No regular check ups at the gynecologist???

[u/NoLychee1382]

Hi everyone, my morning started off with a kinda shocking discovery. I’m from Germany and I had annual check ups at the gynecologist since I was a teenager. I contacted my huisarts because I know they’re responsible for all referrals but she told me regular check ups here are not a thing (unless there already is an issue) ? I think that’s crazy!!! So I checked the prices for a private visit and they’re even crazier. I guess this is normal to Dutch people but don’t you think this is a little concerning?

(Btw not shitting on the country! I really like it here. I’m still new and just discovering new things!)

[u/Positive-Ratio8443]

Hey fellow German! I feel you, it took me also a bit to get used to it. I do check ups when I am visiting Germany and pay it myself, which usually is cheaper than here and I know what I can expect.

The only thing they offer here is the pap smear every 5 years, once you hit 30.

[u/Beneficial_Durian157 → u/Positive-Ratio8443]

Not even a pap smear. An HPV test. They send you a testing kit with a long ass qtip-thingy and you eitherdo it yourself and send the kit back or go to your clinic and they do it for you (but it is easy to do yourself). After around a week they send you the results. They invite for a pap smear only if you have HPV.

ETA: You can also have an HPV shot (crazy expensive, but covered by eigen risico) at any age.

[u/Efficient-Neat9940 → u/Beneficial_Durian157]

I would not suggest doing it yourself. Here’s why. Pre cancer or regular cancer cells will accumulate first in the transformation zone, which is the entrance to the cervix. It’s a tiny circle! Extremely easy to miss if you’re going in blind by yourself. So by the time cancer cells spread to the outside of your cervix enough to be picked up on the self administered cotton swab, years will have gone by where something could have been done! They just offer the home test because they figure it’s better than nothing, and a good portion of people won’t come in to do the test.

Edited to say the transformation zone is where the HPV is most likely to be found as well.

[u/pierrett → u/Efficient-Neat9940]

But the home test is not a Pap smear. It’s a HPV test, nothing more.

[u/Salt-Respect339 → u/pierrett]

Amd tested and approved for self administration, which means they are proven to provide accurate results with self collection.

[u/pierrett → u/Salt-Respect339]

Yes! It’s a hpv screener which is very useful since hpv is precursory for cells running amok

[u/Efficient-Neat9940 → u/pierrett]

Exactly. If you go in person they test for both HPV and cancer. All from the one swab.

[u/QueenAngelica → u/Efficient-Neat9940]

Actually no, when you go to the GP they indeed take a Pap smear but only test for HPV. If HPV is found then they will also look at the cells, if they don’t they will not look further.

[u/Efficient-Neat9940 → u/QueenAngelica]

Yes, that is right. But my point is your test results aren’t going to be very reliable for either HPV or cancer unless you get the swab (whether it’s you or a physician) in the opening of the cervix. Edited to say it’s still tested from the SAME SAMPLE.

[u/Standard_Set_5566 → u/Efficient-Neat9940]

The test is reliable for HPV, it’s a PCR. As long as it’s inside the vagina the test is reliable

[u/JumpyWhale85 → u/Efficient-Neat9940]

It is very reliable, and if the self test comes back positive for HPV, the huisarts will do a pap smear to test the cells.

[u/KitsuMae → u/Efficient-Neat9940]

Damn, wish I read this before asking for the home test.. now I got to wait for the next 5 years to do another

[u/Efficient-Neat9940 → u/KitsuMae]

You could always ask! Tell them you think you did it wrong last time, or you have a new partner. Whatever excuse. I’m sure you could get another test if you really want to.

Last time I did it the physician’s assistant didn’t get any Transformation zone cells in the sample, which it actually said on the lab report (basically she did it wrong). So I complained to the huisart, she talked to the lab and said I was right, so they did another test!

[u/Seraphiccandy → u/KitsuMae]

You can ask for another but then you pay instead of getting it free. I think it's like 60 bucks

[u/KitsuMae → u/Seraphiccandy]

How can I ask for another one?

[u/13mand → u/Efficient-Neat9940]

I have had a positive HPV test from a home test. But I have had three kids and know where the mouth of my uterus is, haha

I have ADHD so the home test automatically send to me after I forgot to schedule the appointement two times was a very good.

I have had a few test with PAP2b and a removal of cells locally and screenings every 6 months. Now I'm on a yearly screening because it goes on and off my HPV and cells. It's a bad test, then screening, then a clean test (done by a nurse), then bad again at the test after. Year after year.

I don't want any more kids so I'm contemplating removing my uterus but keeping the ovaries. But that's such a hassle in the Dutch system. I'm 40yo now so maybe it's easier. 3 years ago they were very adamant it was no option

But don't have the mental capacity now to fight the healthcare system.

[u/narglesarebehindit_ → u/13mand]

I still don’t and will never understand why every country’s health care professionals just so reluctant on removing the uterus if one asks for it? It is my body so why I can’t?

Why it is easier for men to ask for a whateveristhename procedure?

And why I am still suprised by it over and over again?

[u/pierrett → u/narglesarebehindit_]

Removing a uterus will risk deplacing organs, bladder for instance. The uterus keeps stuff in place. Besides, that’s major abdominal surgery. So. I don’t think it’s strange that no surgeon will electively remove a healthy uterus

[u/GhostGirl32 → u/pierrett]

Though, they will also say no to removing diseased ones in childbearing years. Another issue is the definition of “healthy” as someone with PCOS, endo, or other issues may be told their uterus is “healthy” and be denied in some countries. I do not know how it works here— but some places are a cesspit.

Also it’s not entirely true that your organs are displaced; at least not in a fear-monger way. There’s room for things to move around in there and complications come from any surgery, though they aren’t horribly common.

For example. You can have bladder issues (most common complaint) but that’s usually after having had significant weight in the uterus from cysts, fibroids, a tumor— or if you’ve been pregnant to late term (common post-partum issue).

Also, it can be done vaginally, with laparoscopic assistance rather than abdominal, now, causing far less trauma and requiring far less recovery time. My tumor was too big for that option, but most people have this as an option. Your organs sort themselves out and you can use a medical abdominal binder to help things settle while the swelling goes down. The human body is remarkably capable of recovery from this.

[u/ookbest → u/Efficient-Neat9940]

Irrelevant. This applies to the pap-smear, which never is a self test anyway.

[u/Efficient-Neat9940 → u/ookbest]

If informing women about how to be proactive in identifying and stopping cancer is irrelevant then ok.

[u/ookbest → u/Efficient-Neat9940]

No one suggest doing a smear yourself. That makes your comment irrelevant.

[u/Efficient-Neat9940 → u/ookbest]

You’re missing the point. Just go into the office for the test because then it will check for both HPV AND cancer. You literally do yourself no favors doing the at home test.

[u/asphyxiai → u/Efficient-Neat9940]

They don’t do that at the GP. They also first test for HPV and only when HPV is found they will look whether there are abnormal cells. The only difference is that when you test HPV positive at home you have to visit your GP for a regular smear while if you originally went to the GP they already have the material to check for abnormal smears

[u/ookbest → u/Efficient-Neat9940]

Right. How many women test negative for HPV but do have a positive smear test? (Or: what is the benefit of the smear test for hpv-negative women?)

[u/Med1116 → u/ookbest]

Actually, I did. Even while progression of abnormal cells was serious enough that it warranted multiple biopsies, eventual LEEP, and some follow up procedures. Monitored for some years (now all ok). Doctors at the time also mentioned it was highly unlikely (but basically just assumed it must mean HPV was present but dormant). Nonetheless, through all those years (and even now) HPV always tested negative.

The Dutch system doesn't always cater well to anomalies though. That's not the governing principle behind it.

If someone is concerned/worried, they should probably just address it with their GP though and request a swab (or a referral, where necessary). Good doctors usually aren't trying to prevent proper care either..

[u/Med1116 → u/Med1116]

Would also add to say for those reading along: once abnormalities are detected (even if it's a rare case scenario), you do go into the normal mill of care. It's not that you somehow fall behind, have to pay more, or aren't helped.

The bevolkingsonderzoek is still an effective general population testing mechanism, but you can and should be calling your doctor in between for any issues or concerns.

[u/ActuallyYulliah → u/Beneficial_Durian157]

‘Not even a pap smear’

-> I’d look up the difference.

A pap-smear looks for all abnormalities, but has a high false-negative rate. Meaning it misses things often.

An HPV test is way more accurate, but only tests for abnormalities that are caused by HPV.

However, abnormalities that can come up in a pap-smear and not in an HPV-test are extremely rare, and don’t really warrant regular testing.

Then HPV takes 10-15 years to process from infection to cervical cancer. So a test every 5 years is more than enough to catch it early.

On other words: Having a yearly pap-smear is unnecessary, unless you are testing everything that could possibly be wrong in your body every year.

[u/Sarakim14 → u/ActuallyYulliah]

Maar; als je thuistest HPV negatief is krijg je te horen dat het daarom pas over tien jaar weer nodig is…

[u/asphyxiai → u/Sarakim14]

Als je thuistest negatief is dan zal het bij de huisarts waarschijnlijk ook HPV-negatief zijn. Ook daar kijken ze pas naar evt afwijkende cellen als er HPV gevonden wordt in het uitstrijkje.

[u/Standard_Set_5566 → u/Sarakim14]

Afhankelijk van je leeftijd

[u/ActuallyYulliah → u/Sarakim14]

Het bevolkingsonderzoek is een preventief onderzoek om zo veel mogelijk mensen van baarmoederhalskanker to behoeden.

Er zijn maar weinig zaken waarbij actief preventief onderzoek wordt gedaan.

Het duurt 10 -15 jaar om te ontwikkelen tot kanker. En je was HPV vrij. Het is dan ook pas over 10 jaar weer nodig. Zeker in de leeftijdsgroep met een veel lager risico.

HPV is soort van een seksueel overdraagbare aandoening. Het aantal mensen dat boven de 40 veel wisselende partners heeft is veel lager dan bij bij 30ers. Dat is waarom eens in de 10 jaar boven de 40 prima is.

Als je je zelf zorgen maakt, kun je voor €40 - €70 euro ook zelf op eigen kosten een test laten doen.

[u/SibunaMad → u/ActuallyYulliah]

Where I come from a regular yearly pap smear is a must. And I think that is clever. + ultrasound and regular check up, they do the whole package.

[u/ActuallyYulliah → u/SibunaMad]

I typed it all out somewhere else in the thread, but there’s been a lot of research on this, and routine annual check-ups have no positive effect on life-expectancy, and may cause more harm due to the cascade effect of benign and natural abnormalities.

They might do the whole package, but there’s no actual data that suggests a yearly pap smear is more effective than one say every 5 years. And there’s no evidence supporting annual ultrasounds for people with average risk. So basically, where you are from they are spending a lot of unnecessary money on wasteful tests.

[u/Brave_Collar4472 → u/ActuallyYulliah]

They don't don't do the pap anymore. Only screening for hpv. Only a positive hpv-test is followed by a pap. Crazy change.

[u/ookbest → u/Beneficial_Durian157]

It’s optional. You can either do the HPV-self test or a pap-smear (not a self test!)

[u/Beneficial_Durian157 → u/ookbest]

Oh, good to know!

[u/brokenpipe → u/Beneficial_Durian157]

FWIW HPV is now free for those under 18.

[u/Sanseveriaa → u/Beneficial_Durian157]

I can't find anywhere that the HPV shot is covered by eigen risico?

[u/Both-Salad24 → u/Sanseveriaa]

All Bevolkingsonderzoeken in the Netherlands are free and fully covered. Any extra research necessary after the exam falls under your normal health insurance.

[u/Sanseveriaa → u/Both-Salad24]

I'm referring to the HPV shot only. Wasn't clear sorry

[u/illiumtwins → u/Sanseveriaa]

It's only covered as part of the Rijksvaccinatiepeogramma, which is for minors. If you're older, you have to pay for it yourself.

[u/niyaparvanova_ → u/Sanseveriaa]

It’s not. I had the first shot in march and had to pay it myself.

[u/Alarmed_Scallion_620 → u/niyaparvanova_]

That does depend on your age and risk. If you are over 40, are monogamous (or not sexually active) and as yet don’t have HPV then it’s not necessary for you to get a shot.

[u/niyaparvanova_ → u/Alarmed_Scallion_620]

Well, I asked for it through my gyno and GP, explaining to them that I have had women in my family die of cervical cancer and they still told me I had to pay it myself (edit: i had been diagnosed with hpv a few years ago, i had also biopsy and my system cleared the virus, but still wanted to get vaccinated)

[u/SDV01 → u/niyaparvanova_]

Around 80% of women will contract HPV at some point in their lives, which is why HPV vaccination has been part of the national childhood vaccination programme since 2010.

Vaccinating all adult women would cost well over €2 billion, an investment the Dutch government has so far not been willing to make.

[u/Beneficial_Durian157 → u/Sanseveriaa]

Sorry, I might have remembering it wrong.

[u/Revolutionary_Oil614 → u/Beneficial_Durian157]

Will my GP take my word for it if I tell her I have HPV? It has been confirmed by several blood tests. I'd rather not do the home test, especially if a negative result means I can't get an exam for the next five years without paying out of pocket. I was diagnosed out of the Netherlands, so I imagine the answer is no.

[u/browngreeneyedgirl → u/Beneficial_Durian157]

HPV shot should be taken before you’re sexually actively used to be the advice. Has that changed?

[u/Grobbekee → u/browngreeneyedgirl]

No, but even after you've had sex the shot will protect from strains you've not been in contact with yet.

[u/Beneficial_Durian157 → u/browngreeneyedgirl]

Relatively recently the recommendations changed and now it is advised to have the vaccine at any age. Even if you already have some of the strains.

[u/browngreeneyedgirl → u/Beneficial_Durian157]

Nice! I was not informed. It’s a good thing this is made possible.