TORONTO — Naturopathic clinics in Ontario offering Pap smears say their pampered approach to the medical procedure helps put patients at ease.
For approximately $100, the test offered by naturopaths starts with a discussion away from the examination table, during which the clinician also obtains consent.
"Patients can ask questions about contraception, pelvic pain, pain during sex and menstrual, reproductive health," said Colleen McQuarrie, naturopathic doctor and chair of the board of governors of the Canadian College of Naturopathic Medicine.
"We offer extra care and extra attention."
To the sound of soothing music, the client then spends 10 to 20 minutes meditating and relaxing, as they would at a spa.
The procedure starts: external examination, speculum exam for Pap smear analysis and, as necessary, an assessment of the uterus and ovaries.
Towards the end of the 45-minute session, the patient is offered a warm cup of tea, and possibly a hand massage or a vaginal steam.
But while naturopaths say their version of the Pap test caters to women who may not otherwise get screened, some cancer-care specialists say the service is unnecessary and could result in diagnostic delays.
"Is a Pap test really that awful?" asks Dr. Joan Murphy, who leads the cervical screening program at Cancer Care Ontario.
Naturopaths in some other provinces can legally provide Pap tests, including Alberta, Manitoba and B.C., but the concept of the "Pap spa" seems to be mostly developed in Ontario.
"It's extra, I would suggest it's excess. Vaginal steam? Though I am aware of no evidence that it is harmful, nor am I aware that there is any evidence of benefit," Murphy says.
A doctor's office or hospital also provides a thorough health assessment that goes beyond the Pap smear, she adds.
"With a primary care provider (physician/NP), patients get a bigger bang for their buck," says Murphy. "Other aspects of pelvic health will be addressed, like STIs and contraception.
"It's a one-stop-shop if there is someone with a broader scope of practice."
Those who find the Pap test uncomfortable can also speak to their family doctor about their concerns, says Dr. Susan McFaul, obstetrician-gynecologist and chair, PAP Campaign committee of the Federation of Medical Women of Canada.
"They can do meditation, have music in (a physician's) clinic too," McFaul says.
"Why pay if it's paid by OHIP?" she asks.
The issue of followup, especially if a test comes back as abnormal, is another concern for both McFaul and Murphy.
Although performing Pap tests is within the scope of practice of naturopaths, as per the 2015 Regulated Health Profession Act of the province of Ontario, they can't provide the followup diagnostic and treatment care.
"This discontinuity does not work in women's best interest," says Murphy
If a Pap is abnormal, the next step usually consists in a colposcopy, a diagnostic procedure done by obstetrician-gynecologists. Colposcopists require a referral from a family physician or a nurse practitioner to be paid.
While some naturopathic clinics have relationships with a family medicine practice, finding, waiting for and going to an appointment with a family doctor can add a step, and potential delays, into the diagnostic process.
If test results come back abnormal, the patient "must go see a (medical) doctor," says John Wellner, CEO of the Ontario Association of Naturopathic Doctors.
"A more formal referral process would help," he says, about the inability for naturopaths to refer directly to a colposcopist.
However, difficult access to a primary care provider is one of the reasons patients come to the naturopathic clinic in the first place.
"Our clients come either because they have no family doctor — young women who never had one — or had a bad experience with one," says McQuarrie.
The College of Naturopaths of Ontario, founded in 2015, said it has never received a complaint about Pap smears performed by naturopaths.
"Naturopaths don't try to sway patients away from OHIP," says Wellner, but some people refuse to get (the Pap) and alternatives are needed."
Marie-Claude Gregoire, The Canadian Press