Another post in our series Nerdy Notes: Science in Story & Verse
I got my first pap smear (cervical cancer screening) the summer before senior year of college. I was 22 and facing a laundry list of health related tasks before leaving for the fall. The pap smear, at the top of my list, was the most anxiety-inducing. After weeks of pushing it off I finally scheduled it for a Tuesday morning before work. I prayed it would be cancelled or rescheduled. I had no such luck. So there I was at 8 am, feeling anxious and awkward as my primary care clinician asked me all the standard questions. Despite the awkwardness of the appointment, later, eating my lemon poppyseed muffin in the hospital parking lot (my reward for such bravery), I felt a little ridiculous for being so worried about it. I trusted my physician and she was really educational about the process and its importance.
When I returned to school in the fall, I was discussing the appointment with my friends. I was shocked to find out that I was the only one who had gotten a pap smear or was planning to. As the “mom-friend” of the group, I began pestering them about the importance of cervical cancer screening and why everyone with a cervix should have them routinely done. They had a lot of questions and concerns, all of which are very common. So, I am going to share them all with you in hopes that they ease any anxiety you or your loved ones may have.
What is a pap smear/Why is it important to get them?
A pap smear is a routine cancer screening that looks for cervical cancer. A routine exam is a preventative check-up designed to identify potential illness early. The pap smear looks for changes in the cells of the cervix caused by Human Papillomavirus (HPV). Human Papillomavirus is a common sexually transmitted virus that infects the skin and mucous membranes which can cause different types of noncancerous skin growth like warts, but can also lead to cervical (and other) cancers. The cervix is the lower, narrow end of the uterus that opens into the vagina.
(Source: Australian Government, Dept of Health, disability and Aging – pregnancybirth&baby)
The test, which is done within a clinician’s office or a clinic, uses a tool called a speculum, which holds the vaginal walls open so that the clinician can access the cervix. To collect a few cells from the cervix, they use a little tool that looks like a tiny broom, bottle brush or plastic spatula. The sample is then sent to a lab. It is suggested that people 21-65 get screened at regular intervals. There are different recommendations based on your age, context and clinic. Talk to your clinician about your specific recommendations. Another test you may hear about is the high-risk human papillomavirus (hrHPV) test. This test looks for the virus itself rather than changes in the cervix. In the latest set of recommendations, another option was added for people who may not have access or feel comfortable with internal exams. People may be able to collect their own sample for HPV testing every 3 years, using an FDA-approved kit. This option works best if the clinic has a good system for notifying people of their results and making sure patients get any follow-up care that is needed. For more details on screening recommendations, talk to your clinician.
What to expect physically at a pap smear:
The physical part of the pap smear is always the part that most people (myself included) are the most anxious about. It is uncomfortable to be that vulnerable even with a medical professional. When you go in for a pap smear they have you change into a hospital gown. Then you have to lean back with legs propped up. Before this, my primary care clinician showed me the tools she was going to use and walked me through the process. She applied lubrication to the speculum and inserted it. I would not describe the sensation as comfortable but I did not think that it hurt. The whole thing was over very quickly. She gave me a sanitary wipe to clean myself and wipe away any excess lubrication. She left so I could change back into my clothes for the rest of the appointment. If you have a history of sexual trauma or are otherwise fearful of this test, you can bring a support person. You may also speak with your clinician to see if a self-swab is possible.
What kind of questions do they ask/Why?
Before the physical part of the appointment, your clinician will ask you a bunch of questions about your health and sexual experiences. It is important to remember that good medical professionals should never judge their patients and that they always want you to be honest so that they can provide the best care. Your clinician does not care if you have no sexual experiences or if you have had multiple partners, but they are going to ask.
They are going to ask standard clinical appointment questions. These can include:
❓ Are you currently sexually active?
❓ How many partners do you have?
❓ Are you interacting with vulvas, penises or both?
❓ If you are having sex, what type: oral, vaginal, anal, etc?
❓ Do you drink?
❓ How often do you drink?
It is important to be honest in our answers in order to receive the best care.
Frequently asked questions by friends:
Do I really need to get a pap smear if I’m not sexually active?
Yes. It is important to have a cervical cancer screening even if you aren’t sexually active. A cervical cancer screening recommendation is based on age, not sexual activity.
Does it hurt?
This depends on the person and their pain scale. I did not find it painful, just uncomfortable.
What if I have my period?
It is okay to have a cervical exam done while menstruating.
Should I shave?
Do whatever makes you most comfortable. You do not need to shave for your appointment, but if it makes you feel more comfortable and relaxed, then it doesn’t hurt.
Is it awkward?
It is a little awkward. I am very comfortable with my primary care clinician, and I still felt a little self-conscious. It is important to remember that while these appointments may feel awkward for us, this is our clinician’s job and for them, it is totally normal.
How do I even schedule one?
To schedule a pap smear you can call your primary care clinician, midwife/gynecologist, or reproductive health nurse practitioner (NP)/ physician assistant (PA). You may have options through your area’s public health clinic, college health center or Planned Parenthood, as well.
While the idea of getting a pap smear can be intimidating and uncomfortable, it is really important for both personal and public health. It is one of those things that may feel super awkward, but at the end of the day it is a routine check-up well worth the discomfort for the peace of mind and safety. If you didn’t get the HPV vaccine as a child, check with your clinician to see if you are eligible now. The vaccine is a huge public health win, virtually eliminating cervical cancer deaths in women ages 20-24 in England over a five-year period.
Useful links
American Sexual Health Association – A Breakthrough—No New Deaths from Cervical Cancer in Young Women in England.
Pregnancy birth and baby – Anatomy of pregnancy and birth – cervix
Those Nerdy Girls – Who should get screened for cervical cancer? At what point is it unnecessary?
Planned Parenthood – Do I need a Pap test if i’m not sexually active?
Mayo Clinic – Pap smear
