Anatomy at Cornell Medical College.

At the time, (for reasons never made clear) the department was studying the effects of alcohol on guinea pigs and their offspring.

Georgios rapidly bored getting the little fury things drunk, finding the experiments useless and unnecessary. He was still interested in the sexual determination of living organisms. Making an application to the college for money, he was given funding to conduct experiments on a small number of the more sober female animals. The ensuing research, involved the study of pre-ovulatory guinea-pigs.

The experiments required obtaining the ova of the female guinea pigs at a precise stage of development near ovulation. He was interested in examination of the vaginal contents of a number of females every day to determine whether female guinea pigs had oestrous changes. Inserting a human nasal speculum into each of each female guinea pigs, he made daily observations of their discharge. Later, he decided to take smears so that microscopic changes could be assessed. He discovered that the oestrous cycle occurred for 24 hours every 15 or 16 days.

In 1920, he began to use his technique of examining smears under the microscope to study human female cytology.

His wife, Mary, was his first and long term, human subject. Along with smears samples from her, (taken every morning after breakfast over a period of twenty one years.) Papanikolaou then began to wish for more subjects to compare his results. So Mary asked ten friends over for a party, where they too agreed to be sampled.

The following Sunday evening after a light tea, one by one, Mary lead each of her nervous friends into their parlour, in which her husband had prepared his instruments to examine each of the women and take samples from their cervix's. Things were going well until 9pm when one of the ladies' husband turned up at their door looking for his wife. A big argument ensued and the police were called. The 'party' was broken up but by then Papanikolaou had taken all his samples.

However, some weeks later, when he was allowed time and equipment to examine the samples, one of these women was discovered to have 'unusual' cells on her slide.

The Water Flea expert contacted her and examined her a second time, taking the smear to be seen by a proper cytology doctor at Cornell. They both agreed there were 'unusual' cells on the slide.

The University was interested in his finding and in 1925 and began a joint study with the Woman's Hospital of the City of New York.

Initially, examining samples from twelve women that worked at the hospital and later collecting samples from surgical and pregnant patients, (who in a telling insight of what was ahead were told the procedure was a 'legal' requirement of their admittance, were the very first of what was to be a long procession of 'coerced women') he went on to publish an article on his research called , "The Diagnosis of Early Human Pregnancy by the Vaginal Smear Method."

Under examination of the slide, taken from a smear of one of his patients suffering from uterine cancers, Papanikolaou demonstrated abnormal cells could be plainly observed under a microscope.

At the time, there was very little enthusiasm from his fellow pathologists as cervical cancer was considered an 'unusual cancer' due to its rarity. They thought he would be better concentrating his efforts on the cure for more pressing concerns such as stomach and lung cancers which affected a great many more people. Alarmingly, his colleagues also voiced concerns about the specifity of the test. Demonstrating how easy it was to determine cancer was present on the test slides when it wasn't, and more worryingly how often it failed to detect cancer when it _was_ present.

However, just a few years later, the American Cancer Society was established. Having received huge amounts of funding in donations from well meaning benefactors as well as several government grants, it began to look around for new forms of cancer treatments to develop and utilize. Ignoring the very vocal concerns about the test by Papanikolau's colleagues, by 1945 this new organization began pushing and educating hospital administrators about the perceived usefulness of the Pap Smear Test.

Papanikolaou, realising the possible shortcomings of the test himself, began focusing his energies on training pathologists and cytologists on using what he saw as the correct cytological techniques. Prior to that time, he haphazardly trained interested people in his laboratory of an evening when most of the staff had gone home.

The following year in 1948, the First National Cytology Conference in Boston was held. The conference members felt that although there was some value in using the 'Smear' test, they did not feel an extensive campaign should be made until more pathologists accepted the test and were trained to conduct it properly. (Training people

in reading the slides was important in making accurate diagnoses.)

The American Cancer Society began putting the full weight of its endorsement behind the 'Pap Test' as it was now being called. It poured money into the company patenting the equipment used in the test and began proliferating articles in women's magazines about the dangers of cervical cancer.

The disease went from relative obscurity to one of national importance in just over a decade. Suddenly, everywhere, there where campaigns in the media encouraging women to come forward and be tested. The hysteria whipped up by this carefully coordinated assault on women's fears and insecurities about their bodies, tapped into the consciousness of millions of American women that a rampant out of control cancer was 'lurking' ready to pounce in every woman's vagina. Most of the world as yet remained largely ignorant of this internal monster.

In 1960, very good friends of the doctor working for the American Cancer Society put his name forward for the Nobel Prize in Medicine, and he came very close to winning it, just losing out to important research being done in immunity to diseases after organ transplant.

Two years later, however, on February 19, 1962, at the age of 79, the doctor died of a heart attack.

Despite never having taken the Hippocratic Oath or adhering to any of it laws, this dedicated Zoologist probably had good intentions for women in his heart, truly believing he could help appropriately trained medical scientists eradicate this 'rare' and 'unusual' cancer.

What Papanikolaou could never have envisaged, however, is that powerful vested interests would have taken over his work and turned it into the biggest money making business the world has ever known. The 'Cervical Cancer' industry is now estimated to be worth Billions of dollars world wide annually and rising.

Neither did Papanikolaou foresee there would be targets to reach, payments in the hundreds of thousands to doctors getting their female patients to submit to this vile and invasive vaginal procedure, often unwillingly.

That, in the interests of profits, women the world over are being lied to, kept ignorant of the full facts surrounding cervical cancer, herded like sheep into screening programmes to submit to this test regularly - in some countries, annually - their entire adult lives. Tricked into believing this cancer is rampant and out of control in a brain washing programme that would leave the CIA open mouthed in awe.

'Dissenters and Defaulters' (as the medical profession labels women refusing the test) are being coerced, bullied and harassed by their doctors into it against their wishes while presenting for other more pressing complaints and diseases that are often ignored and overlooked.

No other cancer is so ruthlessly searched for, that often, with such intensity, has had so much money spent on it, gains so much media interest to the point that anything else that might be wrong with a woman is not even considered.

The mania that has gripped the medical world in its search for this so called 'number one killer of women' has resulted in huge amounts of unnecessary testing, the often radical treatment of 'suspicious looking' cells which were mostly found to be nothing at all, the mutilation or loss of healthy cervix's, unneeded hysterectomies, miscarriages, pain, bleeding, and loss of sexual desire. Not to mention the worry and misery caused to millions of others who live in fear of this cancer.

How could he possibly have imagined, in countries around the world it would become law for women to have the test. That without a current 'smear' on file, women are not able to get access to basic medical care, the birth control pill, join the armed forces, teach in schools, look after children in nurseries; - that in some places proposals would be put forward for it to be a necessity to get any job, a driving licence! That it has the possibility to lead to a criminal record _and then what_? _imprisonment?_

Papanikolaou's precious 'Pap test' has become the mass raping implement of women the world over, from adults - often overriding religious beliefs, cultural and personal sensibilities, to the elderly in care homes, the disabled, women with mild as well as those with severe learning difficulties, pre pubescent teenage girls, to virgins, lesbians and most abhorrent of all - innocent children.

We now live in an era in which virtually every female alive on the planet today has had a speculum inside her most private place at some point in her life, while a doctor or nurse scrapes around a woman's cervix for cells, with this very uncertain and now archaic test, which in turn are then inspected using a very uncertain and fallible technique, all to look for what is arguably the rarest cancer known to man. (Woman, that is.)

Mary Pap receiving her award for the most smear tested woman in history

### *

The shameful history

of the

British Cervical Screening Programme,

by A. V. Wells

"Who, in the 1940's", writes public health consultant, Angela Raffle in her 1998 letter to The Lancet, "would have thought that by now the USA would be spending an estimated $4.5 billion annually on diagnosing "atypical squamous cells of uncertain significance?" The answer must be businessmen, since if this huge amount of money was in medical hands, a better solution or even a cure for cervical cancer would surely have come about years ago, and the lucrative "vagina business" would never have rolled its way on a tidal wave of emotion, political expediency, and hysteria across the Anglophone world, to fill our bodies, our newspapers, our surgeries, and hospitals with an irrational fear of a rare and declining disease.

This is the shameful history of the cervical screening programme in Britain.

A solution in search of a purpose

In 1920's America, Greek pathologist George Papanicolaou, had been working on the menstrual cycle of guinea pigs, and decided to transfer his work to humans, primarily using his wife as a test before expanding his experiments to some of his wife's friends. When one of the women later went on to develop cervical cancer, Papanicolaou reviewed the slide samples he had taken and realised he could have found on the slides, the earliest signs of a developing cancer. He proposed that if every woman took this test on a regular basis, those who had changed cervical cells could be given surgery, such as a hysterectomy, as a pre-emptive measure before the cancer took a hold.

In the post-war years, Papanicolaou traveled widely across the USA giving lectures on his theory, but there was a lukewarm response from the medical profession, who didn't believe that the changed cells were guaranteed to be a sign of early cancer. Many remained sceptical about the claims made by Papanicolaou and the medical profession was slow to accept the test.

However, in the United States in the early part of the 20th century, the private, insurance-driven healthcare system was seeking medical tests, which could be done on employees to prevent them from becoming ill, claiming injury at work and making a claim on their insurance policies. Annual medical exams, and especially, annual "well-woman" exams became a standard part of American life, and in the 1950's the Papanicolaou smear test, now known as a Pap test, which needed to be repeated at regular intervals to be of any use, became an ideal component of these ongoing exams, since it locked women into frequent medical check-ups, providing an ongoing lucrative business to the doctor.

As each Pap test provided only a snapshot of the cells at any one time and was no true indicator of the way the cells might change, repeated visits were required to monitor any changes throughout a woman's adult life. Any element of doubt would require ever closer surveillance, and more frequent follow up. It soon became a cash cow of immeasurable proportions for the exploding American ObGyn business, and every American woman was expected to have one. Women became locked onto a merry-go-round of repeated testing, repeated biopsies, repeated treatments. The more treatments were given, the more serious women believed their risk to have been, and the more they believed further treatments were necessary. Cervical cancer was such a dreaded disease that women regarded the unpleasant screening tests as a necessary evil to be endured periodically throughout their lives. Feelings of unease about the repetitive, invasive treatments, were brushed aside by good doses of propaganda in the press, suggesting that women "put themselves up for the procedures as casually as they go shopping", and even "caring moms" were encouraged to drag their reluctant daughters into the gynaecologists chair to "groom" them for this rite of womanhood.

In the UK, the NHS was set up in 1947 as a free healthcare service for the sick. The Pap test, which came to be known as a smear test in the UK because of the way the sample was smeared across a slide, was slow to be accepted as a screening tool on healthy women, because of perceived difficulties incorporating extensive preventive healthcare within the socialist system of the NHS.

At a meeting of the Stoke Newington Women's Peace Group in London, on 18th February 1964, a doctor had been invited to talk at a branch meeting on women's health, and told a captivated audience, that in America, women were routinely being given a simple life-saving test for cancer, which British women were being denied. Incensed at this injustice, the women approached their local politicians, and Labour MP Joyce Butler fervently took up the cause to ensure that smear testing be rolled out to all British women across the country. Throughout the 1960's and 1970's she constantly raised questions in Parliament demanding that an organised programme of smear testing be carried out in all GP surgeries.

However, the main reason that the screening test had not crossed the Atlantic sooner was that there were ongoing concerns about the accuracy of the test and how effective it would prove in screening entire populations of healthy symptom-free women. In addition, cervical cancer had always been an uncommon cancer, and was in already in steady decline as post-war conditions and health improved.

No randomised controlled trials were ever carried out on the smear test, but a number of studies took part in various parts of the world. Some medical professionals believed that all changes in the cells would go on to become cancerous and advocated radical hysterectomies without delay. Others were more cautious and believed the changes could stop and go back to normal over time, and no action should be taken except careful monitoring, especially where pre-menopausal women were concerned, since hysterectomies in this age group were a tragic event, especially if women had not completed their families.

Yet in the US and Germany, radical hysterectomy was the treatment of choice (for the gynaecologists) since many feared litigation should cancer develop after an all clear had been given, and there can be no doubt that a great many women must have suffered greatly or even died from their treatment in those days. The policy of "when in doubt, cut it out" became the standard treatment, due to regular widespread smear testing bringing healthy women in for this regular "medical maintenance".

Yet the pressure to bring organised testing to Britain continued to grow, despite many individuals attempts to ensure that evidence prevailed over emotional fervour.

During the 1970' and 1980's leading epidemiologists Petr Skrabanek and James McCormick working from Trinity College Dublin, became outspoken critics of plans to make the smear test a national screening tool. As an emigré from central Europe Skrabanek, had first-hand experience of living under state control. He coined the phrase "health fascism" where the government controlled people with regular medical interventions in order to prevent them from getting sick, and being a burden on the state purse. He rejected the idea of mass screening, not just because such programmes consumed great financial costs and resources, but also because they inevitably involved some degree of medical harm to healthy people in order to weed out the few who might go on to develop cancer. Because they spoke out against a national screening programme, Skrabanek and McCormick came in for heavy criticism and vilification from the pro-screening lobby. Skrabanek came up against difficulties in getting his work published, and had his work described by one Lancet editor as "scurrilous".

On 11th May 1967 at the Houses of Parliament, Mr Alan Williams MP questioned the value of the smear test in the House of Commons. He argued that before rolling out such a programme, the results from an independent Cochrane review should be sought before launching such an expensive and far reaching programme. However, the general feeling amongst some of the public and politicians was that the smear test had already been held up for long enough, and Mr K. Robinson MP replied that it would be wrong to withhold such a screening programme until Cochrane had completed his full analysis. When Cochrane had completed his review, and came out against universal cervical screening, he too was publicly vilified.

Since cervical cancer was a disease which could have very tragic consequences for unfortunate young mothers, it struck a chord with the public that something simply had to be done and emotions about the disease ran extremely high.

With the rise of militant feminism and the women's liberation movement during the 1960's and 70's, there was increasing consensus that the hold-ups were due to the inaction of old-school, male chauvinists in Parliament and in the paternalistic, male-dominated medical profession. While the efficacy of the test was being debated, young women were losing their lives. The urge to implement the programme before it had been properly tested gathered fanatical momentum.

Up to the late 1980's, smear tests were already carried out in a haphazard way on those women who arrived at their doctor's surgeries for other reasons, usually visits to do with contraception and childbirth. Tests were carried out from age 35 – 65, every 5 years, or earlier, if the mother had had more than 3 pregnancies before then. In order to get payment for doing the test the woman had to sign a consent form or there would be no reimbursement for the GP. In this way, a woman gave signed consent for the procedure to be carried out, and, generally, this way of testing cornered those women most at risk, and left others alone.

An organised screening programme is set up

Things reached a crisis point when in 1984, a woman in Oxfordshire died of cervical cancer after having failed to be notified by her GP of severe problems. The women's groups were outraged. The pro-screening lobby demanded that a national screening programme be set up without delay, and new Health Secretary, Kenneth Clarke, casting aside all requirements for confidentiality or human rights, wasted no time in setting up the NHS Cervical screening programme in 1989.

In those days, setting up a computerised call and recall system of every single woman in the UK (some 30 million women), was a considerable undertaking, and a computer system was developed under the name of "Open Exeter". Now seen as an unacceptably long, overdue, and absolutely essential health right for all women, it slipped barely noticed that vast amounts of personal identifiable details about every woman in the country under 65 were being taken out of the GP surgery and put onto a national database. The information was personal, because the exact name, age, address, and hysterectomy status of every woman, was needed to send out appropriate reminder letters at a timely date.

Clarke gained political credit for fast-tracking the programme on the outrage following the death of the woman in Oxfordshire, but in truth there were other reasons at play. Current Prime Minister Margaret Thatcher was very keen to replace the NHS with a privatised insurance-based healthcare system very similar to that in the United States. Clarke was appalled at this scenario, and had many fierce arguments with the Prime Minister to make sure this didn't happen. Clarke favoured the setting up of an "internal market" within the NHS, and Clarke eventually won the day, pushing through his White Paper "Working for Patients" in 1989. A white paper is a pre-legal document designed to implement policy, and iron out problems before it is eventually made into UK law.

In the first year of running the programme, attendance of the new smear test was still only about 40%, but Clarke had further designs on the programme. In a revised version of 1990, he set financial incentive targets for the doctors to reach. The White Paper was bitterly contested by the medical profession for many reasons, one of which was an annual incentive payment of £760 for any doctor who could smear test 50-79% of women on the surgery list. No payment was made at all for less than 50%, whereas under the old system they had received a straight repayment for each smear undertaken. Worse still, a top payment of £2,260 was awarded if the doctor could break through the 80% screening target. In 1990-91 the 80% target was about 12.3% of the GPs remuneration, but in inner city areas, where poverty was worst, a special inner-city supplement of £8.80 per cervix was placed on women, which could earn the GP a considerable sum in those days.

Resistance to the screening targets

Some doctors were appalled at the "bounty" being placed on women's bodies in this way, and questions were asked openly in the House of Commons, that many doctors, having their clinical judgement removed by targets, would be reduced to harassing, nuns, virgins, widows, the elderly and other very low risk groups into undergoing the test, just to reach the 80% screening threshold. On 2nd May 1989 in Parliament, Labour MP Mr Ron Leighton quoted some of the comments he had received from angry doctors such as:

"The immunisation and cervical smear targets are unreasonable. GP's cannot be a paternalistic police force forcing people to have what is good for them"

Another GP, also sensing that Clarke was using the smear test to push the NHS into the private American model, was quoted as saying:

"There is a widespread fear that the Government has a hidden agenda for the privatisation of Health Care".

In the same House of Commons debate, Tory MP Sir Michael McNair-Wilson also spoke out about the screening targets for cervical cancer being impossibly high to achieve and offered the following example from one of his GP constituents:

"Of the women tested, 10% had had a hysterectomy and 8% refused a smear. In [the GP's practice], the annual turnover of women patients was 20%. Accepting those figures, he claimed that a figure of 82% was only achievable if one included women who had had hysterectomies, or 71% if one did not. One might honestly question the value of a cervical smear on a woman who has had a hysterectomy".

On 5th July 1990, Mr Michael Baughen, Bishop of Chester, raised the issue in the House of Lords, that the screening targets were too severe on women, who may not wish to be screened. The woefully under-informed Baroness Gloria Hooper claimed there was no issue because 20% could refuse to screen if they so wished.

One of the most open critics of the screening targets, was Tory MP Emma Nicholson, who spoke for some time on the subject in the House of Commons on 29th March 1990. In her speech, she describes how doctors, just a few percentage points short of their 80% screening target and the top payment, can put extreme pressure on those women still refusing to undergo a test, and how many GP's were finding it difficult to reach their targets in an "acceptable manner".

She went on: "I believe that there should be a case for informed dissenters – women who are educated, well informed, but, who take the conscious decision not to have it. I received a letter from a widow of 64, who was deeply distressed...she had seen a stand-in doctor, who targeted her fiercely saying that if she did not have the test his income and that of her GP would be at risk. She went home. Since then the receptionist has telephoned her a number of times."

In further support, Mr Ivan Lawrence, MP said: "There is a serious question of interference with civil liberties and individual freedom....I ask him to bear in mind the strength of feeling. There comes a time when the nanny state should not go too far and invade people's freedom".

Despite handing over details of a number of cases and asking for leniency on those who were clearly at no risk of cervical cancer, MP Roger Freeman reiterated that there was "medical evidence" that both virgins and nuns were susceptible to this disease and the test was to be carried out on all women, and no categories would be allowed an exemption. This clearly shows the predicament that women in the UK found themselves in: the screening programme proffered a veneer of legality by claiming women had a real choice, and offering a 20% opt out, but in practice there was no option for anyone with a cervix to exercise their human rights and decline to screen.

The round-ups begin

Other politicians took a less humanitarian view of the screening targets, and saw it as their moral duty to drive women into screening, as they believed it was for their own good, and no woman, no matter how remote her risks, was to be exempted from the programme.

A good many politicians thought that women should have no access to evidence or even a choice in the matter. Many were angered by some women's reluctance to take the test, and publicly demanded heavier penalties to ensure that no woman could slip the net. In Parliament on 22nd January 1990, Labour MP Martin Redmond demanded that the leaflet "The cervical smear test: why you need it" be sent immediately to every woman in the UK, and later in April of the same year, fellow Labour MP, Eric Martlew asked Kenneth Clarke, if he would make it a part of every GP's contract to refuse to add women to their lists, if the woman refused to have a smear test. Clarke replied that this would be "highly unprofessional" of the doctors.

Yet unprofessionalism wasn't a concern for some doctors. A study into reasons why GPs removed patients from their lists in 2001 by Mark Pickin et al found that of 300 GP practices, 2 had removed women patients in the last 6 months for the sole reason of refusing to undergo a smear test, and a further 5 of these 300 counted their refusal to have a smear test as a contributing factor to their removal. Although Pickin quotes that these are rare incidences, approximately half (360/732) of all GPs in this survey, replied that they considered the financial incentives to reach screening targets as a genuine cause to remove patients from their lists. If it was rarely carried out in practice, the threat of removal was therefore a very real prospect on both sides of the GP/patient relationship.

Since up to 20% of the population is moving house at any one time, transient populations often meant a corresponding loss in screening revenues for the GP, so another tactic used was to send out letters to women notifying them that failure to respond to the invitation would mean that they were no longer considered to be at this address, and they would consequently be removed from the doctor's list. This further implanted the idea in many women's minds that a failure to screen would lead to removal from the doctor's list, and undoubtedly brought many anxious women rushing to the surgery. Whilst this might seem like a benign goodwill gesture, men are seldom put in the same position of having to contact the surgery or face being removed from the GP list, even if they have had no contact with their surgery over many years.

Being removed from a GP list forces women to register elsewhere, and since the NHS registration form in the UK illegally requires female patients to state the date of their last smear test, many women were again caught when trying to re-register at a new practice. Not only this, but many GP practices insist on an examination and smear test at enrolment for all new female patients. So for many women the decision to refuse a smear test could mean no access to primary medical care at all. As recently as December 2015, a woman posted on the NHS website that on trying to register at a new practice, she is forced to sign a declaration that demanded that she attend regular smear tests, or would she would not be allowed to register at the practice. This post was removed, along with several other complaints about the screening programme, from the NHS website a few days later.

No escape

Illegal activities to keep the screening targets high were not limited to GP's. Although referred to as invitations, the call and recall letters were, and continue to be worded to assume consent has already taken place and an appointment will be duly made. As these letters are often the first time women have been contacted by their GP in this way, nearly all women assume it is obligatory to attend. During the 1990's the internet was slow and offered limited research time, if women had access to it at all. The only information about the smear test, was from daily newspapers and magazines, and advice from the family doctor. Despite patients always having had a legal right to decline or refuse any medical tests, care was taken to ensure that for any of those having doubts about the programme, every avenue of escape was sealed off.

GP magazines contained regular advice on how GP's could "Hit that target", and in an article by husband and wife team, J. and J. Chomet, called "Cervical screening in general practice: a "new" scenario", even sending out smear test invitations on a woman's birthday was considered appropriate. This was one of a number of bizarre initiatives designed to make the experience of having a smear test, seem like a normal everyday activity, like getting a haircut. Advertising campaigns focused on aligning smear tests with various beauty treatments such as leg waxing or manicures. The idea was to distance the "well-woman" procedure to be as far as possible from being the sexually transmitted disease examination it actually was, and present it as respectable for all women to attend. It was promoted almost as a "treat which women deserved", like going to a health spa today. The hoped-for normal result was supposed to give the woman a "feel-good factor" and sense of empowerment making her think it had all been worthwhile. In spite of these dubious efforts, large numbers of British women found the rushed, often painful, impersonal procedure at their local GP surgery a violating and dehumanising experience, and a far cry from anything like a treat.

Throughout the decade of the 1990's over 80% of women were put under great pressure to undergo regular smear tests each year – one of the highest ever rates of cervical screening maintained anywhere in the world. In the GP's consulting room, latest smear test dates were strictly adhered to and any woman finding to be "overdue" was put on the spot to undergo a smear test there and then, regardless of the reason for the consultation. Computer screens were designed with "pop up" windows, which notified the GP immediately, that the patient entering the room was "a defaulter", and it was seen as the doctor's duty to pressure her to undergo a test. If the GP was unsuccessful, nurses were trained to give "woman to woman" back-up advice to those still wavering, and receptionists told to chase and make appointments for those about to slip out of the door. The "fascist" health state which Skrabanek had foreseen began to take shape, as sisters, mothers, aunts and friends were encouraged to "break the taboo in discussing vaginas" and "turn those in" who were still "dodging" their national duty.

Over time, women learned to go armed with some excuses, such as having a period, but when this wasn't possible, questioning would delve into more personal territory, such as the woman being probed about any kind of sexual encounter she may have had, so that the GP could assess whether the woman was competent enough to understand her own sexual history. Since some GPs and most nurses assumed that even virgins were at some risk and insisted on screening every woman with a cervix, there was often very little chance of the woman's informed decision being accepted.

Spiralling costs, anxiety and treatments

In 1998, after 8 years of running the call and recall system, hospital outpatient rates had hugely outstripped the actual prevalence of the disease. Angela Raffle quotes 6800 out of every 100,000 women being referred for abnormalities, when the incidence of cervical cancer had never been higher than 30 for every 100,000 women in its recorded history. The costs of screening spiralled ever higher, not just in financial terms, but psychologically too, as many women perceived an abnormal result to mean they would go on to get cancer. Rather than sorting those few women, who might be at risk, the smear test was so inaccurate that it put hundreds of thousands onto a conveyor belt of repeat interventions and surgery. Since the slides had to be examined by a person, and not computer-read, there was much disagreement about what looked abnormal and what didn't. It was largely down to the opinion of the cytologist reading the slide: one cytologists normal was another's view of cancer.

Originally, Papanicolaou himself had set levels of abnormality, but in later years gynaecologists decided on the levels: CIN1, CIN2 and CIN3, CIN3 being the last stage before cancer was expected to develop. Even still, it was widely estimated that of those with a CIN3 diagnosis, only about 15% of cases would progress to cancer, the remaining 85% could be expected to return to normal without any treatment at all. To ratchet up the level of alert, a new stage of cancer stage 0 was set, which came to be known as a pre-cancerous stage, before stage 1 true cancer developed. To the public the levels have been a constant source of confusion, with many women confusing CIN1 with stage 1 cancer. In their quest to find the very earliest beginnings of this cancer, thousands of women have been left in limbo for months or years at a suspected stage of possible cancer, with scant attention paid to the psychological costs of playing this interminable waiting game. While for other types of cancer, the NHS has been forced to offer the speediest of assessments and treatments, those with "abnormal cervical cells" may spend years being a hospital outpatient, with life revolving from one check-up to the next wondering if the next one will reveal true cancer and require major surgery, or whether it will all disappear and regress to nothing. All this, on healthy women with no ill health at all.

Rather than challenge the endless rounds of treatment, the more treatment women have, the more most believe their lives to have been in danger, and the more they are grateful for having been saved. Women who have been on the CIN merry-go-round often see themselves as survivors, posting online – "that smear test saved my life", "if I hadn't had that smear test, I wouldn't be here today", but in reality, most have not been saved from death at all.

Suppressing dissent

A major priority for the programme has been keeping the herd in check. An integral part of the programme has been to make the test all-inclusive across the female population to avoid stigmatising those attending for testing. Celebrities and even female GPs have been encouraged to go on live TV having smears to give the impression that no-one is above getting the test. Care has been taken to ensure "breakaway groups" do not emerge and deter others more at risk of the cancer from going. Those who have publicly come out about opting out of testing have come in for some heavy criticism, not because they might get cervical cancer and cost the NHS for possible cancer treatment, but because of setting a bad example to those unable to understand the risks. A large part of the promotional campaigns have centred on encouraging women to stay part of the herd, instilling the idea, that since the majority attend, it must be the right thing to do, and the minority must be in the wrong.

Information on how to opt out, has been strictly kept out of the public eye. The recall letters were skilfully designed to appear as a personal invitation from the woman's own GP, as research showed this achieved a higher uptake rate, but no attention was paid to the fact that it is illegal to send such letters under false cover. In fact, the letters are computer generated from a central resource. In flagrant breach of the law, there still is no right to reply, contact, decline or stop the letters from coming from this source, and their provenance still remains a secret from most women. If the programme was barely legal during the 1990's, the advent of the Data Protection Act in 1998, left the cervical screening programme clearly operating outside of the law. The DPA made it illegal to withhold computer data about individuals without them being able to see the data, and for the NHS to use that data to contact them without their consent. Under the terms of the DPA, it is also illegal for the NHS to cause distress to anyone by sending them these letters. To address this legal issue, the government set up Section 251 as part of new legislation in its Health and Social care Act of 2006. Section 251 states that the cervical screening programme can continue to operate "outside" of the Data Protection Act on the grounds that it would be unfeasible and impossible to consult with every woman in the UK, and ask them whether they would like to be a part of the programme or not. A simple solution to this would have been to simply include a right to reply with every first invitation, but this would have opened the door to dialogue over attendance and dialogue with women was the last thing the organisers wanted. Even today, the only option doubting women are offered, is to speak to their GP, who are financially incentivised to stop women from making a choice.

Uneasy consciences

In 1999 doctors C. M. Anderson and P. Foster, who had gone along with the programme and carried out thousands of smears on women, began to doubt the ethics and legality of such a scheme. In an article they wrote entitled, "Reaching targets in the cervical screening programme: are current practices unethical", they criticised the measures stacked against women to block choice and consent, and asked if such a screening programme at all, could ever be compatible with the human rights supposedly guaranteed in the British health care system.

In July 2000 with pressure from the law for the screening programme to tidy up its act, Rouse and Marshall of the Department of Public Health and Epidemiology, at the University of Birmingham, UK, wrote a letter to the British Medical Journal called "Women, Informed Consent and Cervical screening" outlining what GP's should be doing to inform women correctly about cervical screening. They claimed that "in order to obtain informed consent", GPs should at a minimum:

1. Inform women of the absolute benefit of their participation in the  
cervical screening programme. The benefit to an individual woman of  
attending the NHSCSP is extremely small.

2. Inform women of the inaccuracy of the test and disadvantages of being tested.

3. Always make sure that women understand what they have been told.

4. Inform women that because the Health Authority pays them to perform Pap smears that there may be a conflict of interest.

5. Familiarise themselves with the GMC's booklet: Seeking patients  
consent: the ethical considerations.

They added a table to show the true extent of the benefits of screening over not being screened:

Age No of Alive 10  
at start Women alive years later

at start if if they do not attend

they attend.  
____________________________________________________  
25 10,000 9963 9962  
35 10,000 9863 9859  
45 10,000 9713 9708  
55 10,000 9457 9450  
______________________________________________________

Years of blunders

Throughout the 1990's the newspapers fed on an orgy of smear test blunder stories: 1994: 4,000 women recalled for repeat smears due to computer error, 1996: 90,000 recalled for repeat smears after some women went on to get cervical cancer after normal smear results, 1997: 20,000 recalled at Inverclyde, Glasgow after some smears were found to have been misread, and also in 1997, some 8,000 women were recalled for retesting after it emerged that lab workers were testing the slides at home.

The huge leap in smear testing some extra 2 million women after 1990 was not without logistical problems. If women patients were finding it all new, it was also new to the many thousands of healthcare workers drafted in to carry out tests, which they may have only occasionally performed before. Women's experiences varied in the extreme with many finding the allegedly "quick and painless" experience to be anything but. American gynaecologists carrying out similar tests in the US were highly experienced and highly paid. British nurses, on the other hand, were carrying out such tests on a fraction of the pay and status their American counterparts enjoyed. Many showed a less than confident knowledge of the test, but this also acted as an effective buffer of convenience against the more knowledgeable women patients seeking further answers for the justification of these repeat tests. In 1993, 1,100 women were recalled in Birmingham for repeat smears after it was found that a nurse had been using a tongue depressor, instead of the special wooden spatula.

One GP was also doing his own thing: in November 1997, "738 women were recalled for repeat testing, when it was discovered that the GP was found to have been collecting cervical smears using his finger (which the doctor claimed was "suitable for women from lower socioeconomic groups")".

The major incident at the Kent and Canterbury Hospital in 1999 resulted in some hefty pay outs of over £1 million in tax payers money, and came about because of the way the public had been brainwashed into believing the smear test to be completely accurate. A number of women had gone on to develop cervical cancer after smear tests had been returned as negative, and in 8 cases women had died. What came out in court very nearly publicly exposed the appalling accuracy of the test and the rudimentary guesswork involved in deciding who might go on to develop cancer and who might not. The women's slides had been passed as normal or borderline by hospital staff. The hospital argued that it had followed guidelines and it was the inaccurate, subjective nature of the smear test itself which was to blame. However, information that the smear test was unreliable and inaccurate could hardly be allowed to leak out for fear of it reducing public confidence, and as in previous cases throughout the 1990's, judgement was found in favour of the women, and blame put on the cytologists for misreading the slides. When the hospital tried to appeal against the verdict, press reports of this "vengeful" waste of tax payers money further enraged the public opinion against the hospital and the programme continued as before.

Solicitors saw a lucrative business to those subsequently diagnosed with cervical cancer after a normal smear test result (40% of those with cervical cancer will have had a normal result in the previous 5 years), and many advertised special services geared to those hoping for financial gain from a "misread" smear test result.

The result of these cases was that it forced hospitals and cytology labs to err on the side of caution for fear of being caught again. From then on, the bar was raised and any slide with a whiff of suspicion about it meant a call-up to the colposcopy department, with ever more unnecessary cases filling hospitals, and ever more scare stories in the newspapers as a warning to those beginning to doubt the whole process.

In 2000, Raffle wrote again to the Lancet at the lack of sense of proportion surrounding cervical screening, about the escalating over-detection and over-treatment, spiralling costs and anxiety and saying that this should require a return to the drawing board. Yet the vested interests wanted it to go on.

To stem the inexorable interest in litigation against the screening programme, there has recently been more openness on the limitations of the test. The newer leaflets now state that no test is entirely accurate, and there has been more honesty about the reliability of the screening programme although this has largely been a handwashing exercise to stem litigation than to properly inform the public about choice.

Psychological effects

Considerable research has gone into the psychological effects on the women themselves. The stress and anxiety produced by an abnormal smear result can last for years, with many stuck on a conveyor belt of biopsies, tests and ever more frequent recalls. It turns healthy women into hospital outpatients for years at a stretch, and the state of living on the cusp of a cancer diagnosis for such a long period of time affects many women's quality of life. Even when returned back to normal recall, few women can get on with their lives without the fear of the cancer "ticking time bomb" returning. For many screening has become a religion. With poor understanding of the test, many cannot comprehend that a mild abnormality means very little at all. With years of pink propaganda in the media, emphasising that the test is "absolutely essential", a "life saver" and that missing one could potentially "cost a woman her life", women could be forgiven for believing that the mildest abnormality is anything but serious. If every single smear test is promoted as a vital case of life or death, how could an abnormal smear be casually passed off as nothing to worry about at the same time? The screening programme cannot have it both ways.

In addition, the immense pressure for every woman to attend for smear tests no matter how remote her risk, gave many the impression that this cancer was not only confined to certain risk groups, but was endemic across all women. The pressure to go created fear, which in turn created more followers for more, and earlier testing. At each hospital appointment, many women have come away believing their life to have been saved. Many sincerely believed themselves to have been days away from a cancer diagnosis, since the timed 3 yearly recall pattern gave many the impression they were "timed" to get this cancer unless their bodies were regularly scraped. The idea of being on some sort of timer switch to cancer runs through many personal accounts, women have posted online: "I've attended on the dot every year, but was 3 days late this year and already my cells were abnormal", writes one woman believing any delay results in bodily decay . The more things which were found at testing, the more descriptions of abnormalities, the more demand for further testing was fuelled.

The new millennium brings in change

In 2005, the incentive targets for doctors were changed to more gradual stepped 5% increases from 40% to 80% to prevent extreme pressure being put upon women, by doctors just short of a single big target. The change was well overdue, and we can only guess at the collateral damage which may have been caused to women over the years by GP's putting their payment targets ahead of their patients' wellbeing. Liquid based cytology has also reduced the need to repeat inadequate smears by a small amount.

The debate about the success or not of the cervical screening programme continues. Despite the spectacular increase in screening rates during the 1990's, deaths from this cancer have declined steadily at the same uniform rate as they did since the 1950's when there was no screening programme. It will always be open to question, how much deaths from this disease have been prevented by the programme and which have been the result of a natural decline of the disease. Supporters of the programme counter this by saying that there was a projected rise in cases of cervical cancer due to the use of oral contraceptives coming into widespread use in the 1960's, and that the UK programme has stemmed this projected rise, but in other western European countries, where there have been no organised screening programmes, and much lower rates of screening, there have been no epidemics of cervical cancer as "predicted" in the UK. In the Netherlands where there is an organised screening programme offering just half the number of smear tests UK women are forced to endure, and starting much later at age 30, there are better outcomes in the reduction of deaths from this cancer. Despite the death rate now standing at around 800 deaths per year out of a female population of about 30 million women, (about the same number of people die from falling on stairs) newspapers still headline articles about those women who are "risking their lives" by "ignoring their smear tests, as if the disease were at epidemic levels.

A major failing of the national screening programme is that it has always failed to save those truly at risk of this cancer. In the developed world it has always been a cash cow for the medical profession and a religion for the worried middle class well. The disease is highest in areas of deprivation and poverty, and the smear test is a high-end costly, skilled labour intensive solution which was never going to be workable in the less developed parts of the world where cervical cancer is more prevalent. Already it seems likely that simpler HPV DIY tests will surpass the current invasive test, leaving those of us in the developed West stuck with dismantling an expensive relic of misinformed 1970's feminism.

Despite claims that the NHS cervical screening programme has widespread public support, the fact that costly campaigns have and continue to be run to continually maintain uptake flies in the face of this assertion. About half of the £175 million costs of the cervical screening programme are taken up with the incentive payments GPs are paid to chase women. Not only promotional campaigns, but money has been put into extensive research over the years, on how to coerce more women into attending a test, they are clearly reluctant to have. The STRATEGIC project set up at Manchester University in 2010, aimed to research ways of increasing uptake amongst 25 year old women (90% of which have been vaccinated in the UK), who have been called up for their first smear test. Only 53% turned up to their first test invitation in recent years and failure to attend a first test has been shown to be an indicator that women will seldom attend later on. After 5 years of work, costing over £1,000,000 the STRATEGIC research has shown that after everything has been tried, there is very little which affects uptake of the test.

With an internet savvy population of better informed patients, and the ever growing army of those harmed by screening, speaking out against the programme and finally getting past the NHS censors, the pink propaganda of the previous three decades might well have had its day. The national smear test may never have been the best tool for the job it was supposed to do, but it has proved to be the best tool for population coercion, fear, compliance and the expensive privatisation of non-essential medical services.

### *

Diane's story

My mom made an appointment for me to see a gynaecologist when I was a young woman of eighteen. I was scared and shaking before and during my consultation as no one took the trouble to explain to me what was involved or what was going to happen.

In America where I live, it's the norm for mothers to take their daughters to see 'gyno's' when they are about thirteen or fourteen. Although no internal exam of a girls vagina takes place, at this first visit quite often a visual inspection of a girls outer genitalia is undertaken. This is often used as an excuse to rule out abnormalities or infections, though why a doctor simply doesn't ask a girl to report anything she thinks is wrong I don't know, after all, what can some old man having a good 'lech' at your private parts tell you what you don't know about your own body?

Also girls are encouraged to discuss very intimate and private details of their bodies to these doctors, which are unfortunately nearly always older men of about forty or fifty sometimes even older. Very few people question why it is necessary for a young women to be examined in this way by a much older man. It is put over as a normal part of being female and mothers are actively encouraged to take their daughters along to these exams.

Because I was so much older and wanted birth control this doctor decided it was in _my?_ interest to have an internal exam and a 'pap test.' I was embarrassed as I was very much against what I saw was a gross violation of my body. But he persuaded me to undergo it.

However, due to the fact I was extremely nervous the doctor was not able to penetrate my vagina with the speculum. My muscles had gone tight and he just couldn't 'get it in.' At the time I was glad as I didn't have the ordeal of having a speculum exam. Just the sight of the thing had 'freaked' me out.

But this was just the beginning of my problems.

All these things played on my mind and it lead to me abusing drugs for a number of years. I did have relationships with men but as soon as sex was on the cards I would freeze. My vagina would tighten and my partner would not be able to get his penis in. The problem was so bad that they could not even place a finger inside of me.

On the rare occasion I was able to have sex it was so painful I had to pull away. This problem, I feel destroyed any intimacy and enjoyment of sex.

I tried for many years to find out why sex hurt. But because all doctors want to do is give me an internal exam, but were not able to, I have never been able to get an answer to my problem. I asked for sedation so that I could be unconscious for the exam but doctors always refuse to do this. I have never found doctors of nurses to be sympathetic to me. In fact on some occasions I have had the very real sense they have been making fun of me behind my back.

For a long time I felt my life was utterly destroyed. What man would want a relationship with me? We would not be able to enjoy sex together or any other intimacy between lovers. Difficulty having relationships. No loving intimacy.

I have spent most of my adult alone. No one loves me and I love no one.

It's only recently when I went looking for answers, I discovered that for all these years I had probably been suffering from PTSD. (Post Traumatic Stress Disorder)

PTSD is a terrible thing to be afflicted with. It makes the sufferer recall memories in such great detail that it is painful. Because the memories are nearly always of that stupid doctor and him forcing an unwanted pap on me at such a young age, I am left utterly traumatised.

To this day I have never found an answer to my problem.

### *

Chrissy's Story

My introduction to the perverse world of gynaecological exams was at the age of seventeen.

Newly pregnant, I lay naked on the examination table, except for a thin paper sheet that covered my torso. A man in a white coat loomed above me, I felt anxious and vulnerable. I looked across at the attending nurse, a matronly woman in her late fifties, she looked back at me with no emotion, not a flicker. The doctor instructed me to open my legs, at which point I froze.

The emotions I felt at that moment I still remember four decades later, a sickening mixture of horror and fear. I wanted to get up and run away. He could see I was not going to comply, so he put his hands on my knees and forced them apart. Horrified as he pushed his fingers into my vagina, I clamped my legs shut on his arm and again he pushed my legs apart to continue the exam. When he finished, he moved the paper sheet down and began feeling my breasts, "checking for lumps" he said mechanically. My cheeks flushed red and stayed red for hours afterwards, a physiological result of extreme anxiety.

I left the hospital in disbelief, shocked and disturbed at what had just happened.

In my experience, the 1970s and 1980s were not good decades for being pregnant

or giving birth. The majority of births were in hospital and highly monitored and controlled, which they called 'Active Management of Labour', the experience of childbirth was cold and clinical. Episiotomy was the norm for most women in the

70s and they didn't ask for consent to do one. Any attempt at resistance of this regime was met with cold unbridled hostility, and the implication that if you did not do as you were told your baby could die. So I complied. It was clear that I was just a piece of meat on a conveyor belt, absorbed into a dehumanising system with no dignity and precious little kindness. I was just a uterus, a perineum and a birth canal. How many doctors, every one male, had been in my vagina? I lost count. I felt defiled, contaminated and dirty.

I could not find anyone who was sympathetic to my distress, just the confirmation that this is what happens to women and that I needed to shut up and get over it. But, I couldn't 'get over it', so... my coping strategy was to bury and suppress the memories. I have found to my cost that suppressing memories can lead to long term psychological problems.

But that's not the end of the medical profession's interest in my genitalia. The 'invitations' for cervical screening that came through my letter box every few years confirmed that. But this time apparently it was OK as the friendly neighbourhood nurse would be performing the test and not a male doctor. But it wasn't OK, no... not OK at all. I found it violating, horribly disgustingly violating. Every time the 'invitation' came, it would take me between 6 and 9 months to pluck up the courage to go. And I went because I believed that if I didn't I could die of cervical cancer and leave my children motherless.

Fast forward to my mid fifties. It was nearly five years since my last test and I knew the next 'invitation' would arrive soon. The very thought of it made me feel physically sick and I knew for sure that I couldn't face it again, so I went online to research how much of a risk I would be taking if I didn't go.

The realisation the risk was very small and that cervical cancer was rare at first

came as a sense of relief accompanied by a growing sense of anger. Exactly why had I put myself through this every time I was summoned? It was because I believed the 'spin' that cervical cancer was common. I also believed that all abnormal cells would inevitably turn into full blown cancer. I now know that most abnormal cells revert back to normal and that only a small percentage continue on to become cancer.

I began reading of women's experiences with cervical screening and there seemed to be a consistent pattern of manipulation using misinformation, coercion, scare tactics and withholding of medicine/treatment in the attempt to 'encourage' women to submit. This manipulation is not only used by the medical profession, it is also used by women who have bought into the screening system lock, stock and barrel and who believe it is acceptable to instruct, chide, cajole, frighten and insult reluctant women into having the test.

Bearing in mind that cancer screening is elective, that cancer screening has risks as well as benefits and that cervical screening in particular is a very invasive procedure, adding manipulation and coercion into the mix is highly questionable. The medical profession has concluded that the benefits outweigh the risks, so if women are not accorded individual informed consent it means they are taking risks on our behalf.

We have a 'one size fits all' screening programme, with no attempt to initially test for HPV. Instead it is straight to the pap test regardless of the level of risk for each individual.

Those who choose not to screen are labelled as 'avoiders' or 'non compliant', needing to be 'captured' with financial incentives for doctors to test large numbers of women.

Any information we are fed is often biased and economical with the truth, such as quoting third world countries level of cc in comparison to first world countries. Fudged and manipulated statistics, leading on to scare tactics, "if you do not screen, you will die a horrible death"

Add to this other women's brainwashed comments resulting from years of misinformation and deception. They "know of lots of women" who have had treatment for "abnormal" tests, so conclude that there must be an "epidemic" of cervical cancer. They are unaware of the amount of false positives. If you are unfortunate enough to develop cc "it's your own fault because you didn't have the test".

They say the test doesn't hurt (them) and "better 2 minutes of the test than getting cancer". "If you're mature enough to have sex, you're mature enough to have the test". "Suck it up". "Grow up" etc. Bullying, hectoring, insulting and lecturing, as they believe that they know what is best for other women. And then we have celebrity endorsement of the test or some unfortunate celebrity dying of cc. A pap test rap song video with puppets extolling the test. A campaign with women running around with their knickers on show telling other women that this is more embarrassing than a pap test. All designed to 'encourage' women to have the test, whilst at the same time being completely devoid of any factual information.

An emotional blackmail campaign with a poster of a crying child and the caption "My mum missed her smear test, now I miss my mum".

Medical Coercion with doctors withholding hormonal contraception, medication or treatment for unrelated issues unless you agree to a test.

Patronising comments. "Irresponsible, silly girl, doctors know best/better than you". "No need to be embarrassed" the doctor/nurse has "seen it all". The doctor/nurse has seen 'thousands'. Yours is "nothing special", the exam is "not sexual". "It's part of being a woman". "Get used to it". "Get over it" "All women have this". "It doesn't hurt".

Minimising the effects of treatments, which are considered by the medical profession to be minor. Morbidity due to treatment is minimised. Psycho/Sexual dysfunction given little credence. No recognition of psychological implications, feelings of violation dismissed as unimportant.

All this for an unreliable test never subjected to Randomised Controlled Trials. A test that does not conform to the requirements of a national screening programme, and because it is still acceptable in the 21st Century to patronise an adult woman and tell her what to do with her own body.

### *

A short thesis on Bums!

by Linda

Back in 2009 when I heard the news icon Farrah Fawcett had died I was very upset. She was just 62. She was my childhood hero and I loved her.

Me, along with all my school friends watched every episode of Charlie's Angels. We each had our favourite characters. Some loved Kate Jackson, others Jacklyn Smith, one even loved Bosley! But for me it was Farrah. Whichever one we adored, however, the following day after a show, in the playground and during lunch, we were all Charlie's Angels.

I first became aware she had developed Anal cancer in around 2007 after it was reported in the newspapers. Being a well known actor and a very public figure in women's issues she lived her life in full glare of the press. When she spoke about having contracted the disease she had already decided her life was to remain that way and she was going to hide nothing from her fans and followers.

Every painful intimate process she went through to cure herself of this horrible disease was shared with everyone. Then, amazingly later that year after several bouts of treatments including surgery and radiotherapy Farrah Fawcett was given the all clear. She was cancer free and doing well.

The star was described in the press as being 'elated.' A few months later at a routine check up to see how she was doing, Farrah and her long term friend Ryan O'Neal decided to record the consult with a mini camera with the idea they could have it as a memento of her being given the final all clear.

But the physicians news was not what she wanted to hear. The tumour was back and it was twice as aggressive.

Rejecting many of the more invasive treatments offered, she elected to battle it this time in a more holistic manner that would leave her body nourished and intact.

Although this approach worked initially the disease had developed to the extent it took her over. She returned home and took to her bed.

We all watched the documentary that followed showing a frail, tired woman living her last few days of life in pain and with her once famous hair - that we all dreamed of having \- gone.

In a very short time she fell into coma and stayed that way until her death on 25th June 2009.

According to the NHS (2015) symptoms of Anal Cancer are often similar to more common and less serious conditions affecting the anus, such as piles, bleeding from the bottom, itching and pain or small lumps around the anus, discharge of mucus from the anus as well as loss of bowel control. They recommend to book an appointment with your GP if you develop any of the above symptoms. While they're unlikely to be caused by anal cancer - it's best to get it checked out.

To do this a GP will usually ask about symptoms and carry out a rectal exam which involves inserting a gloved finger into the bottom so they can feel any abnormalities. GP will decide if they think further tests are necessary.

Some of the tests include a:

**Sigmoidoscopy** – where a thin, flexible tube with a small camera and light is inserted into your bottom to check for any abnormalities

**Proctoscopy** – where the inside of your rectum is examined using a hollow tube-like instrument (proctoscope) with a light on the end

**Biopsy** – where a small tissue sample is removed from your anus during a sigmoidoscopy or proctoscopy so it can be examined in a laboratory under a microscope

The main treatments used for anal cancer are:

**Chemo-radiation** – a combination of chemotherapy and radiotherapy.

**surgery** – to remove a tumour or a section of bowel.

Both chemotherapy and radiotherapy often cause significant side effects, including:

Tiredness

Sore skin around the anus

Sore skin around the penis and scrotum in men or vulva in women

Hair loss – limited hair loss from the head, but total loss from the pubic area

Feeling sick

Diarrhoea

Other possible long-term side effects can include:

Bowel control problems.

Long-term (chronic) diarrhoea

In men - erectile dysfunction.

In women - vaginal pain when having sex

Dry and itchy skin around the groin and anus

Bleeding from the anus, rectum, vagina or bladder

According to the NHS the exact cause of anal cancer is unknown, although a number of factors can increase the risk of developing the condition.

**infection with human papilloma virus (HPV) having anal sex or lots of sexual partners.** H **aving a history of cervical, vaginal or vulval cancer.**

Smoking, having a weakened immune system.

The NHS doesn't have a screening programme in England for anal cancer. This is because there isn't currently enough evidence to show the benefits of offering screening would outweigh the risks.

While reading my words on the tragic death of Farrah Fawcett and the information on Anal cancer provided by the NHS did you give any thought at all to what was going on in your own bum? Other than worrying if it looks overly big in the trousers you put on this morning or finding a place to park it in order to read this article, have you given your derrière a second thought today?

Cancer Research UK statistics show just as many women get Anal Cancer as do Cervical Cancer. In fact their concern is that while incidence of Cervical Cancer is falling year by year, Anal Cancer is increasing year by year.

Yet, where is the hysteria surrounding this cancer? When Farrah died, why wasn't every second rate celebrity in Britain screaming for us to check between our bottom cheeks every single minute of the day? Where are the television personalities queuing up to have their bums checked live on morning television? Why isn't the Daily Mail issuing minute by minute updates on the real dangers for women from this disease? Why aren't Women's magazines hammering home the importance of having your bum inspected regularly by doctors?

Most notably, why does the NHS feel that the risks far outweigh the benefits for regular bum checks when they have spent the past thirty years damaging women's Cervix's irreparably with their Cervical Screening programme?

The risks didn't seem to come into it when I was told I had suspicious looking cells that had to come off. Where was the fear of risks when I was having my private parts prised open with the Hubble Telescope and hacked at, frozen, burned and removed only to discover - whoops- we got it wrong there was nothing there at all?

The NHS is so hysterical about the state of women's vagina's that as soon as they deem us old enough, they 'invite' themselves in to have a good rummage around on the pretext they are looking for cancer.

This regular inspection goes on all our adult lives until the age when we become nothing more than an irritant to the NHS and a drain on their resources.

They spend sleepless nights wording fear mongering campaigns to force us to take our underwear off and get us on doctors table. They tell us 'we must' 'should' 'it's responsible' 'we have to get on with it.' While a woman who doesn't do the 'right thing' must be 'stupid' 'uneducated' or of such a 'low socio-economic class' that even the Dallit women of India seem like princesses in comparison. So we book our appointment and go. However, even though this part of our body sits mere millimetres away from our bottom and we are statistically more likely to get this cancer, doctors and nurses simply ignore it.

According to the NHS, the supposed causes and symptoms of Anal Cancer and Cervical Cancer are almost identical. They are both caused by HPV, having had multiple sexual partners from a young age, a weakened immune system and of course that old get out- smoking.

The actual incidence of Cervical Cancer is low due to the fact Cervical Cancer is the most rarest cancer a woman can get, but the Internet is awash with accounts from young girls who believe having smear tests has miraculously caught their cancer early and saved their lives. The NHS is totally mute on the subject of risks here.

So why is it a woman is left to report symptoms of her own volition ie. Its best to get it checked out! when it comes to her bum but when her vagina is involved the NHS wants to inspect it as a matter of urgency whenever they feel like it?

If a woman ignores her letters the subject of her outstanding smear test is brought up at every subsequent doctor's visit before she even opens her mouth to recount symptoms she came about. Or if she avoids that, letter after letter and then phone calls by rampant practice nurses, followed eventually by hordes of medics camping out on her lawn and even MI5 putting her under surveillance.

There are dozens of other cancers women get I haven't mentioned here. I just focused on the one that killed my childhood heroine, Farrah. But it seems to me the NHS is only interested in cancer of the cervix. We are forced into spending our lives worrying about this one cancer when we don't even give a second thought or concern to the more prevalent and horrible ones that are very real major heath problems.

Stories about vaginas are sexed up by the media and celebrities and anything about them makes a damn good read, whereas, in comparison, anus's, are just not thought of being in any way interesting. Vaginas are luscious and sexy; they have nice feelings and they can have orgasms and they are great to root around in whereas there's nothing nice about anus's, because only diarrhoea and sh!t comes out of here.

After all what doctor wants to be shining a torch up, and looking in, people's bums all day long, when he can be having a look and feeling around a vagina?

To sum up, a woman can ignore symptoms of anal cancer if she wishes and even if her anus is trailing along on the floor after her, she only needs to report these symptoms if she 'chooses' to, because the NHS thinks " **its best to get things checked out" -** Yet when it comes to her vagina, even though statistically she will probably never get Cervical Cancer or anything else wrong with that part of her body, they deem it necessary to post out 'invitations' which are nothing more than thinly veiled threats to get access, on an ongoing and alarmingly regular basis all her life, to her most private place.

Desperately searching about to see if they can find anything that is remotely 'suspicious' looking even though she is completely well and hasn't reported any symptoms at all.

### *

Ada's story

I'm mid-50's and in my life, I've had only 3 smear tests, as we call them in the UK.

The first one was in my 20's during the mid-1980's. I had gone to a GP about getting the pill and had no idea what would happen to me there. I thought a woman could just ask for it. I found myself having the routine pelvic, breast exam and a smear test. It was carried out with swift efficiency, by a Chinese lady, who had clearly had a lot of experience.

The smear test, however, was a bit of a shock – I'd never seen or heard of such things, and although it didn't hurt too much, it made me very unhappy. I had gone because I wanted to get married, and here I was being prepared like a turkey ready for the oven. I came away feeling like I'd been processed for prison, not married life. Men didn't have to put up with this, and I didn't see why women should be expected to put up with this nonsense either.

I was given 3 packets of Logynon, a tri-phasic pill. The first week I felt fine, but the second week introduced a progestogen combination, which gave me blinding headaches after a couple of days. Normally an optimist, I found myself weeping constantly throughout the day, feeling very down all the time and having a mouth full of ulcers.

At one point I counted 10 in my mouth at once, and was having to get by on liquids through a straw. To cap it all, I developed an unsightly stye on one eye, something I'd never had at any other time. I stopped the packet immediately as I didn't feel I could tolerate this any further, and in a couple of days I started getting back to my normal self again. In later months, I tried twice more, but each time the same thing happened.

The GP was indifferent when I told her and suggested an IUD? I was appalled. Not only did I fear the damage these things might do, but if I were to experience severe side-effects as I did with the pill, there'd be no getting it out to stop it. I had to have something I could control myself, so the doctor and I parted company, and work took us to a new location.

I didn't re-register with a GP for a while, so when the organised cervical screening programme was rolled out in 1989, I don't remember receiving the summons letters at first.

However, when I became pregnant, I signed up with a local practice, and was delighted that they also supported home births. It was at one of my prenatal checks that the GP raised the topic of an outstanding smear test. I told the GP that I didn't want one. I knew that this cancer was caused by a sexually transmitted virus, and I knew my risk was extremely low. However, it was presented to me as something that was an essential part of the "childbirth package".

I was told that all the right boxes had to be ticked for the doctor to allow the home birth to go ahead, and there were to be no outstanding concerns. Despite putting my point across firmly, I felt that I could not rely on the doctor to not pull the plug on my home birth plans at the last minute if I continued to refuse a smear test, so very reluctantly, I gave in.

The GP wrote in my notes: "She is vehemently opposed to the cervical screening programme, but has agreed to have one today". Being vehemently opposed to something but to agree to it at the same time is obviously medical terminology for "forced the patient against her will."

When we had registered at this practice our GP had been a kindly old man, but on his retirement, we'd been transferred to the list of a brash, new zealot. With her initials being **S & M,** the alarm bells should have been ringing loud for me, but other surgeries were out of catchment for us, so I thought if I could get this one over and done with, I'd go elsewhere next time around.

I was extremely sick and ill throughout my entire pregnancy and the fact that Dr SM was dismissive and unhelpful about my debilitating pregnancy sickness further angered me. The sole part of my body she had any interest in at all, was my cervix and nothing else. The procedure hurt and made me bleed. I was alarmed and furious that the weeks of vomiting might have all been for nothing, just so this blundering fanatic could reach her screening quota. The insult to the injury was Dr SM casually saying that the sample was contaminated with too much blood to be of any use, and would be rejected. It had all been a waste of time.

I went home angry and upset, but fortunately, my pregnancy continued to 37 weeks when my waters started to leak. I reported nothing to the midwife, and gave birth normally at home a few days later.

I was overjoyed, but had sustained a 2nd degree tear during the birth. As I was comfortable at home and we had no anaesthetic, the midwives told me I could either go to hospital to get it stitched, or leave it to heal naturally. I chose the latter. The first six weeks with a first baby was the hardest challenge in my life. I was physically exhausted after my 9 month vomiting spree, totally lacking in sleep from the night feeds and my underneath was sore as hell. I can only describe it as though someone has given me a good and sustained kicking into the groin, or, as if I had suddenly taken up long-distance cycling, after never having ridden in years. I was getting up out of a chair like a 75 year old and having to sit on very soft cushions.

Yet the NHS literature I was given was all about getting you onto contraception as soon as the baby had popped out. How on earth did couples get to work on baby number 2 so soon? Was there something wrong with me? The gentle, caring midwife would call every day for the first 2 weeks and always had a look at my underneath, but never touched me. She assured me things were fine, I was healing safely and to take things easy. At the time of my 6 week postnatal check, I was still struggling to cope both physically and mentally and was naively hoping for some help from Dr SM.

On arrival at the surgery, with my baby in a carrier, I was called by the practice nurse and shown a small room, where I was told to wait on the couch with my underwear off. Dr SM was running late and would be along shortly. I was a bit annoyed that the examination was to take place first, when I'd got so many issues I wanted to talk about. Surely, it would have been polite and professional to have exchanged a few words first?

After a while the door opened, and in walked Dr SM with the nurse. Ignoring me without saying a single word, she proceeded to put on some gloves. Feeling uneasy, I thought I'd draw her attention to the fact that I'd recently given birth and introduce my baby, but she just gave my baby a cursory glance, saying something about a small one like that being a good size to start with. It was only then that I caught sight of the blade of a large-sized metal speculum heading straight into my body.

I was shocked. Hadn't she read my notes? Hadn't she guessed the state I might be in after having a baby? It all happened very quickly, so I clenched up, but, unable to get the speculum in, Dr SM simply applied brute force and drove it home, opening it straight away, which made me want to pass out. The pain was as if my torso was being split into two.

I could feel all my muscles in the lower half of my body being prized apart, when they were trying heal after the birth. It was the most pain that anyone had ever inflicted on me. I kept thinking that if I cried out, people outside would hear and come rushing into the room, and more than this, I knew that screaming would distress my baby who was near me. I could only breathe and open my eyes when Dr SM had withdrawn the device, but my eyes were full of tears.

I didn't see what happened after that, but Dr SM must have calmly walked out of the room as if nothing had happened, because nothing more was said. She clearly couldn't give a damn about my well-being, my baby, how I was coping, or that I now lay weeping on a couch. Dr SM was only interested in cervices, and hitting her 80% screening target. Postnatal assessments for her, were simply a golden opportunity to ram that large-sized speculum into the raw, swollen vaginas of new mothers.

When I wiped my eyes the nurse was still standing there staring at me aghast. She'd seen it all. Then she asked quietly if I was alright. What must it have looked like? Without saying anything, I struggled off the couch, put my underwear on and left crying. I was deeply traumatised, in even more pain, tearful and shaken for many weeks afterwards, even though two days later, I managed to get some much needed help from an experienced health visitor.

There is no free time in life with a new baby. The demands are relentless and I had to keep going. My strategy for moving on from this incident, was to carefully "place" this experience in a "strong compartment" in a corner of my mind that I would never go to and never open. I would seal it up and never go back there in my thoughts.

Although I felt I had been painfully raped, I could find no redress in a health system, which saw women's bodies as their property to do with as they pleased. In the eyes of the NHS, this crime is constructed as a medical procedure and no matter how painful and unacceptable, women are conditioned to believe it is "life-saving". In calling it "life-saving", anything less than death itself is an acceptable procedure to inflict on the patient.

But for those of us not at death's door, who are perfectly healthy, with no symptoms, why should we be forced to tolerate these misguided, fanatical exorcisms of the deluded preventive health care brigade?

I decided that in future, I would only accept absolutely, essential medical care for myself and my family, and I would definitely make sure I would never, ever allow a smear test to ever take place on me again. Even today, if I think about it, nearly 20 years later, it can bring me to tears thinking about what was done to me at this appointment. When I asked to view my medical notes from this postnatal assessment, there were just two words in the notes: "smear taken" and a date.

When I had my second child, I reported the pregnancy to Dr SM who said she didn't do smears pre-natally any more, only at the postnatal assessment. I made damn sure I did not attend.

In the event, baby number 2 was a home-born whopper, giving me a 3rd degree tear, which is all the way to the anus. After a relaxed cup of tea, I was off to the hospital for a spinal block and repairs, to come home later that day.

Motherhood the second time around was much easier. I cancelled the postnatal assessment and the subsequent smear test invitations went straight into the bin. At an appointment with my children, I remember this same nurse trying to use my children as bait to get me to agree to another smear test, suggesting that I could be leaving them to grow up as orphans if I didn't have one. I refused in absolute terms. In 2003 I received a phone call from some unknown person asking me why I wasn't attending smear tests. I told her. She asked me if I would like an opt-out form.

Of course, I readily agreed, but I was also angry that such a simple solution was being kept from UK women. The GP had certainly never mentioned this, when I had made my feelings very clear, that I did not wish to be a part of this programme. The form arrived the next day, and I returned it immediately. I have to say, I've never been pestered for a smear test since, and the issue has never been raised at my very rare, infrequent GP attendances since.

In the meantime, I sent a letter detailing this experience from years ago to Dr SM, but she never bothered to reply. I have changed to another GP at the practice, and I've also raised the issue of consent to smear tests at a Patient Participation Group, but got no response. I sent the same details to Healthwatch, a national body in the UK to investigate medical complaints, but I was disgusted with their response. After taking some time to reply, they told me that taking any action against the NHS cervical screening programme might put people off going.

I do not feel my experience could have been an isolated case: it is now NHS policy not to do smear tests on pregnant women or on women less than 3 months after a birth. Although the NHS denies there is any risk in doing so, the real reason can only be, that many others have suffered as I did, or even worse.

Hopefully some of their stories have got through the impenetrable wall of NHS denial, which is an in-built part of this screening programme.

### *

Linda's Story

Between 1988 and 2010, the NHS had me raped on seven separate occasions...

1

Dr Vorn glared at me from under heavily hooded eyelids.

'All women have these,' he snapped in reply at my weak excuse to get out of what I considered to be a horribly intrusive thing.

'It's just part of being a woman.' His demeanour suddenly changed. It became more altruistic; more paternalistic. 'Besides I wouldn't be a good doctor if I didn't give you a smear test before renewing your prescription for the pill.'

Lowering my gaze momentarily to the floor, I felt foolish and childish in front of the much older, wiser, man of medicine. He knew what was best for me. At 22 years old; married with a home; it was time I grew up. Reluctantly, I nodded my capitulation without uttering a word.

A tongue darted out from between his lips, moistening them. He visibly brightened as he explained in a rushed voice, he would step out of the office for a moment while I removed my underwear and pulled my skirt up and hopped on to the examination table and then lay down.

Doing as told, after a few moments he re-entered the room. I lay there terrified, still naive and only now beginning to get an inkling of what was going to happen.

Although he was gentle doing whatever he was now doing, the sensation of some strange implement being pushed into my vagina was repulsive.

My mind retreated to a far away place. A kind of mental detachment to what was going on 'down there.' A detachment of my core self from my own body. My vagina.

And then came the pain. Unexpected. Sharp and cutting. It was excruciating. I could feel an inner twisting on my cervix. It was the most intense pain I had ever felt. Even today I still recall that pain vividly. I don't recall crying out. I remember I was holding myself rigid.

Winding the mechanism's jaws shut, I felt the thing being tugged from my vagina, my introitus sagging with relief as the opening of my vagina closed back in on itself. Catching a glimpse of the speculum, I saw a huge hulking great piece of ironmongery, now covered in grease and vaginal mucus that had somehow opened my precious lady space like a cave. A glob of clear jelly squished from my opening onto the paper drape beneath me. It looked like a party jelly gone terribly wrong. I remember just gaping at it in horror as Dr V reached and grabbed the paper towel beneath me, crumpling it before my wide eyes and tossing it into his waste paper basket.

I was in shock. Feeling somehow violated, found myself inwardly repeating over and over, this was a simple medical procedure, other women went through it. And surely the doctor received no pleasure from seeing a young women's genitals so close up? The parted outer labia, the moist inner labia, the rose bud like clitoris? Peering in to them at his leisure to make sure everything was ok, healthy, free from disease and pleasing to his eye and not wrong in someway, diseased, unappealing; then taking his time placing a foreign object through the vaginal opening and into my most private place? He is the doctor. He looked at women's private parts everyday. They were just something to examine. They meant nothing to him; was probably sick of seeing them. My mind was in turmoil. He left the room as I hurriedly got dressed.

Glanced over at a small washbasin in which he'd placed the used speculum, I recoiled in disgust. It lay lop-sided on top of a heap of others that had been flung there. A half empty bottle of fairy washing liquid was in amongst them. I recall thinking 'ugh' How many other vaginas had those things been in? I felt physically sick. Upset and angry that this is what I had to go through just to obtain the pill.

2

In 1993 a letter came through the door one Saturday morning 'inviting' me to make an appointment for a smear test.

On a wedding invitation or an engagement or birthday one, there is always the opportunity to decline the invite; a slip or a return address, contact details to let people know you're not coming. On these leaflets there was nothing like that; only information on the importance of having regular smear tests, the statement that thousands upon thousands of women get cervical cancer and die, along with the instruction to make an appointment and get on with it.

At first I ignored the letter. In fact, tore it up and threw the pieces in the bin. No way was I having another of those, shuddering at the memory of my first. By now, while I couldn't remember the exact date of it, the deep shooting agony I had felt in my vagina that day never left me.

The next time I visited Dr V he implied that I could not have any more contraceptive pills unless I had another smear test. The two were inexorably linked and this is how it was. I begged but he refused. If I was mature enough to have sex then I was mature enough to have the exams to make sure all was well to go with it. It had been three years since my last test and all the sexual contact I'd had in between could be leading to cancer. _My husbands_ s _emen was very bad for me; rotting away my private place._ It was now a matter of life and death. No test - no pill.

'My name is Nurse Gwyn Grimey.'

She was a big boned woman, late forties or early fifties, I couldn't tell which as her hair was dyed and she wore a lot of make-up. Her whole manner was friendly and welcoming, reminding me of a nursery school assistant or a fairy godmother. Immediately I was put at ease though the impending procedure was there in the forefront of my thoughts.

'Take off your shoes and just pop up on to the table, my Little Angel. When you are

ready raise up your skirt and lie back.'

I did as she instructed.

'Now lets have a little look at you My Darling,' she purred, as she came over to me. 'Just let you knees flop to the side and raise your bottom to me. That's it now, I'll be as quick as I can, Sugar Plum.'

A gloved hand reached for my genitals and parted the labia as she peered at my privates. During my first smear test, I had closed my eyes but for this one I was determined to keep them open and watch the procedure.

Then the speculum loomed into view. It was caked with the jelly lubricant and so were her gloved fingers as she penetrated my genitals, gliding in effortlessly with practiced ease before opening me up for her to peer inside .

'Are you all right, Little Chicken? ' she asked concerned, as my teeth clenched tight with a loud crunching sound; loud inside the small room.

I'd felt the whisper of a scratch in my vagina wall. It was stinging slightly. Reassuring myself it was nothing major, only light, some discomfort to be expected; but my body was remembering. As the speculum was opened fully inside my vagina for this nurse to view my cervix I winced in pain. Ignoring me she began scraping around my cervix. I cried out. It felt as if she was pinching the organ. It hurt like hell and I flinched trying to pull away from it.

A fleeting thunder cloud crossed her features as she glanced away. She forced it from her face before re-donning her syrupy smile but she could do nothing to retract her bared teeth.

'I'll stop if you want me too but I'll be finished in a second, Cream Cake.'

I instantly cried out for her to stop. The command bursting out on a lungful of air I had been holding in. Unbelievably she just ignored me.

'No. Stop. It's too painful.' I told her. 'It feels as it you are scraping out my insides. I feel like I'm on fire.'

'It won't take a second, Honey Bun, I'm nearly done.' she reassured me carrying on.

'You will have to stop now. I can't take anymore.' I called through gritted teeth. I felt dizzy and sick. Glad to be lying down as I was sure I had been standing I would have passed out.

Quickly finishing the procedure, she began withdrawing the speculum. I cried out again.

'I'm being cut.' I remember crying "fu*k this" into the air. 'The thing has ripped my inside. I can feel it.'

'Nonsense, Sweetie Pie,' she retorted.

Lifting the used speculum towards my face. I recoiled in disgust seeing the thing all glistening and shining under the stark glare of the strip lights above.

'You can't be cut by the speculum, the thing had been designed with the purpose of being placed into the vagina and taken out again. It can't possibly have hurt you.'

'I am cut.' I heard myself yelling. I wanted to scream. This was the inside of my vagina

I was complaining about. She was a nurse...

Putting the speculum to one side, she peered at my throbbing genitals.

'Yes, there does seem to be some blood.' Her fingers lifted my labia apart.

'Lets have a look at what's going on in there shall we?' Reaching out for a swab, she placed it over my private area. She pressed it and then pulled it away. 'There does seem to be a small amount of bleeding. Do you have your period at the moment?

'No.' I replied, indignant. 'The doctor told me to book the appointment in the middle of a period.'

She pressed the swab back against my vulva, unconcerned about my discomfort or my dignity. Lifting it away a few seconds later, I could see why she mistakenly thought I was on my period. She put the pad to one side and took hold of a second.

'Hold this in place for a few minutes, Little Chicken.'

Pulling her hand away and pressing my own to it. After a few minutes she inspected me again.

'This has never this happened before.' She began reassuring me. 'I think you might have delicate membranes on your cervix. That possibly accounts for the blood. But I don't know what can account for the pain you were complaining about though. I was very gentle.'

I flinched under her cold gaze.

'Are you a bit sensitive Linda?' she then asked. 'I'm going to put this delicately so please don't be offended - but I think you're over reacting. It could be that you've blown this out of all proportion in your head. And worried unnecessarily about it. I could tell by your face when you first came in you weren't a Happy Bunny.'

'I don't like smear tests.' I mumbled.

Nurse G was smiling sweetly. Too sweetly.

'Well, its all part of being a woman.' she cooed. 'You have to get used to these tests because I can assure you by the time you reach my age you will have had dozens.'

I left nurse G's office sore and still bleeding. I was still bleeding four days later and using pads and I still hurt. The delicate space penetrated by the cheaply made plastic speculum, a sharp bit had sliced the walls of my vagina.

3

A month or so later a letter came in the post. I read it with mounting horror. My recent smear had shown up abnormal cells and I was being 'invited' for further testing.

I didn't understand what had gone so badly wrong. I didn't feel ill and there didn't seem to be anything wrong with me 'down there.' In fact I felt well. There was no mention of anything like this on the leaflet that accompanied my 'invitation.' No mention that having a smear test could lead to further testing. Why hadn't I been warned of this? What were these 'abnormal cells'? How long had they been there? The test was to check for cancer of the cervix, I knew that, but what were these 'abnormal cells' they had found? They must have found cancer, I decided.

Devastated, I convinced myself I was dying of the disease. Nothing could stop it now. I was only 25 but my life was over. I imagined the progression of the tumour now eating at my body. My cervix was beginning to blacken and shrivel. There would be months of hospital visits ahead of me. Surgery, radiation, chemotherapy. Made sick by the round of treatment I could look forward to diarrhoea, nausea and vomiting, while secretly harbouring the thought, perhaps they could do nothing for me and I would die.

Thoughts of my slowly disintegrating vagina forced me to make an appointment to see my Doctor. What was to come was far worse than I could have imagined.

After another smear test revealed suspicious looking cells the NHS was worried would become cancer, my life became a series of hospital visits one after the other which went on for months. I had one biopsy, then a few weeks later another. A few weeks after that they did something else which I could not give the medical name for as only being the patient I was not privy to this kind of information. All I remember is it was excruciating.

Back in the 90's when I was having all of these treatments, no anaesthetic was given as the procedure was relatively new and it was still thought in the still then male dominated patriarchal space of the hospital setting, I would not really feel pain 'down there' The only thing I didn't have was an hysterectomy. Though at one point it was discussed and for a while it was on the cards.

Me and my husband wanted babies but now there was going to be a problem with that.

I was a mess. My cervix was a mess. I was in so much pain. My abdomen throbbed not only from all the procedures but from the indignity of all those hands and tools feeling around and digging around. There were days when my vagina felt so big and swollen I believed the rest of my internal organs were going to fall through it.

Of course, making love with my husband was out of the question. I was 25 he was 28. We were young. We should have been enjoying our youth. We should have been having sex.

Did I have cancer?

No.

Did they find anything?

No.

What, not even something remotely suspicious looking?

### No!

4

Because of the cleverly crafted ruse by the NHS, like many others, I came to believe smear tests were mandatory for women. Law, in fact. When the next summons came I made the appointment for the test within a few weeks of the letter arriving.

'Now, Flowery Loo, let's hope we don't have a replay of the drama of last time.'

I scrunched my eyes, mentally psyching myself for the vaginal torment. My breath was rock solid in my lungs every fibre of my being clenched.

Some years had passed since the treatment for my non existent cancer. It was now a distant memory and I had returned to the normal course of my life.

'I think I might be pregnant this test won't in anyway harm my baby will it?' I asked Nurse G. 'Its just that if I am pregnant its only about six weeks.'

'Are you late for your period?'

'Yes, by about two weeks.'

'Are you trying for a baby?'

'Yes. We've been trying for a little while now. Are you sure it will be OK? Its just that I've heard smear tests can cause miscarriages.'

'Who told you that?' Nurse G seemed startled.

'My friends at work.'

'Well what do they know. Are they doctors?'

'No.'

'Well then. I've never heard of a smear test causing miscarriages. Shall we get on with it, Trinket?

'Ok.' I recall saying hesitantly.

I remember the torrential rain that day as I walked the mile from the surgery to my house. The downpour obscuring my tears. Something was very wrong with my body. There was an inner ache like nothing I had ever known in my life. Upset that I wasn't given a choice to refuse the NHS's demands; couldn't say no; couldn't protect the new life I felt was growing within me.

The following morning sat at my desk at work, there was a painful cramping in my abdomen. My body seemed to be convulsing and I had a slight fever. My colleague and best friend broke off from her telephone conversation with her customer and passed her waste paper bin over to me.

'Here,' she scoffed, 'be sick in this if you're going to puke.'

The bin was barely in front of my face before I heaved my breakfast and the numerous coffee's I'd consumed that morning into it. 'Oh Chr!st.' I screamed as a strange sliding feeling consumed my vagina. Something was forcing its way out. I doubled up and ran full pelt with my arms folded over my stomach to the ladies toilet down the corridor from our office, my friend racing along behind me.

'What the Hell's happening?' I could hear her shouting in my wake.

Reaching the first cubicle, I flung myself in and lowered my knickers to sit on the toilet. Immediately a thick, gelatinous discharge began to flow from my vagina. It came out slowly, coursing down from me in one complete length of mucus and gloop. My cries of shock and pain was the sound of my friend hammering on the locked cubicle door, screaming 'Let me in. Let me in.'

My head was banging and there were lights flashing before my eyes. I felt drunk yet all I'd consumed was coffee. I wretched again and then once or twice more, tho' there was nothing left in my stomach.

Somehow she managed to move aside the bolt and prise open the toilet door.

'What's the matter? Are you alright? For God's sake Linda, you're scaring the sh!t out of me. '

Just then her eyes caught the black and red mass that was now settling itself into bowl and the surrounding toilet water. I saw the frown and the look of bewilderment cross her features. 'Are you alright?'

I shook my head not really knowing how I felt. Glancing into the toilet, we took in the horrible sight. There was blood all over the ceramic.

Swallowing hard, I asked, 'What's wrong with me?

'

Obviously shocked by my plight, 'I think we'd better get you to hospital, Linda,'was all she could say.

'Why? What is it?' 'I think you've had a miscarriage.'

Memories of that morning sometimes come back to haunt me. Before I left the cramped cubicle to wait in the reception area for the ambulance to arrive, I pressed the handle of the toilet and flushed the contents away. Flushed my baby away. _Flushed my baby down the toilet like an unwanted piece of sh!t._

5

'Now then Cockleshell, how are you?'

Nearly three years had passed since the last time I had been given no choice but to come to this 'Angel's' fiefdom. She hadn't changed.

'Ok. I suppose,' was my glum reply.

Nurse G directed me on to her examination table while she prepared her tools.

'Now you don't sound too bright, my Little Princess. Is everything all right?'

Something made me sit bolt upright. I shut my legs together and turned to face her.'Are these tests absolutely necessary?' I demanded. 'I'm in a long term monogamous relationship. Me and my husband were both virgins when we married. There has never been anybody else.'

Nurse G was taken aback. 'Where did you hear that nonsense?' she shook her head and went about finishing her preparation. 'All women are at risk of cervical cancer. _All women._ '

'But I read somewhere there are certain risk factors, smoking for instance or having multiple sexual partners from a young age'

'Well low risk is not no risk.' she replied briskly. 'It's just something we have to get on with. Cervical cancer can strike anyone at any time of their lives. It's best to have the test.'

'I know someone who died despite having all her tests.' I argued. 'They told her she was ok when she wasn't.'

'Well, I don't know anything about that. Shall we?' Nurse G indicated she was impatient to get on with my smear test. Perhaps she had lots of women to test that day.

Any resistance drained from me and I allowed her to go ahead. What was the point of annoying her? She was a nurse. What the hell did I know anyway?

'Are you alright Linda?' She asked concerned a minute or two later, removing the speculum after finishing rummaging around my vagina.

Tears were rolling down my cheek and I was sobbing.

'Its just that... Its just that...'

'What is it Honey Pie? Tell G.G all about it?'

'I never have sex with my husband anymore.' I spluttered in her face. 'There's no intimacy, nothing. Its like I have no feeling "down there." My clitoris doesn't seem to work. It's like it's dead.'

Without even indicating or verbally warning me of what she was about to do, Nurse G reached out with a forefinger and started gently stroking my clitoris.

I lay there too shocked to react. Could she do that? Was this part of her remit too?

It seemed to me she could do anything she wanted to me. I should have said Stop!. I should have pulled away. But didn't. Didn't know what to do. Was speechless.

After a few seconds Nurse G withdrew her finger. My clitoris had reacted to her touch; It was swollen in response.

'There doesn't seem to be anything wrong with it.' She said in a reassuring tone. She pursed her lips at me and shrugged. 'It works fine.'

Something passed between us that moment. A kind of shared intimacy between me and this so called nurse with the most private part of my body. But _we_ did share a strange kind of intimate relationship - she was my NHS sanctioned smear taker and she had rights to touch my body in any way she pleased. Even now nearly twenty years later I can't express what I feel in words. Was I sexually assaulted or wasn't I?

I did have a sexual reaction to her touch. Did she have some right as my nurse to do that to me? Should I have shared such intimate details about my sex life with this women? This zealous pro-screener? This rampant Tw*t Fairy?

Perhaps given a choice if I wanted to have a smear test or not, I wouldn't have been in that compromising situation.

6

When the next 'summons' to book an appointment for a smear test came, I took it in my stride and made one immediately. After all, I only carried the 'hole' in my body around with me. Yes, it was attached to me. I lived with it. Cleaned it. Put tampons in it when it bled. But it wasn't mine. It was wholly owned by the NHS. Belonging to them totally, from time to time they had the right to demand access to my genitals and check 'the hole' for cancer.

It had been one hell of a year. My friend from work had been killed in a car accident and my friend from school committed suicide. As well, I had completed my part time degree in Social History and was about to start teacher training.

Having also moved house, I found my new surgery didn't do smear tests and were instead undertaken at a local Well Woman's clinic.

'Hi. My name's Michaela.' (Not her real name)

I followed the nurse into her examination room. She walked briskly and shut the door to the room a hairs breadth behind me. To my horror, there was a man inside the small room, standing next to the examination table. A clipboard in his hands, I could see my name clearly printed on the sheet attached to it.

He was about twenty, clean shaven and sparkly eyed. Putting the clipboard aside, he stepped forward to greet me and introduce himself.

'My name is John.' (I don't recall his real name) 'If it's OK with you I would like to stay and observe today.'

'He's a student nurse.' Michaela cut in, while busying herself preparing the table with a wad of light blue paper towels.

'Oh.' (I don't remember actually saying anything but it is in my nature to always make some kind of affirmative noise no matter what I am confronted with.)

Thinking, I'm sure this place promotes itself as a women only health centre. It was supposed to be a safe place for women to come to without any men being on the premises. It doubled as a rape crisis centre during the day. Perhaps the rules were different at this time of evening.

'Sure.' I shrugged and without a word stepped behind the curtain to remove my trousers and underwear.

Why didn't I say no to his request right there and then? Why didn't I tell him to leave?

Why didn't I?

But then I remembered, why I couldn't insist on these things., The subtle conditioning and brainwashing by the NHS had been thorough and complete - They could do anything to me they wished!

It was only then I noticed the nurse's fingernails as she eased her hands into the latex gloves. Looking like a Manchurian Princess from pre communist China her red talons stretched an impossible inch in length. I wondered if she would scratch the delicate tissue she was about to help herself to.

Committed now to having the smear test, I took a deep breath and tried to relax. Only the signal didn't quite reach down to my vagina.

'If you could just relax for me.' Michaela the nurse asked in a quiet tone.

When she couldn't even begin to place the speculum in. She glanced at me and said

'You're a bit tense Linda. Do you think you could relax for me?'

It still wouldn't go in after another try. The entrance to my vagina had contracted and wasn't letting anything in.

'Take a deep breath for me Linda.' I heard her say.

I took a deep breath. With what seemed like a heave-ho motion she rammed the speculum in. The sensation was of it going in all the way to my stomach but I knew the anatomy of my vagina simply didn't stretch that far. But Jes*s it was a horrible sensation.

Glancing round the room which seemed to be cloaked in some kind of fog, I took in the face of John at the end of the table, thankfully, his gaze was averted at that moment. He seemed to be looking round the room searching for whatever it was I was looking round at.

'All done,' the nurse exclaimed, throwing aside the gloves and revealing those nails which gratefully hadn't torn me apart. 'By God you've got a tight vagina, Linda. Have you never had children?'

'No.' I stammered. 'I never want children.'

Climbing off the table I grabbed the modesty curtain and dragged it round me. Dressing without a word and without a backwards glance or my stupid oft' given perfunctory 'thank you,' I left as quickly as possible.

The sheer disrespect the NHS and its cronies had for the person inside of my body that lives her life as the entity ' _Linda_ ,' was utterly galling. The complete lack of concern for my bodily privacy, my dignity, my feelings was tantamount to assault. At the time I couldn't put my anger and disgust at these people into words. I thought I was being stupid, immature, over the top. After all wasn't this what every women experienced?

7

'Your Smear taker this evening is Lorraine.' (Not her real name) The receptionist smiled at me. 'She's lovely'

Taking a seat, I sat down and waited for my turn in a daze. _Lorraine._ The name mulled over and over in my mind. How many is that now? I held out my thumbs and fingers as an imaginary counting frame and began listing names. Lorraine. Michaela. Nurse G. Doctor V. Who else? _God knows_. _So many now I can't remember._ Doctors and some nurses from when I was so called dying of cancer. More doctors at the Women's Hospital when I miscarried. A technician wanting to give me some kind of scan? Some German doctor believing it necessary to have a good feel. A Muslim woman, completely veiled, only her eyes showing, she had had a good feel round my vagina: God only knows why as I never saw or heard from her again.

Oh yes, Peter, (not his real name) How could I forget him? Gay and extrovert. Yes, he had been lovely, gentle, so concerned I may need help with any future pregnancies.

How many was that? About twenty? More surely? In fact everyone had been in my vagina. _Anyone who wanted._ Sadly, I reflected, everyone but the lovely man I was married to. He never went there. Was never allowed to.

'Linda.' The sound of my name being called broke me from my reverie. 'I'm sorry I'm running late,' the sweet smiling girl of a nurse apologised, 'it's been a very busy day.' _All those vaginas!_

Following her into the cubicle, she pulled the curtain behind us.

The smear test was uneventful. It was not pleasant but it didn't hurt. My genitals were numb.

'Who'd be a women, eh?' She laughed when she was finished.

I got up from the table and pulled my skirt up. 'I'm coming back as a man.' I quipped back.

She laughed again. She was friendly. I took a deep breath.

'Look,' I said, searching for something deep inside me. _What was it?_ 'Are smear tests absolutely necessary? I mean... Do I have to have them? I've been having them every few years of my adult life and they have caused me nothing but trouble. I don't want anymore. This is my last.'

I was shocked at my boldness. Having started my train of thought by asking her a question, found myself making the self affirming statement. Maybe because, so much older, now forty five, so many life paths painfully trodden, worn down utterly, I found this 'child' before me extremely annoying. How dare _she, along with all the others,_ presume ownership of my body.

Her lips parted as she searched inwardly for her well rehearsed spiel. But instead this young nurse said something which was to have a profound effect on my life.

'Of course you must have smear tests,' she reiterated to me earnestly, in her young eager manner. 'Cervical Cancer is the number one killer of women.'

My work friend killed in a car accident; another friend dead from pills she took; a degree in history which taught me women die from war, famine and disease and at the hands of men. I knew her statement was wrong. I raced home to my computer. For the first time in my adult life I realised the NHS was concocting a total fabrication. I searched and searched year by year the World Health Organisations website. And there it was. My answer.

Is Cervical Cancer the world's number one killer of women?

No. It isn't. It doesn't even get into their top 100 of things women die of. In fact, from their statistics I gleaned Cervical Cancer is fantastically rare.

2015

For the past six years the NHS appeared to have forgotten about my cervix. However, a recent series of visits to my doctor for depression triggered what can only be described as a tsunami slide of pressure to undergo more testing. I was asked at each visit if I wanted a smear test. Each time came my polite refusal. Then the practice nurse got on board and rang me at home. She was given a firm No! But a week later when I saw her for an unrelated problem, the subject was brought up again. Two weeks after that the surgery manager made up some lie the doctor was insisting I come in for the test as soon as possible. It had been so long since my last test they were worried about cancer. _God only knew how bad a condition my vagina was in now, because of my wanton neglect!_

Angered at this sickening approach to get access to my vagina, ( _Hadn't these rampant Fanny Witches read my records?_ ) this time I went searching for answers.

The internet is awash with the horrors women have endured. There are accounts of humiliation, pain, pressure to screen, unnecessary surgeries, tho' I have to say there is nothing like this on the NHS Choices website or the Public Health Site. They only contain stories that tell you how nice the nurse was, or that the woman was nervous but found that having a smear test merely 'tickled.' Anything I posted was immediately deleted from these sites. They don't want anyone rocking their apple cart.

Similarly, when I approached the NHS by letter or email there has been no response. Having sent several letters now and having heard nothing I can only presume this is a deliberate attempt to ignore me.

By accident, I recently stumbled on 'forwomenseyesonly.' A site dedicated to hearing about women's experiences of smears as well as containing related articles. It was amazing to discover anything like it existed. But what was more amazing were the women there and their friendship and kindness.

I was no longer alone.

The reason I am so outspoken accusing the NHS of seven counts of rape.

One of the posters on 'forwomenseyesonly,' Alex, writes often on the subject of 'unconventional' forms of attack. His posts describe how women are conditioned to watch out for 'normal' attacks such as the masked rapist in the darkened alley, but may not recognise subtle forms of attack such as those done in the name of healthcare. A woman while suspecting something isn't pleasant or right or feels she 'should' 'has to' 'must' or 'it's the thing to do' to submit to very intrusive and invasive, intimate, vaginal exams may not necessarily connect it is an outright attack on her.

At first I was disgusted with myself calling what happened to me rape. This was a disservice to the millions of women around the planet who suffer horribly at the hands of men. Who am I to count myself as one of them never having experienced this. Yet the suspicion the NHS had been raping me all these years refused to go away. In my mind there was no difference between the NHS convincing me there was no choice and someone holding a knife to my throat. Desperate to get answers I contacted Rape Crisis. They were very kind informing my concerns were valid. Many women were coming forward with complaints concerning unwanted smear tests.

According to them - Sexual assault is an act of physical, psychological and emotional violation, in the form of a sexual act, which is inflicted on someone without consent. It can involve forcing or manipulating someone to witness or participate in any sexual acts with the penis, the penetration of the anus or vagina (however slight) or with **any object.** (Rape Crisis)

More importantly - The Sexual Offences Act 2003 in England came in to strengthen and modernise the 1956 law on sexual offences and rape. The Act also updated the law about consent and belief in consent.

The word 'consent' in the context of the offence of rape is now defined as - A person consents if she or he agrees by choice, and has the freedom and capacity to make that choice. The essence of this definition is the agreement by 'choice.' The law does not require the victim to have physically resisted in order to prove a lack of consent. The question of whether the victim consented is a matter for a jury to decide.

Current legal definition (In England) of

sexual (indecent) assault

Assault by penetration with a implement.

(1) A person (A) commits an offence if—

(a) he intentionally penetrates the vagina or anus of another person (B) with a part of his body or **anything else,**

(b) the penetration is sexual,

(c) B does not consent to the penetration, and

(d) A does not reasonably believe that B consents.

(2) Whether a belief is reasonable is to be determined having regard to all the circumstances, including any steps A has taken to ascertain whether B consents.

"Discomfort/pain, shame/embarrassment, and/or a feeling of being violated, as a result of penetration of the sexual organs by a person or **an implement** with whom a woman has no sexual interest, achieved through **coercion, fear, and/or intimidation**." ( CPS Crown Prosecution Service )

The numerous solicitors I have approached to help me prosecute my case are very hesitant about taking on the NHS. They inform me my case would be very difficult to gain any kind of outcome. Sexual interest must be proven, and a doctor or practice nurse might easily negate my claim. They could say they believed I gave my consent by the fact I got up on to the examination table and allowed the test to take place. That by making the appointment, getting in my car to get there, actually signing my consent, saying 'hello' and making small talk with my smear taker I waivered any right to say this was done against my will.

Yet my anger still boils. What can I do? One solicitor took the time to listen to me. This is what he suggested.

It is not against the law to take a recording device into any consultation with a doctor or practice nurse. They don't even need to be told you are taping the conversation as by law if you are involved you don't have to reveal this fact. Wait for whoever you are seeing to offer you a smear test. Decline to take it in a manner which cannot be misconstrued. If they continue trying to persuade you to submit either with coercion - (this is what all women do its just a normal part of being a woman) Intimidation - (saying you must do it to stay on our list of patients) or frightening you with 'falsified facts' surrounding cervical cancer. Simply get up and leave. Because you have them.

Because by law THIS IS an ' **attempt'** to assault you with an implement. At this, stage you don't need to prove it was sexual in orientation as no contact with a sexual area has taken place yet. The mere fact they were trying to get you to accept having an implement placed inside your vagina against your wishes is enough to secure a prosecution.

No one has done it yet. Perhaps no woman feels strongly enough to go through with it

I do. I will be waiting. I will be biding my time.

### *

Unconventional Attacks

& Iatrogenic Assault

By Alex

Iatrogenic - Any adverse condition resulting from the activity or treatment received from a health care provider be it a physician, a nurse or allied health care professional or institution. (Miller-Keane Encyclopaedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition, 2003, Saunders)

My article is about 'unconventional attacks' (in this case, medical attack or "iatrogenic assault"). This applies most often to males as well as females, but considerably more for the latter.

The assault is frequently carried out in a perverse manner, yet attacks of this nature are usually disqualified by the medical establishment (an argument that more or less amounts to "What happens isn't what occurred"). I've noticed numerous cultural habits that back up and support these situations in America, but it also seems common in other countries. Specifically, there is the view that bodily autonomy, self-protectiveness, and compositional thinking is only "a situation is what it consists of"- whether someone likes things or not isn't involved. ) and are immature & defective traits in individuals - especially women.

Doctors thinking "Well, I'll refrain from inserting something into this person if I think their reasons are good enough," whether or not this is in a verbally or mentally articulated way, is a problem- since it shows that they feel themselves to be the actuator of other people's decisions (with what does or does not go into those people's own bodies).

When they act this way, they are not totally entitled to make decisions with what they do with THEIR own bodies. Or with what is done TO them, for that matter. Referencing personal freedom as a justification for overriding someone's refusal to be sexually assaulted iatrogenically or otherwise attacked medically is negated by that person's personal freedom to vitiate the agency of the assailant or assailants.

An observation that might seem unrelated at first: Reality is NOT formed by recognition. If it were, nobody would get hit by a car they didn't see coming or have any unexpected good things happen to them (actually, that person wouldn't even happen- since something had to happen before they were around to recognize anything for them to come into EXISTENCE). This applies frequently, since a staggering amount of arguments revolved around this idea- basically a disqualification of reality. Someone acting like they are the actuator of existence, for all purposes (never a good sign, but outright menacing in a medical setting).

The reality is that properties don't change by designation- just like if a doctor poisons someone with a needle, it's still murder. This is because reality is NOT formed by recognition, as mentioned earlier. This point is frequently disregarded with numerous subjects (especially in America), but that's particularly true with unconventional molestation. This, in itself, is especially true with regard to medical personnel & policy implementation workers (because it doesn't have to be police officers, specifically).

To clarify, an interface with sexual areas as a product of someone else's decision-making is an attack. There are conventional variations & unconventional variations. Neither variety has to be all the way up to imposed penetration, but the extrapersonal comportment (When the doctor tells someone "do this" or "do that" ) of situation so as to generate visual access to or physical contact with sexual areas remains a running theme.

Not being able to articulate things is a psychological & verbalization issue for the CLIENT, not the doctor (who might just go by tastes & gravitations wordlessly, but that's an issue with their assessment & output- because it's a case of including their favorite technique or some such & not "aiming their shot at the bulls-eye," medically speaking). The problem for the patient/client/intended victim is that it potentially keeps from being able to form a counteractive response when the medical personnel are aiming things at them & they're trying to halt this situation. They can't articulate what kind of attack it is, so they mentally "file" or "cognitively distinguish" it as "Problems That Aren't Problem Despite BEING Problems."

In medical settings, it's not unheard of for them to take liberties if someone is asleep on the operating table (like practicing internal exams on unconscious clients- something that seems to persist to this day in Canada, Britain & Australia when they are in for certain surgeries & on seemingly anyone that comes into the hospital unconscious.

Or to simply do things by force despite refusal & physical struggle (fairly common in the delivery room, but also in car accidents or falls- there was actually a case in New York where a group of five held down a man & forced a rectal exam on him when he walked into the hospital for stitches on his head!

It's even more common for there to be instances of coercion (like forcing women into getting internal exams for birth control, as well as any other medication or simply to get any kind of treatment- potentially illegal, but then again anything can be sanctioned).

There's also deception (they don't seem to mention risks, inaccuracies, or alternatives very often). These are fairly well-described as is, but it's worth mentioning that one frequently needs a doctor's note to do much of anything- including going to college or getting a job. This presents plenty of opportunity for coercive behavior.

One specific tactic is the phrasing used in engagements with the client. The medical personnel will frequently say what they "will" be doing or what someone's "going" to be having- presenting things as a "fixed situation" (meaning that there exists no capacity for reality to "unfurl" differently). Since what happens is what occurs & an action has to be engaged in order to occur, this is not accurate.

Now, why would someone even try something like this? Well, because there's frequently a presumed honesty & accuracy when dealing with other people. Not the belief that someone else can't POSSIBLY lie or that they are DEFINITELY what they make themselves out to be, but in kind of a knee-jerk way- like when someone asks someone else what time it is & they give an answer.

It's generally not misplaced trust to believe that when that person looks at their watch & says a time, that it's at least the time showing on that watch (it IS pretty bizarre to just lie randomly).

This is true in other ways, as well. In the film Star Wars the character Obi Wan Kenobi pulls something called the "Jedi Mind Trick" The storm troopers who are seeking him and his friends pull them over believing them to be the fugitives they are searching for but are tricked into believing they are not the ones ( in that classic line from the film) "these are not the ones we are looking for."

Similarly patients are tricked into believing an unconventional or iatrogenic assault that just happened was something else of a more innocent nature and not in fact what they think it is.

This is especially true if doctors and nurses are seen to be trustable. Someone might very well see someone in this light simply because they are worried about a problem they have or one that might develop in the future & it's simply act in a way that matches what they HOPE to be true.

They might even ignore signs that indicate this is not the case as a counterphobic reaction (it's something that scares them, so they pretend it's not that way to soothe themselves).

Someone CAN be right when they think of someone else in this way, but the esteem that doctors & other medical personnel are held in is largely due to them being certified - although an expert can always lie (or be taught untrue things that they are held in the esteem of being knowledgeable of - the BODY OF INFORMATION can be inaccurate, not just deviously lied about). The general concept of 'certification' will not magically banish people from a position where they can cause harm. The method of certification, IF it's at all effective, is something that only would apply at the moment of certification. They might have been a particular way when they started out, but that isn't the way they are when they are dealing with a client years down the road.

Included in this broad tactic is to "gaslight" people (to discredit them to themselves) This is very simple: when someone refuses a procedure being done to them, they react as though it is something of low quality. This can include facial expressions & other bodily language as well as verbal expressions (anger, disgust, derisive/mocking humor, implying immaturity, etc...).

Asking "Why?" when someone picks a course of action, particularly refusing a procedure or electing to leave the setting. This is to try to discredit their reasoning, if they can even find the words for it. The goal is to "kick the chair out from under someone" in the sense of their actions.

Instead, doctors and nurses insist someone "do this" or "do that." It kind of becomes a subtle tactic BECAUSE it's not a subtle tactic at all \- and, thus, is unexpected. Some try to "attach riders" to things. A possibility could be that someone goes to the ER & whichever worker they're dealing with tries to do a pelvic exam on them supposedly on the doctor's "orders" to the female patients that came into the ER-

Similar to this all is to try convincing someone that they are doing something dangerous.

These "scare tactics" are seemingly more commonly directed toward women than men. Guilt applies in the same way & sometimes alongside the scare tactics (ex: there a poster in the UK trying to guilt trip women into getting cervical smears, where it showed a sad-looking child & a caption that read "My mommy missed her smear & now I miss my mommy")

The behavior of medical or legal personnel is a major concern. A possible scenario:

If someone, for instance, is mugged & is then the responding medical personnel start saying "We have to take you to the hospital" (even against the direction of the individual- no reason for this person to presume safety in the vehicle, much less anywhere these people take them). Then, while at the hospital, staff think (or just say that they think) that this person was raped - possibly in contrast to what this person has indicated. Then, they take it upon themselves to do a rape kit on this person that's been captured on their behalf- possibly in contrast to their refusal & physical fighting.

If they are successful, this person (that they are theoretically supposed to help) is iatrogenically harmed by them - in the same overall way that they purportedly thought someone else did.

Then, this person goes to the police over this (possibly in handcuffs for repelling the assault directed at them). It's entirely possible that the police response includes similar dynamics (especially in America, because here "just sorting things out" frequently includes a degree of imposed nudity - sometimes penetration, as well).

Afterwards, the person wronged might very well be brushed-off or simply locked-up. [This is plenty of reason to not give other people a chance to add their own influence to a situation like that- their choices might be hostile.]

There's potential for "service incentive payments" for doing certain procedures on people (bonuses for making target quotas). There's repeat costs from test after test, surgery after surgery, follow-up after follow-up (especially since it's not impossible for them to screw something up on purpose or just say that there's a problem- all things that could be deemed mistakes, instead of hostilities or incompetence). Apparently, funding for whatever department can be garnered by lies- but not based on it directly.

In truth, there are also simply people that have "compasses that point backward." They are affirmative of something where someone would say "Aww, that's such a shame." Being too arrogant to catch their own mistakes is possible, but so are deliberate acts of hostility. These would not necessarily be done in an overt manner, hence the "unconventional attack." These actions would also, likely, be done without the cliche facial expressions, devious laughter, etc... . They would also not likely be admitted to.

Included in all this is that "reality is what I say it is" behavior mentioned at the beginning of the article. This could be in the sense of simply taking out their "mommy issues" on someone else, hostility for women that are younger/prettier/etc... than they are, or simply thinking that something isn't harm until they arrive at that particular conclusion.

Allopathic medicine itself seems to mostly based on the idea of attacking the body in a way that generates a benefit.

Historically, the allopaths were the ones people didn't trust because (quite literally) one could die of the cure. They would bleed people (a common means of outright killing someone), give them massive doses of toxic chemicals (including mercury- part of why Ivan the Terrible behaved the way he did, since he was given mercury for his back pain & mercury causes pretty severe mental problems) Something else to consider is the Boyd's Cycle (or OODA Loop- which stands for "Observe - Orient - Decide - Act"). This is a cognitive process that basically amounts to the idea that you have to size things up in order to do something deliberately.

In conclusion, one has to assume that the coercion, deception, scare tactics, language games, and physical force are DELIBERATE. It's not an accident that they wait until someone's asleep on the operation table to do something that they might refuse. It's not an accident that they back women into exams for birth control pills.

If they catheterize someone because nurses don't like that patient because they are difficult (something that can lead to death by bladder infection), this is not a mistake.

It DOES frequently seem to be done with complete mindlessness by the various hospital staff that follow the commands of doctors & nurses, despite the client refusing these things (something that they realize applies to them as the doctor's proxy as much as it does to the doctor themselves).

So if they are told to give the client something that would kill them, there's a good chance they'll do it (I remember there being studies to confirm this, but I believe it might be different in different countries). If they are told to do something to this client, they'll potentially go about this action.

### *

Kat's story

Like many women in the UK, I was in my early twenties when the NHS Cervical Screening Programme captured me.

I had decided I would like to take a contraceptive pill to protect against any unwanted pregnancies. I was young and enjoying myself and wanted to go out with my friends as well as find that special someone and commit to a relationship.

Reading up on as much literature I could find about the different types of pill, I knew all they needed was a brief outline of my medical history, as well a record of my weight and a blood pressure test.

At my initial consult I was surprised to discover my doctor wanted to do a 'smear test,' 'just to be sure,' all was ok.

I was probably one of the few who had some inkling of what a smear test involved and what it was for. I also knew I had a choice if I wanted one or not. I knew they were not compulsory.

What I wasn't prepared for was how incredibly violating having the smear test actually was. My first was very painful and I remember having to bite down on my lower lip to prevent me from screaming.

The thought of some stranger peering at my private parts felt humiliating. Being prone on the examination table, in what I considered to be a vulnerable position, I hated the way I could not see what the nurse was doing. Laying there immersed in my thoughts while some overly efficient, officious nurse rooted around to find my cervix, I wondered what she was thinking. Was she was judging me or comparing mine to others she had seen that day. How did I compare to other women? Was I the same? Was I different? Was I any less?

Over the years I endured many smear tests. I was fortunate in that I was never called for further testing. That I never had to go through colposcopy, or Lletz, or cone biopsies or any of the other horrible things women with abnormal smears endured.

In a long term monogamous relationship, and never having had any gynaecological problems, I would have been surprised if they found anything anyway. I didn't like smears but went along with having them as it was considered the thing to do.

About fifteen years ago I began to realize I no longer wanted smear tests. They had continued to be painful and I had never come to terms with complete strangers fiddling about 'down there' when there didn't seem to be anything wrong.

However, it came about that I submitted to another smear.

During the exam, most nurses make 'small talk' The chat is usually about the weather or holidays, or a variety of topics that come to mind when your underwear is off, you've seen the speculum all 'lubed' up and your trying to put the impending violation out of your thoughts.

The conversation turned to the necessity of smear tests. I remember asking the nurse if there was someway of getting out of them as I had decided I wasn't having anymore. She seemed surprised at my decision and asked me why I didn't want them as she herself considered them a life saver.

I told her they were painful, that the position you had to adopt to have the test was humiliating and that every time I had one it was done by someone different and the thought of all those people looking into and fiddling around in my hoo hoo was...quite frankly... embarrassing.

The nurse laughed and I remember her making a joke about seeing women's private part's all day, every day and that she didn't mind in the least; that in her career she had seen everything and was fazed by nothing she came across. I was made to feel a fool in front of this professional.

As I re-dressed and made my way out of the clinic, the nurse's words reverberated in my mind.

_She_ wasn't embarrassed. _She_ had seen it all. _She_ wasn't fazed.

It was all about _her_.

What about _me_ _?_

My feelings didn't count. Rather - I was made to think my feelings didn't count.

After joining 'forwomenseyesonly' and reading all the articles and posts I now realise negating women's feelings about the exams is part of the NHS ploy to harness all women's compliance. When women voice concerns about the test they are made to feel silly, infantile... stupid. _The doctor or nurse sees women's private parts everyday and are very mature and sensible about it._ Why can't you be? What is your problem? Perhaps there is something wrong with you... perhaps you need counselling. _They_ make you feel that you have no reasonable recourse to refuse the exam.

I thought getting out of having any more smear tests would be simple and straightforward. When the invitations came I decided I would just ignore them.

About a year ago another "invitation " dropped through the letter box. As usual I ignored it and put it in the waste paper bin. However, having read on various websites procedures had changed; Ignore 2 written "invitations " and the nurse will be phoning you, I would find that even less acceptable than the written "invitations " and figured since the practice nurse was probably very busy and didn't need to be spending wasted time chasing me.

So I wrote a polite but firm letter stating I would not be having any more smears, that I wanted no more communication on the subject and I wouldn't sue if I got cancer, and if I did have any problems with my intimate health I'd book a GP appointment.

This seemed to do the trick as I got a form to sign back worded I understood implications and wanted to resign from the program.

I returned the signed disclaimer back to GP but was dismayed the following week after that to receive another "invitation " this time from health authority.

Phoning them to see what the problem was, they informed me they'd not had anything from my GP.

I immediately wrote to health authorities saying I would not have a smear and requested no further "invitations " or contact.

I also asked why in the leaflet which states it aims to help decide whether to screen or not, why no information is given on how to opt out of what you never opted in

to!

To this date I am still receiving postal invitations to screen.

Unfortunately, I do have other health concerns. I am blighted by migraines (which to this day I swear was triggered by the contraceptive pill itself despite my GP saying otherwise ) as well as anemia. At each and every consult for these other ongoing problems I am told I am 'overdue' for a smear test. This fact flashes up on screen before I have even sat down. It is always the first question I am asked regardless of what I booked the consult for.

When I give my answer, sometimes doctors embarrass me and ask why. At first I used to tell them the whole story but now I don't bother and just stay silent. Any reason I give is met with derision and sarcasm.

Unfortunately it's not possible for me to avoid doctors and I find myself hassled about smears at ever appointment. I always understood it is a choice whether to screen or not but this has not been the case for me.

Once I agreed to my initial smear all those years ago and the subsequent ones afterwards, it appears the NHS believes I have no right to change my mind.

The NHS refuses to let me go.

### *

Suzannes's story

I'm writing this just days after receiving a letter from my health insurance company stating I need to call them as soon as I get this letter (written in bold in letter). It goes on to state –

"We see you are due for a PAP test this year. Every year women need check-ups. A PAP test can help find cancer early...We care about your health and want to make sure that you have [sic] the best care. If you have questions about the test or need help making you appointment, please call the Outreach Department at..."

I'll get back to the letter, but first I want to share a story about the first time I recall having my genitals inappropriately examined by a doctor.

I was nine years old and my mother had signed me up for a few weeks of day camp that summer, since we had just moved and she thought it would be a good way for me to make new friends. The camp required a doctor's note for attendance, so my mother made an appointment with a new doctor. I remember the doctor instructing me to pull my underwear down to my knees as I lied back on the table. I complied. The doctor then approached me, without saying anything she quickly pulled my underwear much further down, forced my knees apart, and began handling my vaginal lips, pulling them apart while peering directly between my legs. It all happened so fast and without any explanation. I still remember the shock and humiliation I felt as I lay there exposed and vulnerable. Thirty years later, I still feel angry that I was needlessly put through that just to attend summer camp.

Fast forward to age eighteen. I had just started having sex for the first time and I knew that the responsible thing to do was to get on birth control. At this point, I was conditioned to believe women needed a gynaecological exam to do so. I made an appointment with a health clinic and to my dismay, someone called and left a message on my family's answering machine reminding me of my appointment. I was assuming my visit would be confidential and did not want my parents knowing. The cat was already out of the bag, so I went ahead with the appointment. Physically, I didn't have any discomfort. Psychologically, I found to exam to be very uncomfortable and violating. But I thought it was necessary, so I tried to accept it. A year or so later, I moved to college and wanted to continue with the birth control, so I made another appointment. For some reason, I started to question why an examination and PAP was required for birth control so when I arrived, I asked the nurse why this needed to be done. She stated "because it's a prescription." I pressed again and she again responded "because it's a prescription." It was clear I was going to have to submit to the exam and test if I wanted the birth control, so I did, even though I really didn't want to. I realize now that an honest and appropriate answer to my question should have been "the exam and pap have nothing to do with the birth control you are seeking." A week or so later, I received a letter stating that my pap came back "abnormal." Long story short, when I followed–up I was told (erroneously) that this meant I had HPV, a virus that causes genital warts, which I could never get rid of and that one day I would break out in genital warts. And oh yeah, it's extremely contagious.

To say I was devastated by this information would be an understatement. I was 19 years old and thought my life was ruined. How would I every have another boyfriend? How would I ever have sex again? I honestly considered suicide. For several years, I thought I was contaminated with genital wart virus before eventually figuring out this was false. I dated a jerk of a man for a while during this time, because I had told him about my "virus" and he accepted it. Even though he did not treat me very well, I stayed because I thought I should be happy that at least some man was willing to be with me. Since then I've become more informed about the reality of pap tests and pelvic exams and it disgusted me to know that my early 20's were ruined due to a test I did not need, did not want, and was coerced into.

Some more fun experiences with pap tests include: Having it be a requirement for certain jobs I applied to; Being denied birth control at university without a pelvic exam and pap test (because "it's protocol."); Having a neurologist question me why I did not have a doctor who "checks my breasts for cancer and gives me Paps." After I explained to him that I choose not to test due to my misdiagnosis and the inaccuracy of the test, he took it upon himself to contact my primary doctor and, I suppose, informed him of my silliness. I then received a call from a nurse with the primary doctor's office stating that I "needed to come in for a pelvic exam and pap smear." I told her that was not going to happen and I never returned to that doctor again. I later had problems getting my IUD because the required pap smear came back "abnormal." So I waited a month, went to another doctor and (surprise!) this pap came back "normal." I took the "normal" results and was able to get my IUD. However, I received an alarmist letter followed by a paternalistic phone call from the first doctor's office telling me I needed to come right away for a biopsy. Although I explained I had the test repeated and it came back "normal," the practitioner stressed that I was indeed in harms way and needed to come in immediately for the biopsy. So I gave in and went for the biopsy. It came back normal. A year later, I received another frantic phone call from the same office stating I needed to come in right away for a pap due to the abnormal one from the year before. This time I blew it off. Then a few years later, a new partner and I agreed to be tested for STI's. I went to a clinic and the nurse offered the pap. I did agree to it after we had a discussion. This nurse (finally) agreed that the test is highly inaccurate. This didn't stop the office from sending me a "reminder" postcard in the mail a year later telling me I was due for an "annual." I called the office and spoke to a very disinterested individual and explained that I really didn't want post cards sent to my home telling me to have my vagina checked.

These stories are just the tip of the iceberg. Only recently have medical associations and personnel been coming out and exposing the truth that pap smears are highly over-used, done too often and on women who are too young. Additionally, the pelvic exam is being exposed for the uselessness it is for asymptomatic women. In spite of this, I continue to be met with resistance when I point out these facts. This speaks to the ingrained belief that "women's genitals are so vulnerable they need constant examination and testing."

Getting back to the letter from my insurance company, I spoke to one of the outreach coordinators and explained that the letter they sent me was inaccurate. I'm in process of gathering research articles to send to their department. Hopefully, they will change their practice of coercing healthy women into unneeded medical exams and tests.

### *

Hit That Target!

by Linda

When Papanikolaou's smear test was introduced in Britain in the mid-1960s uptake for the first few years was very low since most doctors considered cancer of the cervix a rare form of the disease in Britain, accounting for less than half a per cent of cancer deaths and around four per cent of cancer cases in women. It was also widely accepted deaths from cervical cancer had been in sharp decline over the past few decades. Records show some doctors may only have seen one or two cases of this cancer in their entire career, others none at all.

In addition, a mass introduction of smear testing wasn't viable as the test failed to meet two of the standard criteria for screening programmes laid down by the World Health Organisation as cervical cancer is extremely rare and its natural course was not well understood.

The smear test itself was mostly administered by doctors when patients presented with intermittent bleeding or vaginal pain between periods and was used as a diagnostic tool to help them rule out some other uterine disorders.

According to Dr Fitzpatrick (2000) In 1988, following criticisms that the Cervical Smear system seemed a bit haphazard in organisation, a national coordinating network for the NHS Cervical Screening Programme was established.

By 1990, a new contract imposed on GPs by the government suddenly introduced substantial incentives worth millions of pounds each year to reach rate performance targets.

As a result of these measures, coverage of the target age group began quickly increasing. Prior to 1988 uptake was anything between 14 - 30 per cent of the adult female population in any given year, however by 1994 uptake had shot up to 85 per cent. The sudden increase was attributed to the fact GPs were now being paid for cervical cytology by means of target payments. The targets were based on the percentage of eligible women on a GP's list who received a smear test in the previous 5 and a half years. The main eligibility criterion being between 21and 64 in England and Wales (Scotland had slightly different age ranges). There were two target rates, 50% and 80%. GPs meeting a target would receive a payment based on number of eligible patients.

Several GPs surveyed agreed that their screening behaviour was influenced by these financial targets. One GP commented: "We are afraid of missing our targets, not missing a cancer", whilst another admitted: "I'm keen to do smears but to be honest more for the targets than for the benefit to patients.

A follow up survey of a group of GPs who had previously had low or high involvement with screening found that two thirds of GPs in the low interest group had increased their cervical screening activity primarily because of the increased financial incentives to do so. (Journal of Medical Ethics 1998;24:151-157)

The JME also reported that there were a number of 'tactics implemented to increase screening uptake. As well as producing information leaflets designed to persuade as many women as possible to accept invitations to be screened, screening providers were encouraged to exert strong influence over their female patients to take the test.

General practitioners have also been advised by articles in medical journals such as the British Medical Journal and GP and Pulse, on how to increase the uptake of cervical screening amongst their patients.

In 1994, Dr Gallen, a family doctor wrote an article entitled "Hit That Target" describing it as essential to "List and chase defaulters who have not responded within three months of the first invitation to a smear test"

Another article featured in Update in 1989 discussed "How to Achieve Cervical Cytology Targets," advising Doctors that "in women of more than 60 years old the procedure for taking smears can be both painful and yield insufficient material. However, if targets are to be achieved we are going to have to persuade some pensioners of the value of cervical cytology screening."

In the British Medical Journal in 1990 advised GPs that if a new female patient is due for a smear "offer to perform one straight away... . **Similarly a woman attending for reasons unconnected with cervical cytology should have the date of her last smear checked and if appropriate be offered a smear on the spot or a future appointment...** ' (Journal of Medical Ethics 1998;24:151-157)

By 2003/4 the low target payment was worth approximately £1000 and the high payment approximately £3000 for practices with an average number of eligible women on their lists (It has been increasing steadily since but the NHS is now very reluctant to reveal any figures relating to this. However, it is estimated the total paid out to doctors achieving targets in the UK in 2014 was about 175 million.)

Uptake of the smear test hovered at about 80% for the next ten years. However this figure wasn't high enough for some.

In 2014, Demos \- an organisation that describes itself as **Britain's leading cross-party think-tank,** published an article called - **The urgent question** by Jo Salter

The question - Why are ' **all** ' women not having regular cervical screening? was asked, citing a combination of 'fear' 'confusion' and the 'struggle' to book an appointment at a convenient time, procrastination and just plain embarrassment and squeamishness at the idea of a stranger poking around your cervix was 'conspiring' to keep uptake of cervical screening among women who are eligible hovering 'stubbornly' at around 78 per cent.

(No mention that women might simply not want the test due to its unacceptably invasive nature)

Offering some spurious mathematics the writer claimed, 'estimated that over a five year period, with 100 per cent uptake of screening, 1,176 additional lives would be saved, over and above the 5,000 (we'll come back to this figure) lives that cervical screening is already estimated to save every year.' She went on to demonstrate 'the full financial impact that women diagnosed with cervical cancer are facing.' The financial side of having cervical cancer was equivalent to losing £487 a month, which apparently is the average financial burden borne by women with the disease. This includes, income lost during time off work, additional costs such as dietary supplements, travel to and from hospital, car parking charges or childcare, to higher spending on daily living costs like energy bills, toiletries and books and films during the recovery process. That the impact is especially high for women diagnosed with the more advanced cancers that regular screening would have picked up at an earlier stage; adding - the combined financial burden for women diagnosed with more advanced cancer is £1,102 a month.

From this 'data,' Demos 'calculated' that if all women in the 25-65 age group were regularly screened, the NHS would save £10 million – almost half of what it then spent on treating cervical cancer –

Using this research Demos actually proposed ' **on the spot'** smear tests during GP appointments, with the guarantee of a female nurse or GP on hand to perform the test, would overcome some of the 'reluctance' many women feel about screening. (because they wouldn't have any time to think about refusing)

There was a huge response from a plethora of respected medical journals and newspapers condoning this manner of harvesting reluctant women into the programme. (reluctant, meaning women who don't want a smear test for whatever reason) For a while it started reading as if the Nazis had won the war and in charge of women's health care.

Laura Donnelly, the Health Editor for the Telegraph wrote -

Call for 'on the spot' smear tests to save lives. Family doctors should offer 'on the spot' smear tests to women during other medical appointments, experts say.

'Women should be offered "on the spot" smear tests during other medical appointments to overcome a tendency to put off screening, Too many women putting off the tests because they were too busy or embarrassed.'

She saw a need for the introduction of more publicity campaigns to alert women to the importance of screening, and suggests mothers and daughters should be encouraged to "pair up" and remind each other to undergo screening. Donnelly also called for celebrities or religious leaders to act as cervical cancer ambassadors to help overcome cultural obstacles to improving screening rates. "We know that many obstacles stand in the way of cervical screening - nervousness, embarrassment, lack of time, lack of knowledge, overwhelmed services, and a feeling of 'it will never happen to me'. It is crucial that these obstacles are removed, making it as easy as possible for women to make cervical screening part of their regular routine, as a smart, precautionary measure."

She quoted a Department of Health spokesman, "We would urge every woman invited for screening to make the important decision to take part, as cervical screening can spot changes that might go on to become cancer. 'On the spot smear tests' are already available to women whose test is overdue at their GP practice or other health clinics. More than half a million women were screened in this way that year.

"We want to lead the world in cancer care and are investing over £750 million over four years, including £170 million to expand and improve our cancer screening programmes. (No mention a substantial sum of that figure is actually incentive fees to doctors reaching their targets)

Similarly, in a feature published in 2014 by GP Stephen Robinson, he argued 'On-the-spot screening could help women who struggle to make appointments at a convenient time, by combining screening with another appointment, as well as overcoming the tendency of women to put off their screening by giving them an immediate opportunity to be screened – ' **one 'they' would find harder to evade.** ' (yes, those are his actual words)

He added 'all practices should give women the option to have screening carried out by a woman.'

Completely disregarding women as if we were nothing but sheep needing to be rounded up and processed, he then goes on to acknowledge the 'potential financial implications for GP surgeries'. 'We recommend that this should be recognised and offset by financial incentives given to surgeries for increasing their local screening rates.' 'This suggests that financial incentives, coupled with the other changes to GPs' working practices, would be effective at boosting take-up of cervical screening by rewarding GPs for their efforts.'

In these reports there is no mention of the women's own health concerns. What if the symptoms she was experiencing were frightening or painful?

What if she couldn't think of anything else and was out of her mind with worry? Nothing is said about that. Only the implication that once inside the consult room and put on the spot, a woman should be given no time to think up a sufficient enough excuse for getting out of one. In all likelihood the women would agree to have the procedure if she believed it would lead to the doctor then addressing her own concerns.

What if the entire consult time was taken up with a discussion about smear tests? Would the women walk away without the problems she was experiencing even being discussed?

Trapped, (and one presumes already feeling ill and below par) it will be very difficult for many women to stand up to a doctor and say, 'No thanks, I don't want one' or 'I'm not prepared to have one today.'

While doctors are no longer afforded the respect they once had, they are still in control of that consultation room, hold a lot of power, have the voice of authority. A lot of women might easily succumb.

These articles blatantly promote the trapping women during a consult for other things into having an unwanted test. No thought is given to her sensibilities or feelings - only that her vagina is a target to be lunged for before she can get away.

The backlash from some women to Demos's article was immediate.

' _Why is a site like Demos promoting this draconian programme, which curbs the civil rights of women, and drastically reduces their access to healthcare for other health issues, if they do not wish to participate in this test?'_

'Screening is our choice, to accept or decline as we see fit. We don't need an "excuse" and you can't "avoid" something the law says is elective.'

'Ms Salter defends the hijacking of doctors appointments for on the spot smear tests saying that this is " one they would find harder to evade." If women are evading something, they are clearly and consciously trying to avoid something they do not want, but why does the author feel justified in promoting this organised entrapment of women into a test they do not want?

' **Women who choose to exercise their right not to screen are treated as miscreants who need rounding up like cattle and put through the branding process.'**

In the interest of damage limitation control the Royal College of GPs came out quickly with a response to the outrageous suggestions -

"GPs will check that patients are up to date with health checks such as smear tests as part of their routine appointment if appropriate. But the choice should always be left to the woman – the average GP consultation is currently only 10 minutes long and it is imperative that this time is dedicated to addressing the particular problem or condition that the patient presents with. No-one should ever leave their GP surgery feeling that they have been pressurized into having a test that they did not want."

The British Medical Association began realising there were also problems ahead in doctors not disclosing financial incentives for offering Smears. They put together a paper sent out to all GP's outlining their new guidelines.

Financial and commercial arrangements and conflicts of interest

In Good medical practice -

You must be honest in financial and commercial dealings with patients, employers, insurers and other organisations or individuals.

You must not allow any interests you have to affect the way you prescribe for, treat, refer or commission services for patients.

If you are faced with a conflict of interest, you must be open about the conflict, declaring your interest formally, and you should be prepared to exclude yourself from decision making.

Conflicts of interest

Trust between you and your patients is essential to maintaining effective professional relationships, and your conduct must justify your patients' trust in you and the public's trust in the profession. Trust may be damaged if your interests affect, or are seen to affect, your professional judgement. Conflicts of interest are not always avoidable, and whether a particular conflict creates a serious concern will depend on the circumstances and what steps have been taken to mitigate the risks, for example, by following established procedures for declaring and managing a conflict.

You should:

Use your professional judgement to identify when conflicts of interest arise

Avoid conflicts of interest wherever possible

Declare any conflict to anyone affected, formally and as early as possible,

in line with the policies of your employer or the organisation contracting

your services Get advice about the implications of any potential conflict of interest

Make sure that the conflict does not affect your decisions about patient

care. If you are in doubt about whether there is a conflict of interest, act as though there is.

Decisions about patient care

You must not allow that interest to affect the way you prescribe for, advise, treat, refer or commission services for patients. You must be open and honest with your patients about any such interests that could be seen to affect the way you prescribe for, advise, treat, refer or commission services for them.

You must not try to influence patients' choice of healthcare services to benefit you, someone close to you, or your employer. **You must not put pressure on patients to participate because of the financial benefits for you.**

Of course most Doctors ignore this. After all why should some dictat from their head office spoil this year's luxury cruise?

### *

Angela's story

When I was ten years old, I had to go to the emergency room, where I was forced against my wishes to have a rectal exam in front of an entire group of medical students while my biological father, ignoring my pleas, just sat there reading a magazine. Later, when I was twelve my mother took me to a doctor to have a breast exam done (which she watched) because she thought that I needed to be examined in that manner since I had begun puberty.

Because of these horrible experiences, I refused to see doctors again for almost twenty years - until that is I got pregnant. I did my research and knew from the outset that I would not submit myself of my baby to "traditional" medicine, for the brief exposures I'd had, had have been enough for me.

During my pregnancy, however, I began to have some discomfort and pain issues that eventually got so bad I sought medical care. At the time, my husband also had surgery scheduled at the VA and I was worried that without having treatment for my own problems, I would not be able to adequately care for him while he recovered.

I made an appointment at North Shore to see a midwife, who shall be called **(K)** During the initial phone call, I was very specific about my symptoms and what

I suspected the problem to be and that I wanted to keep invasive intimate exams to a minimum to avoid discomfort. I was assured my problem would be taken care of during the one and only visit.

When my husband and I arrived at the clinic, I was once again reassured by staff my problem was going to be fixed there and then.

Before disrobing for an exam, I explained to the nurse once again that the exam would feel very personally invasive to me, and I would only consent to having it on condition my problem would definitely be taken care of. I knew from the research I had undertaken it was entirely possible to take care of everything in one simple office visit.

**(K)** entered the room and with a brusque introduction stated she would be "starting the exam now."

During the very impersonal exam, she remarked "Yeah, that's pretty bad" in reference to my problem.

Immediately after **(K)** finished, I asked her how she was going to help me. Explaining I didn't want to be subjected to any more intimate exams and that I was given to understand my problem would be taken care of at the same appointment.

Her rather flippant response to my reluctance to have any more exams was "Oh you'll have a lot worse before you're done being pregnant." After a brief pause she added, "That's what you get when you get pregnant. You need to learn to deal with it.'

Even though she was unaware of my childhood experiences, I was still astonished at her lack of empathy, and only managed to ask "You're not going to do anything to help me?"

**(K)** snorted, "No one will do anything while you're pregnant. I'll give you a prescription for some cream."

At the time I was too shocked to respond. I was feeling lied to and taken advantage of.

**(K)** got impatient, as was reflected in her tone, and said "Well do you want it or not?" in reference to the prescription.

I just said yes but because I was feeling very emotional, I started crying.

**(K)** did not even bat an eye or attempt to console me in any way, she merely wrote out the script (for an OTC ointment) and instructed me on how to apply it. She said "You insert it in your bottom." Upon seeing my stunned expression, she added, "You need to stick it up inside of you." I left the room still in tears.

After getting home I read the package instructions, and it specifically said not to use internally as it was intended for topical use only.

I phoned several times and sent a number of e-mails asking to speak with someone in authority about with **(K's)** care and conduct but no one from the facility has responded to me.

Time has not helped me feel any differently about this experience, and reflection has in fact made me feel that much worse about how I was treated. I still remember, with clarity and detail etched into my memory, every minute of the time I spent in the clinic that day.

On another occasion, I called the surgeon, Dr. H's, office staff who blatantly lied to me and misrepresented the scope and nature of what my appointment would entail when I called to make it. I was specifically told after explaining my medical problem in detail that "There are multiple treatment options and something will definitely do done at this appointment", and "You will receive some type of treatment at this appointment". There is no ambiguity in those statements. The staff repeatedly assured me that I would receive treatment at that appointment and I was subsequently denied treatment at the appointment. This is blatant insurance fraud and was reported to Anthem BCBS.

I feel that the staff and Dr. H made and conducted my appointment in bad faith as nothing more than a means to increase their bank account balances.

As soon as we were shown to an exam, room the nurse immediately set out the tools I would (in the next 5 minutes) realize were for a rectal examination. At the time I did not realize it (I simply chalked it up to a miscommunication), but in retrospect it was obvious that Dr. H had planned to give me a rectal examination (whether or not I actually required one) before reading my chart and talking to me about my symptoms.

During my appointment with Dr. H it rapidly became apparent that she was focusing on diagnosing me with internal haemorrhoids - despite the fact that I repeatedly told her I was not experiencing any of the symptoms she was describing to me.

Neither could she not (or would not) provide me with a reason why she assumed I had internal haemorrhoids. Dr H would not let me re-direct the conversation to my true problem, instead kept badgering me about having a rectal examination.

Throughout the appointment Dr. H kept pressuring me to submit to the invasive internal examination for these 'fictitious internal haemorrhoids.' I repeatedly told her that I did not feel that the exam was appropriate given that I had none of the symptoms to justify the exam. I explained several times why I was refusing. To say that my statements to Dr. H fell on deaf ears is an enormous understatement.

After I refused the rectal examination for the third time Dr. H stated that she was not willing to provide me any treatment for my real problem, since I would not submit to the examination she seemed desperate to perform.

When she left the room, it immediately struck both myself and my husband (who was present for the entire appointment) as a blatant attempt to coerce me to consent to an unneeded internal rectal examination.

At that time, my husband and I decided to leave as it was obvious my own concerns and needs were being ignored. On our way out I informed the staff I would be "reporting this as insurance fraud" since I was promised treatment and then denied any.

I believe, the embarrassing falsehood of a haemorrhoid diagnosis Dr H wrote in my medical records was a deliberate act of retaliation for my complaint.

It was only after informing her, I would report her to the State Health Dept. she finally removed the fabricated diagnosis from my medical records.

I also take extreme offence to Dr. H stating that she did not consider treating my problem to "be worth it" regardless of whether she said that to add to the coercion to have a rectal exam or if she genuinely believed it.

I told her, that should be my choice since this is my body and I am an adult who is capable of making my own decisions regarding what is "worth it" to be happy and healthy.

It is _my_ body and _my_ life and _no one_ has a right to tell me that my discomfort with _my own_ body is unimportant and that _I_ should just live with it.

After I had my son (at a planned homebirth with my CNM that was PAINFUL but wonderful) we made our son's first doctor appointment so he could get his two month shots.

At it, **(Witcher)** who I think of as being a 'Witch,' made several errors in my son's health history, (Another nurse had to go back through and amend my son's medical records to correct all the errors.)

During the appointment **'W'** clearly had an issue with the fact that my son was a planned home birth even though it was assisted by a Certified Nurse Midwife possessing over twenty years of experience in hospital OB and as a CNM for homebirths.

Her tone became very brisk and condescending when the subject of my homebirth was brought up, when previously she had been cordial. According to her, having a midwife attend me constitutes "no prenatal care".

She then proceed to overtly rolled her eyes in annoyance when we informed her my son was circumcised, and that it was done by a religious circumciser (as required by our faith) who has 20+ years of experience and is licensed to perform the medical procedure.

Immediately after the appointment, my husband and I decided it best to switch our son's care provider (due to feeling 'The Witch' was too judgmental about the home birth and our religious customs)

A month later I needed to make an appointment at the same facility since I was still experiencing lingering pain/complication as a result of my pregnancy. I did not know t the appointment was going to be with **'W'** until I arrived there. I had only stated when making the appointment, my care provider must be female as my problem is in a private area and my religion decrees the importance of same gender care for such matters.

At this appointment she wasn't interested in listening to my health concerns, but once again began implying I'd had "no prenatal care" (the exact words she put in my medical record) despite informing her about my midwife care and the monitoring the CNM did of my pregnancy.

Once again I informed her the scope of my care with my midwife was the same as would have been allowed by my religion, regardless of care provider, and therefore would have precluded the same religiously forbidden procedures with an OB as well.

Apparently, her definition of care is not dependent on the level of care, amount

and/or type of monitoring, or even the procedures themselves. ' **W's'** definition is purely based only on the actual title a the care provider holds and not the level of care provided itself.

By that standard, anyone could argue, I received no care at all , because, 'The Witch' is actually only an NP and not a qualified MD.

After **'W'** finished mangling my health history and trying to brow beat me for not submitting to a medicalized pregnancy and birth, she moved on to trying to bully me into getting a Pap smear.

**Five times !  
** She said "Let's also get a Pap smear."  
I said "No thanks."  
She said "You need a Pap smear."  
I replied "Not interested since I'm here about my _lingering pregnancy problem."_  
**Witcher** "You have to have a Pap smear."  
Me "I will not consent to a Pap smear."  
**Witcher** "Do you know what it's for?" in a very condescending tone.  
Me "Yes I do. But" - _She_ interrupted me.  
**Witcher** "Well then what's it for?" in the same patronizing tone as before.  
Me "It is an outdated, highly unreliable, invasive procedure to, ostensibly, test for cervical cancer that is no longer recommended, and in evidence based practice has been replaced with the HPV test."

It was obvious to me that **'W'** was obsessed with forcing me to have a Pap smear. I turned to my husband and announced - "Let's leave and ask for someone else."

' **W'** warned me "Well, we can come back to the Pap smear later, but you still need to have a Pap smear."

I did not reply to this because of her abrupt attitude as I consider myself zero risk for cervical cancer; I was a virgin until my wedding night and my husband tested negative.

This whole exchange, was an attempt to coerce me into having a separate procedure by withholding the care I was there for. The only reason she finally provided me with some care was that I threatened to ask for another NP and my explanation for the switch most likely would have resulted in her being pulled up by her superiors.

' **W'** finally proceeded to examine me and declared that I needed a referral to a surgeon because I needed medical correction of my problem. I reminded her that I needed to see a female because of my religion, but she just walked out without a word.

After a time, a different member of staff came in to give me my referral. On it I could see the name of a male surgeon. I immediately alerted her to the fact I only wanted a female surgeon because of my religious requirement for same gender care.

This woman's response was to roll her eyes in an overtly exaggerated fashion. She snapped the chewing gum rolling round inside her mouth and snorted "That's too bad." Then she too walked out of the room!

My husband and I immediately demanded to speak with the supervisor to alert them to these women's conduct. During the conversation with the supervisor I told her I was not comfortable with **'W'** and no longer wanted her involved in any way with mine or my son's healthcare and that we wouldn't be returning to them for my son's four months shots.

The next day, I was finally given a referral to a female surgeon.

During my son's weighing in I saw **'W'** talking with another employee at a counter area near the scales. She turned her head and saw us and ceased her conversation and just stared at me and my husband until we were led back down the hall to the exam room.

A few days later, however, despite having had no direct contact with me. **'W'** suddenly claimed I had Post-Partum Depression (PPD).

I was not pleased with the course of the conversation at the surgeon's office.

The surgeon's office called me later that day to inform me **'W'** in what seems to be blatant retaliation, had called the police to come to my house. When the officers arrived, they seemed surprised at the nature of the call out and couldn't understand why **'W'** thought a well being check for PPD was necessary.

One of the Officers said something to the effect of "We'll let her know everything's OK. There wasn't any cause for concern."

It is for this reason that I believe that, when the police told her they saw no cause to take action, she chose then to contact Child Services in another act of retaliation.

A week later, when I received the full Police report of this incident I found numerous false statements she had made.

It is obvious that **'W'** did not bother to review my medical history before alleging PPD (which she is in no way qualified to diagnose, being a NP and not a Psychologist). My medical file makes it clear that I am married and live with my husband and our son; **'W'** stated in the police report - "it is unknown if the boyfriend resides with her."

She also makes the false claim that the surgeon claimed I tried to harm myself, and that I left his office "sobbing."

I find it concerning that her 'hearsay' was given any weight whatsoever. If my conduct was so concerning, why didn't the surgeon or her staff call the police and CPS instead of wasting precious time on contacting **'W'**?

The surgeon's office has all of my contact information, and I was told by the clinic previously that it was noted in mine and my son's files that this woman was not to have any contact with us. There is not a compelling piece of medical reason for her to have made the complaints she did against me.

The CPS complaint was summarily dismissed as unfounded. The CPS agent who came to my house told me that it was the clinic that had made the complaint, and that the person who complained had volunteered, unprompted by CPS, my personal medical information and it did NOT pertain to any alleged PPD 'diagnosis.'

In the final CPS report, the source reiterates the lie I had no prenatal care, that I tried to self-harm. That I was upset about the news the surgeon gave her, but I was not suicidal," "That they called law enforcement for a welfare check."

It is obvious that the report source was **'W.'**

I made a HSS complaint, one to the Department of Professional Licensing, Health Department, and several others. Not one was willing to help me.

Witcher 'The Witch' and ( **S)** of Indiana CPS have discriminated against my family and threatened us because of our religious beliefs. When the police came to our home, because of an obviously false and retaliatory report made by **'W'** she had declared 'our religion' was ignorant and dangerous and the equivalent of medical neglect .

She threatened us with kidnapping our son because I retaliated by equating her words and actions to that of the Gestapo in Nazi Germany.

She would never answer me as to what my religious beliefs had to do with anything, yet she constantly equated my religiously required duties as 'foolish and dangerous.' She kept referring to us as **"Jews"** even after I told her the way she was phrasing the term was pejorative.

When my husband and I called **'W's'** supervisor ( **S)** we were told she had no problem with how her subordinate acted, adding "Whatever" in a sarcastic tone when told about **'W's'** bigoted and anti-Semitic comments. At the close of the conversation we were warned, if we continued making complaints in this manner, it would lead to them reopening the complaint against us, and would "probably remove the child."

In the final report, made after our complaints, **'W'** only writes a few sentences out of an entire A4 sized page addressing the actual allegations of neglect and spends the rest of the report describing me paranoid for questioning her authority and for believing my family was being discriminated against. Also in what I consider an obvious attempt to embarrass and humiliate me, she repeats at every opportunity that I have hemorrhoids.

( **S)** later came into the Social Security building where my husband works and actually verbally and physically threatened him and several other staff, but fortunately the area director of Social services was not going to allow federal employees be bullied on the premises.

He contacted DCS to complain about their employees conduct and the last Social Security heard, ( **S)** is going to be severely disciplined by demotion or even loss of her job.

Of course, the complaints I made about **'W'** and ( **S)** were just swept under the rug and ignored by all the agencies I tried - including the Anti Defamation League!

The only saving grace is that my husband is a federal employee, and after ( **S's)** documented actions in a federal building, she is tagged as a trouble maker for life by the system.

As an additional plus, acts by **'W'** and those of Child Protective Services against my son, will be viewed, until proven otherwise, as retaliatory and legally actionable in the eyes of the Federal government, who have agreed to supply us with legal representation should the need arise.

My husband has several memories of his time spent stationed in Iraq that he also recalls with unwavering detail. _Traumatic memories._

The belittling and dismissing of my pain, embarrassment, and concerns caused me trauma. Being intimately examined without being helped caused me trauma. Being denied treatment caused me trauma. Having to live with this issue, having it cast a pall over the remainder of my pregnancy and beyond has caused me trauma. Being treated as nothing more than a flesh incubator has caused me trauma. My health, physically and emotionally, did not matter and it caused me extreme trauma. And despite my best efforts I cannot release that trauma. My husband is pursuing surgical sterilization so as to prevent another pregnancy. The existing trauma, my health problems from my pregnancy that were left untreated, and how I am treated (or rather lack thereof) while pregnant (and even currently) have forced us to give up on our dream of more children.

I simply cannot endure anymore and still be a good mother and wife.

This is my body and my life and no one has a right to tell me that my discomfort in and disgust with my own body is unimportant and that I should just live with it. It is enormously insulting, denigrating and patronizing for someone in a position of authority to belittle, ignore and then dismiss the discomfort and concerns of a human being who came to them for help.

I have reached the point I no longer trust medical professionals, as I have been blatantly lied to, mistreated and abused on so many occasions.

### *

Eliz's story

I remember being shocked when I first heard about pap testing, it wasn't just the test itself, it was the militant approach taken by the medical profession, women's groups and most other people. I felt quite alone in my concern about this testing.

I was being told that I must or should have this test, if I didn't test, then I was immature, silly, reckless, and could blame no one but myself for my early demise. It seemed impossible to question this testing, expressing a doubt, concern or even asking for more information was often the prompt for a verbal attack, even name-calling. No other subject seemed to be beyond question, to stir such emotion; it said to me there was something very wrong with this testing.

Whenever I'm pushed, I dig my heels into the ground; I was being ordered into testing with no information on the risks and actual benefits. I've found over the years that demands accompanied by high pressure or emotion usually mean something isn't right and my inner voice screams, "stop, beware – walk away and take your time with this one". My instincts were right with both cervical and later, breast cancer screening.

In about 1980 when I was 21, I went off to the Medical Library looking for answers. I'd rejected the test; it was unacceptable to me, so I wanted to know what sort of risk I was accepting as a non-screening woman.

I did my own research; I read all the things they'd hidden from women, read articles critical of the cervical screening program by Professor Archie Cochrane, the eminent epidemiologist. I also spoke to a couple of medical academics. I devoured this information, something told me it would protect me from this testing; it was my armour.

I think many women fear this topic being raised, especially in the consult room, they feel embarrassed, guilty, silly, some start to stammer, blush, apologize, put themselves down, that's what this program and it's promoters have done to women – we feel like criminals or idiots if we choose not to test. I think this is why real information was kept from women, to make us easier to control, manipulate, overwhelm and deceive.

I walked away from that library feeling shocked and afraid, women were getting a screening story, not balanced information on the pros and cons of testing. An unreliable test for a cancer that had always been rare in the developed world, a test that would benefit very few women but would condemn huge numbers to unnecessary biopsies and over-treatment. There was also hidden concern about testing young women, with the certainty it would lead to a lot of over-treatment for no benefit. There were also no randomised controlled trials for pap testing, a must for ethical cancer screening.

No wonder they wanted women to just do it, accept it's necessary, like brushing your teeth. The women's group on campus suggested we, "Just make it a habit".

I knew the truth, but couldn't believe they'd do this to women, by those who pledged to, " **first do no harm** ". Some of the women's groups who'd fought hard for women's rights and to challenge the exploitation, control and abuse of the female body had been conned in the worst possible way and were now in firm partnership with our abusers. The call for the offer of a free and regular pap test for all women had, in my opinion, turned into systematic and deliberate medical abuse.

The very same groups that shouted down paternalism and the abuse and control of women were among the loudest in the call for all women to have pap testing.  
Incredibly, it seemed this test had become a feminist icon. It seemed to me we could hardly be equal to men if our bodies belonged to others; that they could demand we have an intimate inspection and test every 2 years and judge us harshly if we refused or even questioned this testing. I can't think of another elective screening test "offered" this way.

As an informed woman, I felt like a spectator, listening to misinformation and the scare campaigns and watching the women in my life being deceived, distressed and harmed by the medical profession and the program.

The approach taken to get women to test felt oppressive, the information was incomplete and unbalanced, it was closer to propaganda, the screening campaigns felt and looked like social and mental engineering, it felt wrong.

It's been 36 years since that young woman walked away from that library, transformed into something this program greatly fears, an informed woman. We were expected to file in like ignorant sheep, we were being conditioned to become part of a compliant screening herd and there was no room for individuals, consent or informed consent.  
Surely someone would stop this madness, no, everyone was silent, our medical leaders and associations had nothing critical to say about this appalling treatment of women.

It felt like few women questioned this testing, of course, most were coerced, misled or pressured into testing and some just submitted thinking they had no real say in the matter.

Some women gave in and tested after years of pressure at every consult or being threatened with removal from surgery records or found it was "necessary" for the Pill, pre-natal care, HRT or even migraine meds. To be fair, there was virtually no real information around; most women simply heard the screening stories over and over again.

I know many women who were coerced into testing felt like they'd been taken advantage of, assaulted or raped. Some felt the doctor had enjoyed their initial resistance to testing and the final act of submission. Some felt overwhelmed by the power dynamic in the consult room. There was no real outlet for these women; complaints were promptly dismissed and the woman was always judged. A friend was told, "some women might foolishly avoid pap testing if doctors didn't insist on it, you should thank him".

I couldn't start to quantify the damage this program has caused to so many women, but the numbers would be huge. The damage is often on-going as well, with health, obstetric and/or psychological issues.

This program has taken a lot from women, including the right to say who'll have intimate

access to our body, our legal rights and the quiet enjoyment of our lives.

This level of deception and abuse is only possible with everyone in the medical profession on board. I think some doctors were probably concerned as well but felt it was safer and easier for them to just go along with the program.

In my opinion, this program shows us the misuse of power, the power imbalance, and allowing doctors to violate consent and informed consent leads to open abuse. I still hear doctors brag that they hold the Pill to force women to have pap testing. Medical associations continue to say women on the Pill "need" pap testing, and one spokesman for the AMA said he'd be surprised if doctors prescribed the Pill without a pap test. No one says a word, yet if they said men on Viagra need a colonoscopy or the script would be held until they screened, that would be swiftly challenged. The old double standard is still firmly in place, it says to me the medical profession still view women as something less than men.

I could make an informed decision about testing, that was a NO. Of course, declining to screen meant living around this program, it meant avoiding doctors in my 20s and most of my 30s and never asking for the Pill. In my late 30s I decided I wanted a doctor so went looking for someone I could work with, I found her and she remains my GP many years later.

The arrival of the Internet made research easier, I began to find more information from countries like Finland, the UK and The Netherlands.

I continued to watch this program deceive and harm women. It felt like the asymptomatic female body was under attack, that being female meant a lifetime of medical control and orders, invasive exams and testing and lots of harm.

I was delighted in 2003 when I saw the research by Dr Angela Raffle from the UK, I read it over and over again, but most Australian women have never seen this important research. The conclusion: 1000 women need to screen regularly for 35 years to save one woman from cervical cancer. I knew the program was bad, but wow, that research was damning, surely this would lead to change?

No, nothing, no changes, no comments, no concern. Our medical leaders and

associations were silent. I was amazed when Professor Michael Baum from the UK stated that choosing not to have cervical screening was a perfectly reasonable decision. I will be forever grateful to the handful of doctors, mainly from the UK, my medical heroes, who openly challenged these programs, they gave me hope at a time when I'd lost all hope and encouraged me to keep fighting.

Articles on informed consent in cervical cancer screening arrived very late in this country, as far as I'm aware, the first article appeared in the MJA this year: 2015.  
Incredible that our right to make an informed choice was dismissed for decades and only now is there a trickle of concern, one academic article. How could so many see informed consent or even consent itself in women's healthcare and screening as unimportant or optional?

I knew censorship was protecting this program. When you're misleading women, you have to go to great lengths to hide the truth.

I wrote to the Health Minister, to the media, to all sorts of groups and politicians, no one would touch the subject. Papscreen simply sent me a copy of the screening brochure and urged me to screen without delay.

I started posting wherever I could, I'd set aside a few hours every week to post on as many sites as possible. I firmly believe the only way to change this program is to reach women, usually one by one, to give them real information and encourage them to make an informed decision. I know most dismissed my posts as the ravings of a mad woman, but now and then I'd get a private message from a woman who wanted more information, was facing another biopsy or couldn't face more screening. It was telling that many didn't feel they could reply to my posts, it had to be a private message, it wasn't considered safe to speak openly and critically about this testing.

I knew many women were unreachable, it was the others I wanted to reach, maybe, I could give them real information, help them make an informed decision about screening. It was not for me to tell women what to do; others were doing that, I wanted and still want all women to have balanced and complete information so they can make the best decision for them.

I remember a vivid dream, my husband reminded me about this dream just recently, it happened 3 or 4 times. I was walking along a dark shore with a lantern, there were lots of women in the water struggling to stay afloat, some reached out to me and I pulled them to safety.

The dream made sense to me, I knew women were in danger, if I could help some of them it was the right thing to do, I had to get real information out there, where they could find it. So strong and deep is my outrage for women, I doubt I'll ever stop looking, stop reaching, stop posting, stop challenging...

I was one of the lucky ones, they didn't get a chance to harm me, I've never had a pap test, but this program has affected my life. I've lived with feelings of shock, outrage and sorrow for all the women negatively affected by this program, it's always there, bubbling away under the surface.

Often the backlash on forums was savage and personal, on a few occasions I couldn't return or finish reading the comments, it was too threatening. I was banned and moderated on quite a few sites, my medical journal references were deleted, but an article promoting pap testing with blatantly incorrect information remained in place. The story had become the evidence, that's how effective the propaganda had been, even some doctors believed the screening story. I was told many times that my comments might lead to deaths; I was being irresponsible, playing with women's lives.

This program and its protectors can't meet real information so they don't permit comments on their website, or they have the final word and close the thread. Over and over my comments and references were dismissed and the screening story was held up as the Holy Grail.

It's been a slow process but about 5 years ago something changed, more women were listening, more women were informed, this spells trouble for this testing. Nothing pleases me more than getting to a forum and finding an informed woman, one I probably know, one of my on-line friends, has already posted real information. It makes me think there are now lots of women running along the screening shore pulling women to safety, that makes me very happy.

I hope there is some justice for the women harmed by this program, it should never have happened, and must never happen again. The cervical screening program is not a great success story; it's an example of what happens when power and vested interests are permitted to violate basic human rights, the law and proper ethical standards.

I hope one day the female body will be valued and viewed with respect, without the insane focus on our reproductive organs. I hope women will be trusted to make their own healthcare decisions based on real information. No targets, no target payments, no coercion, no opportunistic screening, no scare campaigns and no screening stories.

It means continuing to challenge the perverse attitudes that shaped this program, those who felt this was an acceptable way to treat women, who abused women and called it health care.

### *

Bibliography

Historic Hansard freely available online

Reaching targets in the national cervical screening programme: are current practices unethical? Peggy Foster & C. M. Anderson  
Jnl Medical Ethics, 1998, 24:151-157

D. Gallen, Hit that target, Doctor, 1994, October 12:72 quoted in Ilana Lowy's "Cancer, women and public health: the history of screening for cervical cancer", Ilana Lowy, Rio de Janeiro, v17, supl 1, July 2010, pp53-67

J. Chomet & J. Chomet, Cervical screening in general practice: a "new" scenario, BMJ, 1990, 300:1505

Risk of transmission of human papillomavirus by vaginal specula, McCance, Campion, Baram, Singer The Lancet, October 4th 1986

Viruses, specula and cervical cancer, Skegg and Paul, letter to the Lancet 5th April 1986

Women, informed consent and cervical screening, Andrew Rouse, Tim Marshall, 3rd July 2000, Birmingham University

New tests in cervical screening, Angela Raffle, letter to the Lancet 24th January 1998, vol 351

Cancer, women and public health: the history of screening for cervical cancer, Ilana Lowy, Rio de Janeiro, v17, supl 1, July 2010, pp53-67

Cancer test smeared: preventive medicine or an expensive mistake? Alison Hann, Critical Public Health, Vol 9, no 3, 1991, pp251-255

Honesty about new screening programmes is best policy  
Women, Informed Consent and Cervical screening  
Andrew Rouse and Tom Marshall  
BMJ 2000; 320 doi: http://dx.doi.org/10.1136/bmj.320.7238.872 (Published 25 March 2000)Cite this as: BMJ 2000;320:872  
 http://www.bmj.com/rapid-response/2011/10/28/women-informed-consent-and-cervical-screening

The Tyranny of Health: Doctors and the Regulation of Lifestyle, Fitzpatrick 2000, Routledge.)

