“Are Pap smears painful? Uncomfortable yes. Painful? Usually not.”
What hurts the most is our pride in having this intimate procedure.
No one said that being an adult would be easy. Even doctors are uncomfortable with the thought of gynecological procedures.
“Confession time.
I only had my first Pap smear at age 28. What a hypocrite, right? But please, this is a classic example of do as I say and not as I do, or rather, did.“
Let’s get into the reasons why. I’ll discuss in detail the following questions that my patients often need answering:
- What is a Pap smear?
- Why should I have it done?
- How is it performed?
- Do you have tips for the day?
- What should I expect after the procedure?
- When should I start screening?
- How often should I have a Pap smear?
- Where can I go to have a Pap smear?
What is a Pap smear?
A Pap smear is the original screening test for cancer of the cervix.
What is a cervix?
Some patients don’t know this and are too embarrassed to ask.
Your cervix is the mouth of or entrance to the womb. It protrudes into the top of the vagina. It looks like a doughnut or a cone.
Cells are taken from the cervix and studied under a microscope. The fancy medical term for this type of testing is cytology.
PAP is named after Dr. Papanicolaou. He was the clever doctor who discovered the method about 100 years ago. SMEAR because the cells are wiped onto a small piece of glass called a slide. This is then examined under a microscope. 1
These days, we don’t do ‘Pap smears’ often anymore, but rather a more advanced version of it. A new test called LBC (Liquid-Based Cytology).
As you can imagine, smearing or wiping is rough and might damage cells. In LBC, the sample of cervical cells goes into a liquid-filled bottle. This better preserves the cell structure for more accurate microscopic diagnosis.
“The term ‘Pap smear’, however, has stuck. We still use it broadly to mean ‘cervical cancer screening’.”
You might have also heard your friends mention HPV testing or read about it on social media. This is a newer screening weapon in our fight against cervical cancer. It can be done at the same time as, or instead of, your PAP. It is fast becoming the gold standard screening. Read my blog on HPV to find out more!
Why should I have it done?
Cancer of the cervix does not appear overnight. Before malignancy develops in healthy cells, there are first slow changes that happen.
Cancer can be prevented by checking for these changes in the cervix cells.
Laura Flaherty tells her story about how a Pap smear saved her life.
How is it performed? Are Pap smears painful?
Are Pap smears painful?
No, the thought of having your first gynae examination is scary, though.
Knowing what to expect may help to relax you.
“9 out of 10 of my patients report it not being as traumatic as they had expected.
Comments made are, “Is that it?” or, “Why did I get so worked up over nothing?”“
Using a speculum
The best way to visualize this instrument is that it resembles a duck’s beak.
- Your doctor needs a clear view of the cervix to take a good sample of cells for testing. Because it is at the top of the vaginal canal, the doctor inserts a speculum into the vagina to see the cervix.
The thought of this conjures up pain, but a medium-sized speculum is about the same size as 2-3 fingers.
- We use a lubricant to minimize discomfort.
- Some countries use stirrups. In South Africa, we do not. Lying flat on your back with your knees bent provides enough access.
- The speculum is inserted, opened gently, and moved around until we find the cervix. Some are easier to find than others. Some point forwards, some backward.
Do you have tips for the day?
- “Some patients are more relaxed having an intimate examination when they are freshly showered. If you fall into this category, it might help to book the day’s first appointment.
- Empty your bladder; this will make it more comfortable. Some doctors like to test your urine at your appointment. Ask the receptionist if they need a sample before you head to the ladies.
- Request a disposable plastic speculum. It is more comfortable! Metal is cold!
- Consciously relax your pelvis. Tense muscles will make the examination more difficult and uncomfortable.
- Avoid your screening around your period. Blood will make the cells more challenging to examine.”
What should I expect after the procedure?
- It is normal to have some spotting after the procedure. The brush is rough and scrapes the cervix.
- You might experience a slight tummy ache, similar to mild period pain, but not for long.
“If anything worries you 12 hours after your appointment, contact your doctor.”
When should I start screening?
Start at age 21. 2
Even if you are a virgin, this is recommended. 3
A blind smear can be done if the speculum examination is too uncomfortable. This means the doctor can insert the brush into the vagina without using a speculum. A sample of cells is taken without seeing where they are from. This is not ideal, but better than no sample at all.
How often should I have A PAP smear?
Good news, ladies, the days of the annual screening are over! 3
- If no abnormalities are found, every 3 to 5 years, depending on what screening test you have done.
- Cytology every 3 years, or Co-test/HPV every 5 years up to age 65 for negative tests.
- You can stop at age 65 if there have been no abnormal tests in the past 10 years.
There are exceptions to these recommendations which your doctor will consider.
Where can I go to have A PAP smear?
Your GP can be your first point of call if you have no other female problems or concerns. You do not have to see a gynecologist to have this test.
Nursing sisters at health clinics are also qualified to screen you, especially if cost is a factor.
In summary
- Cervical cancer is preventable because the changes take years to occur.
- Unlike your breasts which are easily accessible for self-examination, your cervix hides away, high up in your vagina. Without specialized screening tests, this makes detecting lumps, bumps, and changes impossible.
- Please read my blog on HPV (Human Papilloma Virus). You can request this test at the same time as your smear test.
- Prioritise testing today, make an appointment, and take control of your health.
References
- Tan SY, Tatsumura Y. George Papanicolaou (1883-1962): Discoverer of the Pap smear. Singapore Med J. 2015;56(10):586-587. doi:10.11622/smedj.2015155
- Cervical cancer screening. National Cancer Institute. (n.d.). Retrieved February 25, 2023, from https://www.cancer.gov/types/cervical/screening
- Mayo Foundation for Medical Education and Research. (2022, December 7). Pap smears recommended for regardless of sexual history. Mayo Clinic. Retrieved February 26, 2023, from https://www.mayoclinic.org/tests-procedures/pap-smear/expert-answers/pap-smear/faq-20057782
