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Girls: what do you think of #smearforsmear? Do you avoid your pap smears and why? watch

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    My friend recently underwent a speculum exam she did not ask for or consent to, only expecting an examination of an irregularity, but did not feel she was in a position to ask him to stop. She felt violated and raped as a result.

    She raised her concerns with the hospital, and made a complaint, however they said he was just trying to do his job and make sure he doesn't miss any illnesses. They did not seem bothered by the fact that she did not agree to it. I found this strange, as clinicians have to ask permission for any other examination, even just listening to your heartbeat. Why is it that a clinician has to ask whether they can, I don't know, check for any lumps on the sides of your ears, for example, but they don't need to ask before they insert a plastic object into your vagina? Doctors are allowed to rape?

    As a result, I feel as if medicine, as practice, is about doctors doing what they think they need to do, rather than clinician's helping patients look after their health. Slight difference in emphasis. In my friend's case, the clinician left her in worse health.

    So female posters*, have you ever felt violated by a gynaecological exam, or do you avoid pap smears or visiting your GP about gynaecological issues, because you feel a lack of control over your body in such examinations? And I would also be interested to hear from female posters who are medicine students, or already practicing.


    *I would appreciate if male posters could just leave this thread, this is a chance for you to just listen and learn- if you want to discuss this you can start another thread. I would really appreciate if people could ignore male posters and not encourage them by responding, as someone will surely decide to post anyway.

    Reason being, we also see campaigns about trying to get more young women and teenage girls to do pap smears:

    http://www.jostrust.org.uk/smearforsmear/ (this campaign just feels very rapey, smudged lipstick, unwanted penetration?!)

    but we never hear about why young women and teenage girls don't want to go and do them in the first place. Personally, especially after what happened to my friend, I think we need to more education on what exactly a smear test is, and what a girl's rights are during the test, what to expect during the examination. Not a slightly rapey sexualised campaign with smudged lipstick encouraging girls to be penetrated when they clearly don't want to.

    Anyway, I want to hear from you now.
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    That campaign doesn't seem rapey at all to me. :erm: I don't think it seems particularly effective, and very gimmicky, but frankly I find that sanitary towel ad (don't know which company) with the babyish voiceover and lullaby music much creepier!

    I agree that there should be more public information about what to expect from a smear test, but I don't see how you're helping matters by calling it rape? Unless if there was some kind of sexual context that you're leaving out, what happened to your friend was (to my eyes) an unfortunate medical oversight that should have been prevented. Not a wilful violation. Doctors are often rushed and some of them are pretty deficient in seeing things from the patient's point of view, which should definitely be worked on. And I agree that as a body part like any other, there should wherever possible be consent for a vaginal exam. But as it is a body part that can go wrong, these examinations are necessary and to be encouraged.
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    (Original post by Anonymous)
    My friend recently underwent a speculum exam she did not ask for or consent to, only expecting an examination of an irregularity, but did not feel she was in a position to ask him to stop. She felt violated and raped as a result.

    She raised her concerns with the hospital, and made a complaint, however they said he was just trying to do his job and make sure he doesn't miss any illnesses. They did not seem bothered by the fact that she did not agree to it. I found this strange, as clinicians have to ask permission for any other examination, even just listening to your heartbeat. Why is it that a clinician has to ask whether they can, I don't know, check for any lumps on the sides of your ears, for example, but they don't need to ask before they insert a plastic object into your vagina? Doctors are allowed to rape?
    Any healthcare practitioner who carries out a procedure on a person who hasn't consented when they have the capacity to do so is assaulting that patient. Doesn't matter if they're just trying to do their job, it's the law. Also, any male doctor who is going to carry out that sort of procedure on someone will take a chaperone in with them to protect both the patient and themselves, if this isn't the case then this doctor is in a lot of trouble and your friend should chase this up and escalate her complaint.

    (Original post by Anonymous)
    *I would appreciate if male posters could just leave this thread, this is a chance for you to just listen and learn- if you want to discuss this you can start another thread. I would really appreciate if people could ignore male posters and not encourage them by responding, as someone will surely decide to post anyway.
    You've commented on a public part of the site on an issue around consent in the health section of the site. Just because I have a penis doesn't mean my opinions or comments are irrelevant, people can choose to ignore me if they wish to however you have no right excluding people from this thread on the basis of their gender.

    (Original post by Anonymous)
    but we never hear about why young women and teenage girls don't want to go and do them in the first place. Personally, especially after what happened to my friend, I think we need to more education on what exactly a smear test is, and what a girl's rights are during the test, what to expect during the examination. Not a slightly rapey sexualised campaign with smudged lipstick encouraging girls to be penetrated when they clearly don't want to.

    Anyway, I want to hear from you now.
    If you don't want to have a smear done then don't have it done. If you don't understand what's involved in a clinical procedure then you are free to ask, doctors are more than willing to ensure you understand completely what is going to be done so that you can give informed consent. In the end, this procedure is done to screen for cancer and to protect the health of women, not for the fun of it. Jo's Trust is using social media to raise awareness to increase uptake of people having smear tests done, the lipstick smear selfie is nothing different to the breast cancer memes that have done the rounds on facebook through the years. Lots of charities have jumped onto the social media bandwagon because it's a really effective way to get your message to lots of people quickly and relatively free of charge.

    If it's something that raises awareness and helps less women suffer from cervical cancer then that's surely a good thing isn't it?
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    Medical student here, if she felt violated then obviously that's terrible and I hope she feels better.
    Consent doesn't need to be verbal, we had a seminar on it a while back and the general rule is that if a patient goes along with something then that is consent.
    For instance if a GP says roll up your sleeve so I can take your blood pressue and you do so then you are doing it so they can proceed, no verbal consent is required. Obviously there is a difference between that and an intimate examination but I can't really comment more on what the doctor did in terms of whether it was appropriate. I bet a lot of patients are nervous before an examination, especially if they haven't been before.
    I don't think the smear for smear campaign is rapey, it a terrible campaign and annoys me a lot but since the "Jade Goody" effect has now ended and the % of women going for smears is dropping there needs to be a campaign of sorts.
    It's not about penetrating women who don't want to be, it's about preventing cancer by picking up on abnormal cells. I bet if there was a less invasive way to do that than the current methods doctors would prefer it.
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    Weak trolling.

    Feel free to opt out of cervical screening yourself, but seeking to erode the scheme by using intentionally provocative language is just downright harmful.

    Uptake of screening in young women is already poor and subsequently treatable pre-malignancies are allowed to progress into fulminant cancer. Pushing this bilge and discouraging women to attend makes you, in part, responsible for that.
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    (Original post by Etomidate)
    Weak trolling.

    Feel free to opt out of cervical screening yourself, but seeking to erode the scheme by using intentionally provocative language is just downright harmful.

    Uptake of screening in young women is already poor and subsequently treatable pre-malignancies are allowed to progress into fulminant cancer. By pushing this bilge and discouraging women to attend makes you, in part, responsible for that.
    :ditto:

    I don't know exactly what happened to your friend, but calling it rape is unnecessary scaremongering. The doctor should have explained better what they were doing and why, but consent for an examination would be implied by someone following instructions to e.g. get on the couch and remove underwear. If your friend didn't want the examination or didn't understand why it was being done, then she could have said so and they would be happy to explain.

    That campaign looks a bit naff, tbh, but I see no harm in it. And no, I wouldn't refuse my smear tests, because I don't want to die of a preventable condition.
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    Hi,

    (Original post by Valvopus)
    Medical student here, if she felt violated then obviously that's terrible and I hope she feels better.
    me too, but we are in the minority in that- she's faced the most appalling wall of aggression from the hospital, as if they have to protect the clinicians concerned, rather than her, as a patient.

    [QUOTE=Valvopus;53272909]Medical student here, if she felt violated then obviously that's terrible and I hope she feels better.
    Consent doesn't need to be verbal, we had a seminar on it a while back and the general rule is that if a patient goes along with something then that is consent.
    For instance if a GP says roll up your sleeve so I can take your blood pressue and you do so then you are doing it so they can proceed, no verbal consent is required.
    /QUOTE]

    that's interesting to know. That's exactly why I think the health community is a step behind society, informed consent is crucial.

    (Original post by Valvopus)
    I don't think the smear for smear campaign is rapey, it a terrible campaign and annoys me a lot but since the "Jade Goody" effect has now ended and the % of women going for smears is dropping there needs to be a campaign of sorts.
    It's not about penetrating women who don't want to be, it's about preventing cancer by picking up on abnormal cells..
    Yes, which is why I think the health community needs to think about why women and girls are not going, rather than just carrying on as usual, and telling women and girls that they should be going.

    (Original post by Valvopus)
    I bet if there was a less invasive way to do that than the current methods doctors would prefer it.
    I don't. The fact that a less invasive hasn't been found yet speaks volumes.

    In summary, I think medicine needs to shape it's practices to suit women and girls, in order to best serve their health needs, rather than telling women and girls that this is good for you and this is how we do it, therefore you should do it.
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    OP I really think you're reading something into this that just isn't there. Men go for prostate exams, women for smears. They are both appropriate methods for screening against serious illness. Few people enjoy doing them, and many avoid it - doesn't mean that it isn't necessary and desirable for them to be done.
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    Hi,

    (Original post by Helenia)
    :ditto:

    I don't know exactly what happened to your friend, but calling it rape is unnecessary scaremongering.
    I did not intend to upset anyone, and sorry if you felt scared, but she was raped.

    (Original post by Helenia)
    :ditto:

    I don't know exactly what happened to your friend but
    You should reserve judgement if you don't know what happened, rather than offer you opinion on why it wasn't rape.

    (Original post by Helenia)
    :ditto:
    The doctor should have explained better what they were doing and why, but consent for an examination would be implied by someone following instructions to e.g. get on the couch and remove underwear. If your friend didn't want the examination or didn't understand why it was being done, then she could have said so and they would be happy to explain.
    It sounds as if you have a set scenario of how rape plays out- most of the time, it's not a violent struggle, like in the movies.

    (Original post by Helenia)
    :ditto:

    That campaign looks a bit naff, tbh, but I see no harm in it. And no, I wouldn't refuse my smear tests, because I don't want to die of a preventable condition.

    That's nice for you, but clearly, the fear of death hasn't compelled enough women and girls so far. I am suggesting the health community needs to change its approach to how it examines women's bodies, because it' clearly not working for most women.
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    (Original post by Anonymous)
    Hi,



    I did not intend to upset anyone, and sorry if you felt scared, but she was raped.



    You should reserve judgement if you don't know what happened, rather than offer you opinion on why it wasn't rape.



    It sounds as if you have a set scenario of how rape plays out- most of the time, it's not a violent struggle, like in the movies.




    That's nice for you, but clearly, the fear of death hasn't compelled enough women and girls so far. I am suggesting the health community needs to change its approach to how it examines women's bodies, because it' clearly not working for most women.
    She wasn't raped
    She wasn't even sexually assaulted as there was no sexual context
    She was possibly assaulted in legal terms.... it depends how the law views consent in a medical context.
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    I am very sorry to hear about how your friend felt after her speculum examination. It is an intimate examination which can leave you feeling vulnerable and your friend clearly didn't feel that the examination was explained to her clearly enough. If she had her concerned then reporting it was definitely the right thing to do. However I would like to point out the informed consent is required for all examinations and if an examination is performed without consent it is referred to as assault. As a doctor I disagree with your statement that we do what we think that we need to do ignoring our patients wishes. My role is to advice my patients of their options and then it is their decision. Do my patients sometimes make decisions that I think are the wrong ones? Yes they do but that is their right and all I can do is to inform them of the options and try to help them make the correct decision for them whatever that might be.

    However while an intimate and sometimes uncomfortable procedure smear tests do save lives so I think it is important to present a balanced view of them. In the last few years I have had a smear test. It was performed by the practice nurse. I was fully informed of what to expect before it was done and I was also treated with dignity and care and given the privacy to undress and prepare behind a curtain before she came in. The smear test itself was slightly uncomfortable but not painful and lasted less than a minute. I have also had a number of internal and speculum examinations during my pregnancy and labour with my son 7 months ago. Again all of these were performed with care and respect.I have had intimate examinations from both male and female practitioners (doctors, the practice nurse and midwives) and I can't say that any of them performed in anything but a professional way.

    Smear tests are an effective way of detecting early signs of cell change which can lead to cervical cancer. Because of their introduction into our healthcare system the number of both young and older women who are dying of cervical cancer has dropped dramatically. The following quote is from an article on patient.co.uk which though written for professionals is useful for those wanting to know more about the rationale behind screening.

    "Incidence of cervical cancer in the UK fell by 43% between 1987-89 and 1997-99, apparently attributable to the screening programme introduced in the late 1980s.Three-yearly screening up to 39 years of age prevents 41% of cancers. Five-yearly screening between 40 and 54 years of age prevents 63% of cancers. It has also been shown that the cervical screening programme is associated with improved rate of cure of invasive cervical cancer." Source

    So there is a lot of evidence that smear tests are effective at preventing cervical cancer. There currently isn't a non-invasive method of screening if there was I am sure that the NHS would be looking into whether it was a viable option to introduce it. The way that we screen for risk of cervical cancer will change a lot over the next decade with the introduction of the HPV vaccine and also the introduction of screening for HPV in smear samples. However we aren't there yet and I think it is important that we continue to encourage not just young women but all women within screening age to attend for them. I do agree with you that it is important to look for the reasons that women might not be attending and try to provide them with the information that they need to make an informed choice. This process is starting already as the information leaflet that I received with my letter about my smear test told me the rationale for doing it and also explained the procedure and what would happen with the results very well.

    I think that the campaign that you linked to is trying to encourage women to learn more about smear tests which is a positive thing. They are trying to use social media to help raise awareness and are slightly jumping on the ice bucket challenge and the no make up selfie idea. It is also not that dissimilar to the "got milk" campaign that has run in america. I don't see anything inherently wrong with it, but it isn't something that would personally appeal to me.
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    (Original post by Kabloomybuzz)
    She wasn't raped
    She wasn't even sexually assaulted as there was no sexual context
    She was possibly assaulted in legal terms.... it depends how the law views consent in a medical context.
    Hi,

    Re read my response to the above post. You do not know the details of her appointment, so your opinion on whether or not it is sexual assault is invalid. I'm not about to share the details of what else was said and done, it's not my place.

    I'm here making a point about the way these examinations and the apathy towards them more generally.
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    if a woman thinks she was sexually assaulted then she was. whether it is a stranger in a dark alley or a doctor in a clinic. she should report the assault to the police.
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    (Original post by randdom)
    I am very sorry to hear about how your friend felt after her speculum examination. It is an intimate examination which can leave you feeling vulnerable and your friend clearly didn't feel that the examination was explained to her clearly enough. If she had her concerned then reporting it was definitely the right thing to do. However I would like to point out the informed consent is required for all examinations and if an examination is performed without consent it is referred to as assault. As a doctor I disagree with your statement that we do what we think that we need to do ignoring our patients wishes. My role is to advice my patients of their options and then it is their decision. Do my patients sometimes make decisions that I think are the wrong ones? Yes they do but that is their right and all I can do is to inform them of the options and try to help them make the correct decision for them whatever that might be.

    However while an intimate and sometimes uncomfortable procedure smear tests do save lives so I think it is important to present a balanced view of them. In the last few years I have had a smear test. It was performed by the practice nurse. I was fully informed of what to expect before it was done and I was also treated with dignity and care and given the privacy to undress and prepare behind a curtain before she came in. The smear test itself was slightly uncomfortable but not painful and lasted less than a minute. I have also had a number of internal and speculum examinations during my pregnancy and labour with my son 7 months ago. Again all of these were performed with care and respect.I have had intimate examinations from both male and female practitioners (doctors, the practice nurse and midwives) and I can't say that any of them performed in anything but a professional way.

    Smear tests are an effective way of detecting early signs of cell change which can lead to cervical cancer. Because of their introduction into our healthcare system the number of both young and older women who are dying of cervical cancer has dropped dramatically. The following quote is from an article on patient.co.uk which though written for professionals is useful for those wanting to know more about the rationale behind screening.

    "Incidence of cervical cancer in the UK fell by 43% between 1987-89 and 1997-99, apparently attributable to the screening programme introduced in the late 1980s.Three-yearly screening up to 39 years of age prevents 41% of cancers. Five-yearly screening between 40 and 54 years of age prevents 63% of cancers. It has also been shown that the cervical screening programme is associated with improved rate of cure of invasive cervical cancer." Source

    So there is a lot of evidence that smear tests are effective at preventing cervical cancer. There currently isn't a non-invasive method of screening if there was I am sure that the NHS would be looking into whether it was a viable option to introduce it. The way that we screen for risk of cervical cancer will change a lot over the next decade with the introduction of the HPV vaccine and also the introduction of screening for HPV in smear samples. However we aren't there yet and I think it is important that we continue to encourage not just young women but all women within screening age to attend for them. I do agree with you that it is important to look for the reasons that women might not be attending and try to provide them with the information that they need to make an informed choice. This process is starting already as the information leaflet that I received with my letter about my smear test told me the rationale for doing it and also explained the procedure and what would happen with the results very well.

    I think that the campaign that you linked to is trying to encourage women to learn more about smear tests which is a positive thing. They are trying to use social media to help raise awareness and are slightly jumping on the ice bucket challenge and the no make up selfie idea. It is also not that dissimilar to the "got milk" campaign that has run in america. I don't see anything inherently wrong with it, but it isn't something that would personally appeal to me.
    This is great, you sounds like a great clinician, and I am pleased that you were treated with dignity, unlike my friend. Unfortunately, this is not the case for all clinicians, and moreover, a girls/ woman's experience of healthcare varies, according to age, race, class etc. Whilst I would agree with you that carrying out such an examination without informed consent is assault, this has not been the case in my friend's instance. I am not certain of why so many responses take issue with this, especially when they know so little about what happened.

    I disagree. I also know that the usefulness of screening increases with the number of people that do it, similarly to breast cancer screening- it may not be accurate for each individual that undergoes screening, but more people being screened increases the chances of abnormalities being detected overall.

    To address both the point campaigns and the examination itself, I don't agree with the idea ends justify means, I really think we need to keep the end in mind when we try to achieve it. So these campaigns might mean well, but that's not enough, they need to be properly thought out, for the sake of our health and wellbeing. It's good for you therefore you should do it is just not convincing, and slightly authoritarian.
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    ''Whilst I would agree with you that carrying out such an examination without informed consent is assault, this has not been the case in my friend's instance.''

    To clarify, the health providers concerned do not share this view, which suggests it's a cultural issue, for the health community, in the U.K. at least.
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    (Original post by Anonymous)
    This is great, you sounds like a great clinician, and I am pleased that you were treated with dignity, unlike my friend. Unfortunately, this is not the case for all clinicians, and moreover, a girls/ woman's experience of healthcare varies, according to age, race, class etc. Whilst I would agree with you that carrying out such an examination without informed consent is assault, this has not been the case in my friend's instance. I am not certain of why so many responses take issue with this, especially when they know so little about what happened.

    I disagree. I also know that the usefulness of screening increases with the number of people that do it, similarly to breast cancer screening- it may not be accurate for each individual that undergoes screening, but more people being screened increases the chances of abnormalities being detected overall.

    To address both the point campaigns and the examination itself, I don't agree with the idea ends justify means, I really think we need to keep the end in mind when we try to achieve it. So these campaigns might mean well, but that's not enough, they need to be properly thought out, for the sake of our health and wellbeing. It's good for you therefore you should do it is just not convincing, and slightly authoritarian.
    I can't speak for others, but to me your repeated use of the word 'rape' to describe something entirely non-sexual (within the limits of what you've stated) is actually really offensive. :sadnod: Rape and sexual assault are awful, emotive issues, and they should not be used to sensationalise something which to all appearances has no sexual context.
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    (Original post by Anonymous)
    This is great, you sounds like a great clinician, and I am pleased that you were treated with dignity, unlike my friend. Unfortunately, this is not the case for all clinicians, and moreover, a girls/ woman's experience of healthcare varies, according to age, race, class etc. Whilst I would agree with you that carrying out such an examination without informed consent is assault, this has not been the case in my friend's instance. I am not certain of why so many responses take issue with this, especially when they know so little about what happened.
    I agree that in principle performing an examination without consent is assault. However without being privy to all the details of your friends case it would be unprofessional for me to comment on her case specifically.

    I disagree. I also know that the usefulness of screening increases with the number of people that do it, similarly to breast cancer screening- it may not be accurate for each individual that undergoes screening, but more people being screened increases the chances of abnormalities being detected overall.
    While it is true that in any national screening campaign there were will those for who despite the screening are missed and those who have a positive screening result who go on to have further investigations which find that it was a false positive. However the number of false positive results when looking for abnormal cells in a sample from a smear compared is much lower than for the breast screening program where you are looking for unusual appearances in a mammogram. It is not 100% when it comes to picking things up but it is actually one of our more reliable cancer screening programs. This should be something that is communicated to women before the smear test and is definitely mentioned in the literature that I got with my letter.

    To address both the point campaigns and the examination itself, I don't agree with the idea ends justify means, I really think we need to keep the end in mind when we try to achieve it. So these campaigns might mean well, but that's not enough, they need to be properly thought out, for the sake of our health and wellbeing. It's good for you therefore you should do it is just not convincing, and slightly authoritarian.
    I am slightly unclear as to whether you feel that we shouldn't be doing smear tests as screening at all or whether you feel that there is an issue with the smear test program we just need to do more to make sure that women have all the information that they need so they can decide if they want to have the test or not?

    While I personally don't feel that the smear test campaign that you have linked to is particularly harmful I can see why you and possibly others might feel that the imagery is inappropriate. I don't know if it would be worth emailing the charity with the concerns that you have as they might not have considered the possible interpretation of the image of the smeared lipstick?
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    (Original post by Anonymous)
    Hi,

    Re read my response to the above post. You do not know the details of her appointment, so your opinion on whether or not it is sexual assault is invalid. I'm not about to share the details of what else was said and done, it's not my place.

    I'm here making a point about the way these examinations and the apathy towards them more generally.
    OK, but unless he actually had sex with her, legally it wasn't rape

    I'm telling you factually how the law defines rape and sexual assault, not giving my opinion whether it was or not...

    As to the apathy... or rather resistance to getting these examinations done... I think its because as a society, we have and create around ourselves so many fears and insecurities around our bodies, that the idea of an intimate physical examination is very offputting to a lot of people... add that to to "it won't happen to me" mentality... its not that people don't realise that cervical screening is important, just like people who refuse to see a doctor until they feel like they're dying don't understand that they probably should, its just some peoples mentality around both seeing doctors and showing their bodies to people, even medical professionals for good reasons.

    What might actually help is challenging the society of shame.
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    (Original post by the bear)
    if a woman thinks she was sexually assaulted then she was. whether it is a stranger in a dark alley or a doctor in a clinic. she should report the assault to the police.
    Incorrect.

    Sexual Offences Act 2003 42.1.3

    Sexual Assault:

    (1)A person (A) commits an offence if—
    (a)he intentionally touches another person (B),
    (b)the touching is sexual,
    (c)B does not consent to the touching, and
    (d)A does not reasonably believe that B consents.
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    I just want to share my recent experience to further show that what has happened to your friend is an abnormality and definitely not what happens in the majority of cases.

    I have had issues with pain when using tampons since the age of around 15/16 which then went on to be pain during intercourse once I was sexually active. I have been to see the doctor about this previously and nothing was done about it. So, when it came to having my first smear done last August, I was really apprehensive. This was discussed with my GP surgery and a longer appointment was booked for me so the nurse had more time to do it. When it came to having the smear, I again suffered the pain I normally experience down below. The nurse was aware of this and tried everything she could to do the smear without causing me pain, but she unfortunately couldn't do it. I have since seen the GP and been referred on to the gynaecologist at the hospital.

    Although I experienced pain, this is not a usual experience. It is due to other medical issues that have now been picked up. All the people I have seen were really patient, answered all my questions, showed me what "instruments" they were going to use, and talked me through everything that happened.

    I think people are put off having their smear done because they think it is going to hurt and aren't really sure what is going to happen. This may be through lack of education regarding the process, and also bad word of mouth from friends and family. I am not sure if this is nationwide, but I certainly received quite a few letters from the local health service reminding me to come in for a smear, and each letter was accompanied by a great leaflet explaining everything. I really don't think the process is "rapey" - what happened to your friend is obviously horrible for her, but that doesn't sound normal for this procedure.
 
 
 
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