It certainly doesn’t feel like rainbows and butterflies when you’re headed in for the dreaded Pap smear. As a Nurse Midwife for the last 4 years, I’ve realized that many women fear this important test without even knowing why it is done. Women should change the conversation from “Oh, that Pap test is horrible!” to “This is a necessary exam that can literally save lives.” It saddens me whenever I encounter a woman who has put off the test for 5, or even 10 years, because of their anxiety. I have even had women come in for the exam, panic, and then decline despite my thorough education on the subject. We have developed a culture surrounding this test that has kept women from truly taking care of themselves and being educated on their bodies. This fear is dangerous because it can prolong critical treatment. I want to equip you with the knowledge today to walk into your next Well Woman’s Exam with confidence that you are taking the right steps to ensure optimal health. This post will explain why the Pap smear is valuable, what exactly is HPV, and how often the test is required. I’m also going to break down the procedure and instruments utilized, as well as tips for making it a tolerable experience. Are you ready to learn more? Then keep reading!
What is a Pap Smear?
A Pap smear is a screening test for cervical cancer, which is why it’s dangerous to skip out on this test. The cervix is the lower part of your uterus that extends into the vagina. According to the American Cancer Society, approximately 13,000 new cases of cervical cancer will be diagnosed in the United States for 2019, and about 4,000 women will lose their lives to it. These numbers used to be significantly higher before the Pap smear became part of routine screening for women. Since the cancer is very slow growing, often occurring between the ages of 35-45, starting the screening at the recommended age of 21 can greatly reduce your risk. When a Pap smear is done, it collects cells from the cervix, and then the lab determines if there are changes in the cervix and/or HPV. If changes are found, you may require a biopsy and/or surgical procedure that can prevent these changes from developing into cancer. So, remember, a Pap smear is a screening test; it only looks for abnormalities, but is not used to actually diagnose cervical cancer. The Pap smear also is not a test for gonorrhea, chlamydia, trich, etc. If the lab sees it, it will report it, but it’s not specifically looking for these infections. Many of my patients assume this is included, but insurances will often not cover both on the same day over the age of 25. Please make sure you ask your provider specifically for STD screening if you desire it.
So What is HPV?
HPV stands for the Human papillomavirus. It is spread through sexual contact, including vaginal, anal, and oral sex. Often times, people with HPV will not know that they have it, so it is the most commonly spread sexual infection. Currently, 79 million Americans have HPV, and the CDC predicts that every person who is sexually active will be exposed at some point if they do not receive the vaccine. There are numerous strains of HPV and many will clear on their own or cause no problems to you. However, some can cause genital warts, and 13 that we know of can cause cervical cancer. When I receive a HPV positive result on a Pap smear I ordered, it is letting me know that person has one of the 13 high-risk types for cancer. I also like to know if someone has HPV 16, 18, or 45, which are the 3 riskiest types for cancer. HPV 16 gets a lot of attention for being responsible for most of the cancers diagnosed; however, HPV 45 is the most common cause of cervical cancer in Black women.
The first thing I’m asked when I tell a woman she has HPV is whether her current partner gave it to her. I will never know the answer to this question because you can be infected with HPV years before it finally shows up on a Pap smear. So, if your provider says you have HPV, please don’t go breaking up with your partner, as someone from 10 years ago could very well be the culprit. The best way to protect yourself is to utilize condoms and receive the HPV vaccine. The vaccine is recommended for girls and boys starting at age 11 until 26. If you are older than 26, talk to your provider about receiving Gardisil9, which has been expanded for individuals between 27 – 45 years of age and protects against 9 HPV strains that can cause cancer. The earlier you and/or your kids receive the vaccine, the better, as in an ideal world the vaccine should be given before exposure to HPV occurs.
Prevention is so important because there is no cure for HPV. Many of my patients are devastated once they hear this, especially since they didn’t even know HPV existed before being diagnosed. Depending on the strain and your immune system, your body may be able to fight off the virus naturally. Definitely being as healthy as possible with a nutritious diet, regular exercise, and daily multivitamin naturally strengthens your immune system. Age also plays a huge factor as women in their teens and early 20s have a better chance at ridding themselves of the virus. However, there is no pill to take to get rid of the virus, and there is no guarantee that your body will naturally fight it off. Bottom line: prevention is key!
How Often Do I Need a Pap?
Many of you will be relieved to know that the U.S. Preventive Services Task Force no longer recommends yearly Pap smears. This organization conducted extensive research to determine the best guidelines for cervical cancer screening. Please keep in mind these guidelines are only for women with normal test results and healthy immune systems (not with HIV, for example).
Under 21 years of age – Absolutely no Pap smear is needed, even if you are already sexually active. Research has found that even if women under 21 have cervical changes and/or HPV, their immune systems will natural fight off the virus. More damage was often being done with biopsies/surgeries than simply letting women in this age group naturally rid themselves of the infection.
21 – 29 years of age – Pap smear recommended every 3 years if normal. If you are not yet sexually active, can delay screening until you are.
30 – 65 years of age – Pap smear with HPV testing every 5 years if normal
65 years of age and older – If your Pap smears have been normal, you can stop cervical cancer screening at this time.
With these new guidelines, you do not have to experience a Pap smear yearly. However, you do still want to visit your provider yearly for a regular breast and pelvic exam. Also, if your Pap result is ever abnormal, please follow the recommendations of your provider, as it varies based on your individual result. I don’t know about you, but once I learned that I only had to do the test every 3 years if it was normal, this greatly relieved my anxiety. What are a few minutes of discomfort for 3 years of peace of mind?
What is the Test Like?
The Pap smear is often done at the end of your Well Woman exam. Once your provider has checked your upper body, including breasts, they will proceed with the pelvic part of the exam. Here are the steps below and tips for comfort.
1) Provider will pull out stirrups (foot rests) and have you come down to the edge of the table.
Tip: Keep your shoes on or wear socks, as sometimes the footrests can be cold. Make sure you scoot all the way down until you feel like you are halfway hanging off of the table. This will ensure that the speculum can be inserted fully without bumping into the table, decreasing the time for the exam.
2) After examining the external area of the vagina, the provider will insert a device called a speculum into the vagina and open it just enough to visualize the cervix.
Tip: You can request a plastic speculum, instead of metal, which is more comfortable and isn’t cold. If your provider uses metal speculums, you can ask if they have a warmer for the devices, such as my office does. Always ask that lubrication is used on the speculum; a small amount will not affect the sample. I also always request that my patients take a deep breath and when they exhale, I insert the speculum. This relaxes the muscles, and you want to continue to breathe and not tense up as tensing up causes pain and inhibits the provider from seeing well, which prolongs the exam.
3) Once the cervix is visualized, the provider will use small instruments called a spatula and brush to collect samples. The spatula collects cells from the outer part of the cervix, and the brush is inserted inside to collect samples there. Usually, when the brush is inserted, a cramping feel will occur.
Tip: You can ask your provider to talk you through the steps and explain what is next before doing it. I always do this and am mostly met with gratitude for providing that mental preparation. Some patients don’t want to know though and just want me to do it quickly without warning. So it’s entirely up to you. Don’t be afraid to ask if you want the step-by-step breakdown because you certainly deserve to know what is being done to your body.
4) After the samples are taken, the speculum is removed, and you usually feel a huge relief at this time. The last part is a bimanual exam where the provider inserts two fingers into the vagina and presses down on your lower abdomen to assess any cervical pain and abnormalities with the uterus and ovaries.
Tip: Again, lubrication should absolutely be used during this last part. If not done, speak up and request it. Remember to breathe and let your provider know if you have any pain or tenderness.
That’s it, the whole exam takes less than 5 minutes, but its important to stay relaxed. If you move away, close the legs, or tighten the muscles, it’s impossible to see and get a good sample, so the time will take longer. Also, if you are on your menses, it is best to reschedule the exam as blood can affect the sample. There’s nothing worse than having to return when the menses is off anyways to repeat the test.
I hope this guide has provided you with the knowledge and confidence you need to book your appointment and go without fear. Many women often tell me their anxiety about the test was much worse than the actual exam. Also, if your provider does not make you comfortable or take your requests seriously, please find a better one. Like I mentioned earlier, cervical cancer develops very slowly, so if you are staying on top of your regular screenings, early detection will save your life. Sadly, the cases when I have had a Pap result come back actually stating cancer (which is extremely rare) are when it was someone’s first Pap after 10 years. It may not be the most pleasant experience, but 5 minutes of discomfort is worth my life and yours. Please let me know if you have any additional questions. As always, be strong.
xoxo, Global Midwife
Disclaimer: This is not medical advice, only education. Always check with your healthcare provider.