Are you Terrified of Getting a Pap?

I speak with so many women about their uterine and cervical health, and it's no surprise that many are dreading - or even terrified of - their next Pap smear. It can be an uncomfortable procedure, and the topic of why we need them and how often seems to be riddled with misinformation and fear.

If you are among those who are terrified of getting their next Pap smear, I hope I can offer some tips that will make it a not-so-terrifying experience.

First things first, what is a Pap smear even? 

A Pap smear is a super common procedure which checks for abnormally growing or precancerous cells on the cervix (which is the opening of the uterus at the top of the vagina.) It involves inserting a speculum in the vagina, which looks sort of like long bird beak with a rounded tip (that doesn't sound comfortable, I know.) The speculum spreads the vagina open far enough to take a quick swab from the cervix. The whole thing usually takes about 2-3 minutes total and is recommended for women every 3 years starting at age 21, perhaps more frequently depending on health history.

90% of cervical cancer is due to Human papillomavirus (HPV,) which is the most common Sexually Transmitted Infection (STI.) Though HPV infection on its own is quite common and may clear up without showing significant symptoms, it can cause abnormal cell growth on the cervix. Often abnormal cell growth corrects itself, its only if left unchecked for long periods of time that abnormal cells may eventually develop into cancer.

Pap smears on their own do not check for HPV or other STIs, but they may be paired with STI screening if you request, or if it's part of your provider's standard annual exam, also called a well woman exam.

What's the difference between a Pap smear and a Well Women Exam? 

A "Well Women Exam" is usually provided by a gynecologist, OBGYN, or licensed midwife, and is more extensive than a Pap smear alone. It usually includes a Pap smear if needed, bimanual exam of the uterus and ovaries, STI screening, breast exam, and counseling.

Women with histories of fibroids, ovarian cysts, endometriosis, or those looking for well-informed counseling on specific topics such as birth control options, treatment for an STI, or family planning, may opt for WWEs because they are more thorough and screen for more issues than a Pap smear alone.

I find that many of my patients, however, don't feel they need, want, or can afford an extensive WWE, but they end up skipping the standard Pap smears along with them. Don't throw the baby out with the bath water! Even though Pap smears are only recommended every 3 years, they are still important preventative care.

So, why are you terrified? 

Let's get to the meat and potatoes of why you are so scared of getting a Pap.

Because: It will hurt 

This is the most common complaint I hear, and while the Pap smear procedure may be uncomfortable, it shouldn't really be painful for most women.

First of all, any time you are uncomfortable, anxious, or concerned about a medical procedure, advocate for yourself and let the medical professional know your concerns. For example, "I have had really painful Pap smears in the past and I'm concerned this will be painful as well, is there anything we can do to reduce my discomfort?" Make sure your healthcare provider hears you and addresses your concerns. If they are dismissive or don't make you feel comfortable for any reason you can request someone else do the procedure or tell them you've changed your mind. It's your body and your right.

A common reason Paps may cause discomfort, or even pain, is because some women have smaller and/or tighter vaginas than most (signs might include difficulty using tampons or inserting anything vaginally) which means the speculum is simply too large for comfort. Requesting a child-sized speculum may make all the difference.

It also may be possible for you to take some over the counter pain medications prior to the procedure to reduce soreness and inflammation - check with your doctor beforehand, if you are doing blood work or any other procedures that day they may not recommend it.

Because: It's might show some scary results 

Pap smears are meant to catch abnormal cell growth early, before they develop into anything dangerous. 9 out of 10 Pap smears come back normal, but even an abnormal result does not mean you have cervical cancer, just that there are abnormal cells present.

If it's your first abnormal result, your doctor may not recommend anything other than a follow up Pap smear to see if it resolves on its own. Even persistent abnormal cells, which may eventually become pre-cancerous, can be removed. Many of the procedures to remove abnormal cells from the cervix have minimal discomfort or side effects, especially when caught early.

Ask around to your friends to see if they've ever had abnormal Pap smears or procedures to remove abnormal cells - it's incredibly common and I bet you'll be surprised to find many of your friends have survived the dreaded abnormal results just fine.

Because: I don't have a Gynecologist 

I'll tell you from personal experience, you don't need a gynecologist to get regular Pap smears. Here are some of the various places you can get one:

• Planned Parenthood
• A free or reduced-cost health clinic
• Student health center
• A hospital
• An urgent care center
• A naturopath's office
• A midwife's practice/Birth center

If you are getting a general physical/check up from your doctor and you're due for a Pap smear, ask if they are able to do it there as part of your exam, if they can't they should be able to refer you somewhere that can.

Because: I can't afford it/I don't have insurance 

There are a lot of affordable options for Pap smears, especially if you have insurance the procedure should be covered. Even if you don't, they aren't that expensive to pay for out of pocket. Plus, paying for preventative care screening is almost always cheaper than waiting until something feels wrong and having to face much more expensive treatment options.