Whether you’ve had a pap smear or not, chances are you have some questions about how they work or why you need them. I put together some info on commonly asked questions and concerns, from what is a PAP test to what exactly is being screened for during a PAP.
Nobody looks forward to cervical screenings but they’re important so I have some tips and tricks to help make the experience more comfortable.
So keep reading for all the ins and outs of pap smears!
What is a PAP Test?
A Papanicolaou smear/test (Pap smear) is a method of screening to detect potentially precancerous cells on the cervix. Globally, cervical cancer is the fourth most common type of cancer found in people with cervixes 1.
Since the introduction of the PAP smear in the 1940s, cervical cancer mortality rates in developed countries have diminished by 70% (lower income countries that do not have access to PAP testing correlates with higher mortality rates) 2. This is due to the fact that cervical cancer is the most treatable form of cancer when caught early. Cervical screenings save lives.
The age in which Pap smears begin, and the frequency depends on your geographical area’s guidelines; check with your local health care provider for more information for their screening recommendations.
How is a PAP Screening Done?
A PAP smear can be done in a doctor’s office, by a midwife, in a health clinic, or community health centre. Your healthcare provider will have you lay on an exam table, undressed from the waist down. An instrument called a speculum is then inserted into the vagina to expand the walls so the provider can access the cervix.
A small plastic brush is inserted into the vagina to brush the cervix and collect cells from the surface. That brush is then placed in a secure vial and sent to a laboratory to be examined for any abnormalities.
HPV and Cervical Screenings
The majority of cervical cancers are caused by a strain of Human Papillomavirus (HPV), which cause cells to mutate and change, becoming precancerous. HPV is actually very common; 80% of people will have an HPV strain in their lifetime, but often our bodies are asymptomatic and clear the virus on its own 3.
There are over 100 different strains of HPV, with only 14 strains linked to cancer, and two the cause of70% of cervical cancer cases (type 16 and 18) 4. The Gardasil vaccine protects against type 16 and 18, which has also helped to reduce mortality rates of cervical cancer since its introduction.
During a PAP screening, an HPV test is often administered at the same time. The HPV testing is the same as the cell swab, however, it looks specifically for HPV in addition to cell changes. When getting a PAP done, feel free to ask your provider if they are also testing specifically for HPV!
Tips to Make A PAP Smear More Comfortable
1. Book a Double Appointment
If you’re nervous about getting a cervical screening done, book a double appointment time. The first appointment the provider can walk you through what will happen, show you instruments, and make sure you understand everything fully. At the second appointment, you can have the exam done. Remember: you are in control and can always say stop or change your mind about having it done in the moment.
2. Ask for a Smaller Speculum
Speculums are not one size-fits-all. If you have a tight pelvic floor, vaginismus (pain with penetration), or are nervous about the discomfort of a speculum, ask your provider for a size small. If their office doesn’t have small speculums, ask them to order one in. You can also request plastic instead of a metal speculum!
3. Ask for a Warmed Speculum
Ask your provider to warm up the speculum with hot water first so that it is less of a shock to the system. Your provider should also use a lubricant to make it more comfortable, but you can double check to ensure they do.
4. Dress the Part
Wear a dress/skirt if you are comfortable with doing so. This way you just have to take off your underwear and shimmy up the skirt rather than taking off entire bottoms. It can help people feel less vulnerable. Wearing warm, thick socks can also help to make you feel more covered.
5. Insert the Speculum Yourself
Oftentimes providers have no issue allowing you to insert the speculum into your vagina yourself. This gives you the element of control and takes away any surprises. You can go as slow as you need.
6. Switch Positions
You don’t have to be flat on your back with legs in stirrups if you don’t want to. You can lay on your back with your knees bent on the table, or even lay on your side to have a PAP smear done.
7. Avoid Booking a PAP on Your Period
If you book a PAP on your period, the menstrual blood may fog the sample. This can skew an inconclusive result or a false-abnormal result, which would mean getting an exam done all over again
8. Pee Before Your Exam
A full bladder can place extra pressure on the vaginal walls during a PAP smear, which can make having a speculum inserted uncomfortable. Going to the bathroom before your appointment can help prevent this discomfort!
PAP Smears can feel anxiety-inducing; but at the end of the day the benefits far outweigh the cons. Remember that your healthcare provider is there to help make screenings a comfortable experience for you. Ask questions, take the time you need to prepare, and stay regular with when you’re due for your next screening.
About the Author
Victoria Alexander (she/they) is the face behind The Elephant in the Womb, a space centred around reproductive health education and menstruality. Victoria strives to further stand up for inclusive menstrual equity and actively works with local government to achieve LGBTQ+ centred period and pregnancy care options.