FDA Panel says HPV test can take the place of PAP test. What's an HPV test?

[SKL]

How do they test for HPV?  Is it basically the same (uncomfortable, invasive) procedure as the PAP screen, or something different?  Is the cost different?

[Butter]

But what about women who get cervical cancer but do NOT have HPV?  A small percentage are not caused by HPV at all.  I'd be pretty mad if I got cervical cancer (I've never had HPV) but it was caught too late because they were only doing HPV screening and not PAP tests.

[SwallowTail]

Really?  That isn't what I read.  It seems that the vast majority is caused by HPV. 

 

But a vast majority does not = all.

[Butter]

But a vast majority does not = all.

 

Exactly.  Some will be missed that would have been caught under the current recommendations if this new recommendation is adopted.

[SKL]

We don't invasively screen everyone for ANY other cancer (except theoretically colon cancer after age 50), so I don't see getting up in arms if a tiny minority of cervical cancers are not screened for....

[Butter]

PSA for prostate cancer.  Mammograms/manual breast exams for breast cancer.  Everyone at risk for those cancers (based on age/sex - same as cervical cancer actually) are screened (or encouraged to be screened... you obviously cannot *make* people have any medical test).  Given that the HPV test and the PAP test are apparently done in the exact same way, it doesn't make sense to do a test that will miss some.  I could see it if, say, the HPV test was a blood test or something not involving swabbing the cervix, but since both require you to be in the oh so comfortable position, it's puzzling why they would purposefully go with a test that will not be 100% accurate.  (Cost and/or the fact that we now have an HPV vaccine are my guesses on why they actually voted the way they did.)

[Ameena]

PSA for prostate cancer.  Mammograms/manual breast exams for breast cancer.  Everyone at risk for those cancers (based on age/sex - same as cervical cancer actually) are screened (or encouraged to be screened... you obviously cannot *make* people have any medical test).  Given that the HPV test and the PAP test are apparently done in the exact same way, it doesn't make sense to do a test that will miss some.  I could see it if, say, the HPV test was a blood test or something not involving swabbing the cervix, but since both require you to be in the oh so comfortable position, it's puzzling why they would purposefully go with a test that will not be 100% accurate.  (Cost and/or the fact that we now have an HPV vaccine are my guesses on why they actually voted the way they did.)

 

I agree with the bolded.

 

Plus something here is not adding up to me. If the point of a vaccine is to "trick" the body into making immunity to a virus, such as HPV, AND the test they are proposing swapping to swab checks for ANTIBIODIES to HPV, similar to checking titers to see if a vaccine "took" - isn't EVERYONE who got the vaccine going to, at least in theory if it's 100% effective, going to test POSITIVE?

 

I can EASILY see a scenario similar to this - go in for yearly exam, get swab, test positive, go back for pap only to find out yeah nothing wrong. But the Dr. gets to bill insurance at least twice, maybe even 4 times {you know, exam 1, results, exam 2 / pap, results}.

[Lucy]

So are you guys saying that because I don't have HPV, I have no risk of cervical cancer?  Then why do they do the PAPs on me at all?

[Butter]

Although what makes you know you don't have HPV? (You don't actually have to answer that.)  I'm just saying unless you have never had sex you could have HPV.  You would not know you have HPV.  There really aren't symptoms.

 

The OB/Gyn I went to last did both PAP and HPV tests automatically on women over 30.  HPV was negative.

 

Something I don't know and was wondering if anyone knows... if you are HPV positive once are you always HPV positive?  Or does it go away.  They say a large percentage of women have had HPV by age 25 or 30 or something like that.  If they are positive once and always positive then wouldn't future HPV tests be useless and then they'd always have to have a PAP?

[SKL]

I think I read that the recommendation was made because the HPV test would have fewer false negatives and fewer false positives ??

 

I agree, it's concerning because it sounds to me like they might do more testing than before without any real need to do anything.  But I am just a lay person, I don't really know one way or the other.

 

It's a rare cancer, and I'm in the "less is more" camp.  I was hoping they were coming up with something less obnoxious than a PAP test.

[SKL]

The OB/Gyn I went to last did both PAP and HPV tests automatically on women over 30.  HPV was negative.

 

Something I don't know and was wondering if anyone knows... if you are HPV positive once are you always HPV positive?  Or does it go away.  They say a large percentage of women have had HPV by age 25 or 30 or something like that.  If they are positive once and always positive then wouldn't future HPV tests be useless and then they'd always have to have a PAP?

 

They say it usually goes away by itself.  But you could get it again if you have sex again.

 

[SKL]

PSA for prostate cancer.  Mammograms/manual breast exams for breast cancer.  Everyone at risk for those cancers (based on age/sex - same as cervical cancer actually) are screened (or encouraged to be screened... you obviously cannot *make* people have any medical test).  Given that the HPV test and the PAP test are apparently done in the exact same way, it doesn't make sense to do a test that will miss some.  I could see it if, say, the HPV test was a blood test or something not involving swabbing the cervix, but since both require you to be in the oh so comfortable position, it's puzzling why they would purposefully go with a test that will not be 100% accurate.  (Cost and/or the fact that we now have an HPV vaccine are my guesses on why they actually voted the way they did.)

 

I dunno what PSA is but I assume it's less invasive than a PAP test.

 

They have stopped recommending mammograms unless you are in a high-risk group.  And besides, I don't consider a breast exam or even a mammogram to be as obnoxious as a PAP test.

 

[Butter]

I dunno what PSA is but I assume it's less invasive than a PAP test.

 

They have stopped recommending mammograms unless you are in a high-risk group.  And besides, I don't consider a breast exam or even a mammogram to be as obnoxious as a PAP test.

 

 

PSA = Prostate Specific Antigen.  It's a blood test.  They say that if a man lives to be over 80 it's not a question of if but when he will get prostate cancer.  However, some recommend not doing routine PSAs even knowing that.  My dad was diagnosed with prostate cancer in 2008.  His PSA was elevated, but that actually does not mean they definitely have cancer.  PSA can be elevated with benign prostate growth.  The next step with an elevated PSA (depending on how elevated) is a biopsy.  My dad never had a single symptom, but thank goodness his doctor automatically does PSAs after age 60.  Some insurances don't cover it anymore (even post-ObamaCare since it's not considered a "necessary" well man screener).

 

PAPs are very obnoxious.  The HPV test is done the same way, though.  I'd be all over saying women now only have to have a blood test to determine cervical cancer risk.  That would be fantastic.  These recommendations don't change the way the test is performed, though.  It's still invasive.

[SKL]

That's the thing.  Call me crazy, but I am suspicious of the "benign-ness" of all this testing.

[Butter]

About the PSA thing, I read that one of the issues was men being treated for cancer when they wouldn't have needed to be.  And it's not like cancer treatment is generally a walk in the park.

 

"Wouldn't need to be" is subjective.  One of the schools of thought in prostate cancer is to take the "wait and see" approach.  Some men choose to do that, particularly older men.  That's a valid choice.  My dad chose surgery to have the prostate removed.  Since his cancer was caught early, he did not need any additional treatment (except regular PSAs because you can grow prostate cancer cells and not have a prostate anymore).  For a time, they were treating if the PSA was elevated with no further testing.  That was a problem since PSAs can be elevated without having cancer.  That would be like a woman finding a lump in her breast and immediately jumping to cancer treatment.  Instead common sense says you do a biopsy first to confirm it is cancer.  My parents had several hours of classes on prostate cancer at Walter Reed after my dad was diagnosed and they were told flat out that what they do with the cancer information (and whether PSAs are allowed in the first place) is mostly a matter of money.  The majority of people who get prostate cancer die within 10 years whether they are treated or not simply because most people are older when they are diagnosed.  The difference is those who are not treated generally die of cancer (like my grandfather and great-grandfather - can you say strong family history...?) while those who were treated generally die of other natural causes (such as heart disease or old age).

[magnificent_baby]

I dunno what PSA is but I assume it's less invasive than a PAP test.

 

They have stopped recommending mammograms unless you are in a high-risk group.  And besides, I don't consider a breast exam or even a mammogram to be as obnoxious as a PAP test.

 

 

Just a quick clarification. Correct me if you were talking about this in another context.

 

Mammograms are recommended every year at age 40 and up. Or sooner if you are in a high risk category, plus a possible MRI. 

 

http://www.cancer.org/cancer/breastcancer/moreinformation/breastcancerearlydetection/breast-cancer-early-detection-acs-recs

[Spryte]

 

That's like the ovarian cancer thing.  My mother died from it.  There are some tests I could have done regularly, but they have so many false positives it's not all that worthwhile. 

 

I'm sorry about your mother.  That's rough.  :(

 

What types of tests can they do to early detect ovarian cancer?  ...I wonder this at times, as I don't think I'd have many (any?) warning signs - I have no uterus, no cervix, just ovaries.  I guess no one really has signs though, right?  Generally, I've taken the head-in-sand approach to this one... 

 

Okay, didn't mean to hijack in any way, shape, or form.  Hopefully this is relevant, since it's related.  :)

[SKL]

Just a quick clarification. Correct me if you were talking about this in another context.

 

Mammograms are recommended every year at age 40 and up. Or sooner if you are in a high risk category, plus a possible MRI. 

 

http://www.cancer.org/cancer/breastcancer/moreinformation/breastcancerearlydetection/breast-cancer-early-detection-acs-recs

 

My provider has sent me letters saying that they no longer recommend this, because it is not clear whether mammograms actually make any difference in cancer outcomes, and some believe the Xrays might increase the risk of cancer.  They list 4 or 5 risk factors and say if any apply to me, I should come in for a consult.  Otherwise, if *I* want a mammogram, they'll do one (covered under my insurance), but they aren't saying whether I should or shouldn't.

 

ETA:  I'm 47.

[Spryte]

Thanks, Wendy. Yes, I agree - keeping one's ovaries is preferable to instant menopause.

 

You echoed my vague impression - that testing is iffy, and if one's having symptoms things are fairly advanced. [sigh] at least it is rare, even with family history.

 

Ok, head back in sand now.

[Catwoman]

My doctor does both a PAP and HPV test on me every year.

 

I know that some people think cervical cancer will never happen to them, so they don't bother to go for annual exams, but as I have mentioned in past threads, in my case, if I hadn't gone for my exams, I wouldn't be here today.

 

That's why I tend to be a little fanatical about recommending the annual gyn exams and testing. (And BTW, I have no family history and haven't exactly lived a high-risk lifestyle over the years.) It's only a few minutes a year of minor discomfort. It's not a big deal, and there's no reason to be embarrassed about it. It's not like your private parts are the only ones your doctor has ever seen, you know. :D

 

One last thing -- HPV can remain dormant in your body for many, many years, so you don't always know you have it until it shows up on your test results. The majority of the people who contract HPV are fortunate and their body fights it off with no intervention, but that's not the case for all of us, and it's almost impossible for most of us to know for sure that we have never contracted it.

 

OK, I'll get off my soapbox now. :)

[MercyA]

Yes and it's beyond an incredibly small amount.  I cannot find any information that states other causes.  I once read about it many years ago and came across some obscure study in a journal that found that some celibate nuns had gotten cervical cancer.  Of course can we be 100% certain they were celibate?

 

I actually think the HPV test instead of the other test is kind of dumb except maybe for women over a certain age because so many people test positive for HPV (but will never get cervical cancer). 

 

Certainly I think if someone wants to be screened for any sort of cancer they should be.

 

My mother died from ovarian cancer.  There is no screening for that.  Sure wish there was. 

 

I agree with most of what you said here, but there is at least one other possible cause of cervical cancer.  Women have an increased risk of developing a rare type of cervical cancer if their mothers took DES (a synthetic form of estrogen) during pregnancy.  DES was only prescribed from 1940 to 1971 in the U.S. and only until 1978 in Europe.  More info here:  http://www.cancer.gov/cancertopics/factsheet/Risk/DES

 

[magnificent_baby]

My provider has sent me letters saying that they no longer recommend this, because it is not clear whether mammograms actually make any difference in cancer outcomes, and some believe the Xrays might increase the risk of cancer.  They list 4 or 5 risk factors and say if any apply to me, I should come in for a consult.  Otherwise, if *I* want a mammogram, they'll do one (covered under my insurance), but they aren't saying whether I should or shouldn't.

 

ETA:  I'm 47.

 Interesting! Hadn't heard of this. I can understand the exposure risk. 

[Carrie12345]

Here's a question - Isn't the pap to check for cells and HPV to check for virus? If the HPV comes back positive (typical for the majority of youngish women), wouldn't you have to just go back for a pap to check for cell change??? Seems stupid.  Or would it be an automatic referral for a colposcopy?

 

 

[Carrie12345]

Yep. 

 

I read several places though that they are recommending the HPV for those 30 and over. 

 

I would hope they wouldn't automatically do a biopsy.  That's way more invasive.

 

Mine didn't show up until I was 32!

 

My first colpo wound up not needing a biopsy, so that's good. But still, who wants to sit with a microscope between their legs when they could have just had a dual hpv/pap test to begin with!

[mamaraby]

Not sure if the how question was answered from the OP, but this link gives a good overview - http://www.cancer.org/cancer/cancercauses/othercarcinogens/infectiousagents/hpv/humanpapillomavirusandhpvvaccinesfaq/hpv-faq-h-p-v-testing

[Laura Corin]

I dunno what PSA is but I assume it's less invasive than a PAP test.

 

They have stopped recommending mammograms unless you are in a high-risk group.  And besides, I don't consider a breast exam or even a mammogram to be as obnoxious as a PAP test.

 

 

I refer you to bowel cancer screening, which is offered to everyone in Scotland when they turn fifty.  I'd take a PAP smear in preference any day.

 

L

[SKL]

I refer you to bowel cancer screening, which is offered to everyone in Scotland when they turn fifty.  I'd take a PAP smear in preference any day.

 

L

 

I've done that, but I qualified that in my comment (colonoscopies for people over 50).

 

We call them the roto-rooter procedure over here....

 

Colon cancer is much more prevalent and deadly, and even so, they don't make people get tested every year.  Even my mom, who had half of her guts removed thanks to colon cancer, doesn't get the roto rooter every year.

 

ETA, I just clicked on your link and that's not the colonoscopy, that's just smearing poo.  You'd really prefer a PAP over that?  Not me.

 

[Laura Corin]

 

ETA, I just clicked on your link and that's not the colonoscopy, that's just smearing poo.  You'd really prefer a PAP over that?  Not me.

 

 

Yes, I do.  And I'm really happy to have had the PAP because it once detected cell changes that could otherwise have developed into cancer.

 

I've had a fair number of pregnancy-related and other internal exams and they don't worry me.

 

L

[Butter]

Yeah that is rather questionable too.  Listed cause of death often doesn't paint the full picture.  My mother's official cause of death was COPD because her lungs filled up with fluid.  But she had ovarian cancer that spread so this was a complication of the cancer.  They didn't list cancer as cause of death.  Not sure why exactly.

 

That's rather odd.  Especially since they can list secondary causes of death on the certificate as well.  But if you had your prostate removed and your follow-up PSAs are all 0, then you did not die from prostate cancer.  It's actually something they can be sure of.

[Trish]

We don't invasively screen everyone for ANY other cancer (except theoretically colon cancer after age 50), so I don't see getting up in arms if a tiny minority of cervical cancers are not screened for....

 

So why would a person who is not sexually active need either test?

 

[Trish]

They probably would not.  But I've read some places that sometimes the virus can lie dormant.  So I suppose that is a possible explanation.

 

But if a person was never sexually active then yeah I can't think of a single good reason.

 

That is quite a few years I could've skipped, starting at age 14.  :toetap05: 

 

[redsquirrel]

my mom had uterine cancer and it was detected by good nursing and a pap test. She had a regular pap (I should add that my family has a genetic syndrome that results in a very high rate of many cancers so she gets tested for everything. My mom has the genetic syndrome so...) And her pap came back normal but there was one healthy uterine cell in the pap report. The nurse said she was taught that uterine cells should only be in the uterus and she decided to follow up. Turned out that my mom was in the very early stages of uterine cancer. She had a full hysterectomy and some radiation treatment and is now considered cured. That was 15 years ago.

 

So, I am making the choice to get that pap or HPV or whatever it is. Given my family history and possible risk it makes sense.

 

She has also had breast cancer in each breast but it was caught by mammogram. Now, it was the common ductal cancer that can be slow growing, but given our family's history we don't take any chances.

[Wheres Toto]

I agree with most of what you said here, but there is at least one other possible cause of cervical cancer.  Women have an increased risk of developing a rare type of cervical cancer if their mothers took DES (a synthetic form of estrogen) during pregnancy.  DES was only prescribed from 1940 to 1971 in the U.S. and only until 1978 in Europe.  More info here:  http://www.cancer.gov/cancertopics/factsheet/Risk/DES

 

 

And this is why I usually go for regular exams.  Although I'm about a year behind right now due to lack of insurance last year and not having gotten around to making an appointment this year.

[SKL]

So why would a person who is not sexually active need either test?

 

 

You wouldn't, if you've never been sexually active.

 

Now what I'd like to see is a no-nonsense HPV test that tells you "as of today, you do not have HPV" so that going forward, as long as you are not sexually active, you can stop worrying about PAPs etc.

[SKL]

I didn't start that young.  That seems excessively young.  And frankly I think I would have been traumatized!

 

I was traumatized when I had my first (and last) PAP in my late 30s.

 

I might be willing to get one HPV test if it would confirm that I don't have to ever think about it again, or at least not unless & until my relationship status changes. ;)

 

[Catwoman]

I was traumatized when I had my first (and last) PAP in my late 30s.

 

I might be willing to get one HPV test if it would confirm that I don't have to ever think about it again, or at least not unless & until my relationship status changes. ;)

 

 

Please feel free to ignore my question if it's too personal, but I have had many, many PAP tests and I can't imagine how it could be a traumatizing experience for the average woman, so I'm wondering what happened. 

 

Again, please don't feel like you have to answer. I know I'm putting you on the spot, but I'm genuinely curious.

[Sun]

Here's a question - Isn't the pap to check for cells and HPV to check for virus? If the HPV comes back positive (typical for the majority of youngish women), wouldn't you have to just go back for a pap to check for cell change??? Seems stupid.  Or would it be an automatic referral for a colposcopy?

 

When they do the initial screening for HPV, they do a pap too. The advantage of the HPV test for women in monogamous relationships is that if they test negative for it, they can skip a pap for the next few years (up to 5, according to the CDC).

[Unicorn.]

Please feel free to ignore my question if it's too personal, but I have had many, many PAP tests and I can't imagine how it could be a traumatizing experience for the average woman, so I'm wondering what happened. 

 

Again, please don't feel like you have to answer. I know I'm putting you on the spot, but I'm genuinely curious.

 

How are you not traumatized?  I refer to it as legal rape and sodomy.   Seriously.  Some tests are just too invasive.  I'm glad you are still around, and those tests saved your life, but I guarantee if men had to endure these tests, they would have found a much less invasive way to do it before now.

[Catwoman]

How are you not traumatized? I refer to it as legal rape and sodomy. Seriously. Some tests are just too invasive. I'm glad you are still around, and those tests saved your life, but I guarantee if men had to endure these tests, they would have found a much less invasive way to do it before now.

I think that is absolutely ludicrous. It's a doctor's visit. Period.

 

To even remotely equate an annual gyn exam with rape and sodomy is beyond extreme.

 

For heaven's sake, doctors are professionals and the whole exam is done in a few minutes.

 

And FWIW, men go through some less-than-pleasant testing experiences, too, so to suggest that things would be different if men needed the same tests is insulting and sexist.

[Unicorn.]

So I'm insulting and sexist.  I find them more than just uncomfortable, and it's not "just" a doctor visit.  It's extremely invasive.  Obviously we disagree on the level of "discomfort", and that's okay.  Like I said, glad they saved your life, but I don't have to like them.'

 

I did read a couple of years ago that a blood test was available, but it isn't covered by insurance, therefore docs don't do it.  You'd think it would be cheaper, or at least a similar cost, and insurance would cover it. 

[Catwoman]

So I'm insulting and sexist. I find them more than just uncomfortable, and it's not "just" a doctor visit. It's extremely invasive. Obviously we disagree on the level of "discomfort", and that's okay. Like I said, glad they saved your life, but I don't have to like them.'

 

I did read a couple of years ago that a blood test was available, but it isn't covered by insurance, therefore docs don't do it. You'd think it would be cheaper, or at least a similar cost, and insurance would cover it.

I'm not sure anyone particularly "likes" those exams. ;)

 

I just took offense at the "legal rape and sodomy" comment, because it seemed really over the top. Also, my gyn is a great guy, and he goes out of his way to make his patients comfortable. He's very gentle and the physical discomfort is very minimal.

 

I did go to one gyn many years ago who wasn't gentle at all, and that exam hurt a lot, so I can understand how a bad experience could feel invasive and that it could definitely make a woman want to delay the next visit for a while.

 

I think the level of trust and comfort we have with our doctors probably makes all the difference in the world. A good doctor can make the exam seem routine and pretty much pain-free, but a rotten one can definitely make us dread having to make that appointment.

[Laura Corin]

I think that is absolutely ludicrous. It's a doctor's visit. Period.

 

To even remotely equate an annual gyn exam with rape and sodomy is beyond extreme.

 

For heaven's sake, doctors are professionals and the whole exam is done in a few minutes.

 

I actually find going to the dentist more invasive than having a PAP smear: it takes longer, is more uncomfortable, and the interference with the breathing/speaking mechanisms doesn't feel comfortable at all.

 

When I have a smear, I'm usually chatting to the doctor - it helps us all to relax.

 

L

[Elfknitter.#]

I actually find going to the dentist more invasive than having a PAP smear: it takes longer, is more uncomfortable, and the interference with the breathing/speaking mechanisms doesn't feel comfortable at all.

 

When I have a smear, I'm usually chatting to the doctor - it helps us all to relax.

 

L

Actually, I find the dentist/hygienist annoying when they ask me questions that I obviously cannot answer with the instruments in my mouth.

 

I'd rather not chat during a pap. I usually have to spend my time breathing to relax.

 

While I might not enjoy an exam, I can't dismiss another woman's feelings of violation. I find downplaying it as over the top to be offensive and dismissive.

[Laura Corin]

While I might not enjoy an exam, I can't dismiss another woman's feelings of violation. I find downplaying it as over the top to be offensive and dismissive.

 

I apologise if that's how I came across.  It's actually because I take sexual abuse and rape very seriously that I am very concerned not to blur the boundaries between consensual and forced actions.  

Someone may feel violated by a consensual medical procedure: it is a personal feeling, and no less valid for that. But  to say that the procedure is legalised rape diminishes the concept of assault, I believe.

 

Again, I apologise if I seemed to deny the validity of someone else's feelings - that was not my intention.

 

L

[Butter]

So why would a person who is not sexually active need either test?

 

 

Usually they wouldn't.  There is the unexplained HPV found in those nuns, though.  Not that nuns 100% never had sex (whether consensual or by force), but usually you'd assume nuns are virgins, and whether those particular nuns were or not, I don't know.  If you've had sex in the past it's possible to have gotten HPV and it be dormant for a while apparently so sexual activity level *now* may not matter in light of the past.

[Catwoman]

I actually find going to the dentist more invasive than having a PAP smear: it takes longer, is more uncomfortable, and the interference with the breathing/speaking mechanisms doesn't feel comfortable at all.

 

When I have a smear, I'm usually chatting to the doctor - it helps us all to relax.

 

L

Same here! :)

[Catwoman]

While I might not enjoy an exam, I can't dismiss another woman's feelings of violation. I find downplaying it as over the top to be offensive and dismissive.

I'm sorry you feel that way, but to describe a routine medical exam as "legalized rape and sodomy" truly was over the top.

 

I also think that kind of horrifying description of being "traumatized" may frighten women who have never gone for an annual exam and discourage them from having what many of us believe to be important testing.

 

I can understand that a victim of sexual abuse might have serious psychological problems with any kind of examination of her private areas, but that's an entirely different situation. I can also understand why some women might find the process a bit embarrassing and uncomfortable, but there is simply no way the "violation" should be considered to be the equivalent of "rape and sodomy."

 

While you can choose to find my comments offensive and dismissive, I found it far more offensive that gynecologists were being accused of legally raping and sodomizing women. They are doctors. They are professionals. Are there a few perverts out there? Sure, probably. There are a few perverts in every line of work. But I stand by my assertion that it's over the top for the average person to make a blanket statement that a routine annual pelvic examination is the equivalent of legalized rape and sodomy, because it quite simply is nothing of the kind.

[SKL]

Obviously there is quite a range of feelings on this matter.  I know someone who forces her husband to come with her when she has a PAP test, to reduce the likelihood that she will have a massive panic attack and pass out.

 

These are feelings.  Nobody is trying to suggest that the doctors are rapists, legal or otherwise.  I would choose different terminology, but for many women it's more than "just a routine procedure."  Why question that?

[SKL]

And I agree that there simply has to be a better way to engineer this, if someone bothered to make an effort.

[SKL]

There are many things that have been done to women over the years in the name of "health" that were completely unnecessary, unhealthy, and frankly more for the doctor's convenience than anything else.  Is this one of them?  Perhaps.