healthy bytes: the dreaded pap smear
I can picture you wrinkling your nose already. I promise this article won’t be gross or painful. Because in fact, pap smears aren’t gross or painful.
I decided to write this article after hearing a relatively unsurprising piece of data from a friend of mine. She’d recently asked around in her study group and found that six of the eight young women were yet to have their first pap smear. Reasons given included, ‘I always use condoms’, ‘I’m really sensitive’ and ‘my doctor’s an old guy’.
If you fit into the six out of eight young women category, here’s the deal with pap smears.
- All women over the age of 18 need to have pap smears.
- This includes virgins, lesbians and women who use condoms.
A pap smear tests for the early warning signs of the human papilloma virus and cervical cancer, by taking a sample of cells from your cervix and looking for any abnormalities. Contrary to popular myth, it doesn’t test for STDs – it detects signs of cancer. Which I bet would be more gross and painful than a pap smear procedure.
So, with that in mind, here are some tips I gathered from my own pap smear experience, and ‘women’s issues’ doctor experiences in general:
- It’s normal to feel shy about the pap smear procedure. The doctor (or nurse) will expect this if it’s your very first pap smear, and they’ll explain to you what they’re going to do so you know what’s going on. To make yourself more comfortable, I’d suggest wash just before you go, and wear underwear and clothes that are easy to remove.
- Remember that this is the doctor’s job to perform pap smears. They will have seen a whole lot of vaginas before so they will not be fussed about seeing yours.And believe me, they won’t care about what underwear you have on or your grooming habits either.
- The ‘I’m really sensitive’ excuse: Some women complain that pap smears hurt. From personal experience, they shouldn’t ‘hurt’ – it’s more of a slight tickle. I think the more relaxed you are, the less you’ll feel. My doctor used lubricant and a tiny spatula. (They have two sizes and the larger one is used for women who have had kids.) The whole procedure was over in less than thirty seconds.
- The ‘my doctor’s an old guy’ excuse: As I said, all doctors have seen vaginas before, regardless of their own gender. If you’re really worried about having a male doctor perform the procedure, ask at your local clinic for a female doctor or nurse. Otherwise, contact a women’s health centre or sexual health clinic, but make sure you check their bulkbilling options when you book in at a new centre. Being a young woman, now is a good time anyway to find a gynaecologist (male or female) you can visit for regular check-ups.
If you’re over 18 and haven’t had a pap smear yet, it’s time to get organised. Check out the government’s site for more information, or else post your questions below!
When I went for my first pap smear, I resented everyone who said it doesn’t hurt. Because my pap smears hurt, and they always have for me. My mum says its the same for her. It’s very uncomfortable (the procedure, not spreading my legs for a stranger) and takes a lot longer then 30 seconds for mine too. I’ve had a couple of doctors do it for me and it’s never been awkward, other then my low sitting cervix and all the moving around we have to do to get to it. I’ve had no problem requesting a female doctor either; medical staff are usually very helpful!
However I know that it’s once every two years and it’s really not that big of a deal, I make myself go in and get it done. Even though it takes longer than a few second for me, it’s still only a few minutes lying uncomfortably with my fists under my buttocks to prop up the areas needed; compared to not knowing if you could stop a common disease.
A few extra swabs could give you some info about your sexual health as well. Once I asked for that, and I don’t ever really need to get those tests again.
I always had a male doctor while growing up, but when I found out about PAP smears I immediately asked for a female doctor. GP’s and hospitals are always happy to help out if you are uncomfortable with anything. No one should be afraid to be uncomfortable, especially when it comes to your own body.
Always a cringe-worthy subject for women, but it’s definitely an important thing to get done for your health/sexual health. Glad you took the time to dish out the facts so that we could all learn a thing or two.
A lot of incorrect information here, no woman needs annual pap tests, it just produces huge numbers of false positives and provides no additional benefit over 5 yearly pap testing. Also, no country in the world has shown a benefit pap testing those under 30, but all have evidence of harm, young women produce the most false positives which can lead to excess biopsies and potentially harmful over-treatment. (that can damage the cervix and lead to cervical stenosis, infertility, cervical incompetence, premature babies, miscarriages, c-sections etc)
The Dutch and Finns have evidence based programs and offer 6-7 pap tests, 5 yearly from 30 to 60 and they both refer far fewer women for colposcopy/biopsy, fewer false positives, And the Finns have the lowest rates of cc in the world and the Dutch no more than Australia and probably less than the States. The Dutch are moving with the evidence and their new program is 5 hrHPV primary triage tests offered at ages 30,35,40,50 and 60 and only the roughly 5% who test positive will be offered a 5 yearly pap test. The vast majority are HPV negative and not currently at risk, they will be offered the remaining 4 HPV primary tests and there is also a self test HPV option, the Delphi Screener. (already in use in the Netherlands, Italy, Singapore and elsewhere) Those HPV negative and no longer sexually active or confidently monogamous can forget further testing. Sadly, HPV testing is not recommended for those under 30 as 40% would test positive, almost all are transient and harmless infections, by age 30 only 5% will be positive, these are the women who have a small chance of benefiting from a 5 yearly pap test. This program will save more lives, greatly reduce over-treatment and excess biopsies and unnecessary pap testing. It will also save scarce health resources. Women should demand smarter testing. As a low risk woman my risk of cc is near zero, the risks were too high for me and I have always declined pap testing.
HPV Today newsletter No 24 outlines the new Dutch program, registration is free. Also, the Health Council of the Netherlands website and the Delphi Bioscience website provides info on the Delphi Screener.
Thanks for the feedback, guys — I’m glad other doctors are just as diligent and caring as mine 🙂
Elizabeth, it’s interesting/refreshing to hear the differences in opinion across countries. I looked into the Netherlands’ health schemes and found that they also have no regular screenings for other kinds of cancer, or general check-ups — from this I gathered that the general approach to preventative medicine and treatment is very different to that in Australia.
Ruby, if you look at the evidence behind many checks and screening tests, you’ll see there is often no evidence of benefit and often risk. Eg…Routine breast and pelvic exams are aggressively pushed at American women, yet it has been known for many years that routine bimanual pelvic exams are of poor clinical value and carry risk, even unnecessary surgery. The routine breast exam…there is no evidence that it helps and it’s linked to excess biopsies.
If it doesn’t help, carries risk or the risks far outweigh the benefits, I know that it’s not something I’d consider…but we need balanced info to make that call, we shouldn’t have to fight through the misinformation and hype to get to the facts. Hopefully, over time we’ll see more respect for informed consent in women’s cancer screening. The review currently underway will hopefully make sweeping and long overdue change to our programs. Too many women are being worried and harmed…and most of it is avoidable.
http://www.australiandoctor.com.au/news/latest-news/cervical-screening-program-needs-urgent-review–ex
Dated 2008…the current review will conclude in 2014 and then the govt must act on the recommendations. The delay is inexcusable.
Women under 25 will be excluded, finally…and hopefully, we’ll see something similar to the Dutch program which would save more lives and better protect the vast majority of women who are hpv negative and not at risk…who’ve suffered terribly with excess biopsies and over-treatment.
Hi Ruby, I agree with Elizabeth. Women have been “told” they “should”, “must” etc have a pap smear every year/two years, or even more often. NO details about the extremely high rate of false positives and negatives are given, no information regarding the possible dangers of unnecessary follow on procedures like LEEP, colposcopy, biopsy is given. In some cases women are told if they do not submit to a pap smear they will not be getting birth control or other medication. This is insane, illegal, and outrageous in this day and age. To highlight my point, read all the literature that men are provided with regarding prostate testing, then read the brochure that women are given. One looks like it is written for an adult, with all possible outcomes, both good and bad, with having the screening and possible follow on treatment, the other reads like something written for a naughty school kid who may or may not have learning difficulties. As Elizabeth pointed out, the Finns and others have the lowest rate of cervical cancer in the world, and they test much less regularly than Australia, UK, USA & NZ. Professor Margaret Davy (Australian leading expert on cervical & other gynae cancers) wrote a paper admitting that no country in the world has had any proven benefits in testing women under 30. Sadly that paper was written for a medical paper, not for the general public. What is also not widely known is that doctors get a payment for each woman they screen (in Australia it’s called the PIP scheme, check it out by searching for PIP under Medicare). How on earth are we to expect ethical screening (OPTIONAL screening by the way, pap smears are an OPTIONAL screening tool) from doctors who have quotas to fill regarding this screening? Are doctors who are only 100 screenings short of their yearly quota of big bucks seriously going to forgo that money by not screening the next 100 women to come into their practice? How will we ever know? These payment incentives are not widely known about, but to me the very idea of payment incentives for an optional screening tool is highly unethical, particularly when almost no member of the public is aware of the practice.
There are also many, many cases of women being held hostage – no pap, no birth control pill (or other medication). All that is needed for a pill prescription is a blood pressure test and medical history. It’s appalling the amount of women who do not know this and are bullied by their doctor to have a pap or forgo the pill.
I am not against screening, but I am totally against lying by governments and the medical profession. The hrHPV test has been PROVEN to be much more accurate than Pap Smears, why in God’s name are women forced to put up with an outdated, unreliable screening tool, when there are cheaper, more accurate tests available right now? Instead of bullying women into having pap tests and lying to them (it doesn’t hurt, it’s all over in a jiffy, what’s wrong with you? If you are ‘adult’ enough to have sex you’re ‘adult’ enough to have a pap, do you WANT to get cervical cancer and die? – these are the usual responses from other women towards women and girls who are nervous about, or unwilling to have a pap smear), we need to support each other and start demanding a better way of screening for cervical cancer, and supporting women who can’t or won’t have a pap smear (due to rape, abuse, cultural or religious reasons, or just because she is not comfortable having a smear), and insist that we embrace things like the Delphi Screen which can be done at home, and the hrHPV test, which will weed out women who don’t even need a pap smear.
Why do virgins need pap smears? You need contact of the HPV virus with the cervix to cause cervical cancer.
The other thing is why do people always play down how a pap smear feels? I used to resent as a child being told that a needle was “just a little pin prick” when it was painful enough for me to cry. It made me mistrust doctors then and the playing down of how pap smears are like a tickle(!?) is just the same old tactics. It has never felt like that to me. It is uncomfortable, very uncomfortable. Why not just be honest? We’re adults now.
My mum’s breast cancer was discovered thanks to a routine breast exam. Better “excess biopsies” than excess breast cancer deaths, in my humble opinion.
Josephine, if women are given the pros and cons for non-evidence based exams and tests and want them, that’s their business, but it is a very different thing for a doctor to just do a routine exam without your informed consent or misrepresenting the situation by claiming there are proven benefits or no risks. My younger sister was given no information on pap testing and endured an unnecessary cone biopsy…I’m pleased your mother was helped, but there is no evidence of benefit, only excess biopsies and so women should understand that…for too long doctors have made decisions for women and accepted risk on our behalf. Prostate screening is handled very differently…risk information and uncertainty of benefit came out quickly and doctors were reminded to obtain informed, women are still waiting for the same respectful treatment.
Of course, doctors have a professional responsibility and would be expected to dissuade a teenager who wanted a mammogram….for example.
My gripe has always been the demands made for women to screen with no real or misleading information and zero respect for the individual and informed consent.
Virgins most certainly do not need pap smears. I think you’ll find the government guidelines state ’18 years or age or 2 years after sex, whichever is latest’ for first Pap smears.
In saying this, though ,as HPV is spread through genital to genital skin contact, it is potentially possible for a women to be infected with HPV without having had ‘intercourse’ (depending on where you draw the line, I guess). If it has been 2 years since a woman has had genital to genital skin contact, and she hasn’t had intercourse, it would be wise to chat to a doctor she trusts about Pap smears and her needs.
I’m also very concerned that some women are being bullied into having pap smears, as after all they are a voluntary screening service. If you find you are being bullied, I suggest you look for a new doctor who you trust (though it seems its getting harder and harder to find a good GP these days). The most important thing is that a woman feels safe throughout the whole procedure.
Additionally, while I whole heartedly agree that our program is very much out of date and needs to be updated, the truth of the matter is that it is a long process. DOHA has to be incredibly thorough with it’s research and spend a great deal of time consulting with a range of stakeholders in order to ensure that the new guidelines are accepted and understood both within the medical community and amongst the general public. While alternative forms of testing might be available now, if DOHA were to change their guidelines without proper consultation and due course and it turned out the decision was made prematurely and for whatever reason wasn’t beneficial, imagine the public backlash that would occur. Not to mention the difficult process of communicating the need for a change in screening interval and starting age to women in a way that provides as little confusion as possible. Unfortunately, this all takes time.
Be patient ladies, thing are set to change for the better soon, but in the mean time Pap smears remain the best way (that is widely available in Aust) to detect pre-cancerous changes to the cervix. Also, make sure you’re exorcising your power as a consumer and if what the doctor says doesn’t feel right, you’re well within your rights to leave and seek another service 🙂
Karen, I can’t agree with you, the delay is inexcusable and IMO, the stalling has been quite deliberate to enable research into the effects of Gardasil to be completed…they know young women (under 25) must be excluded from this testing when the program is finally changed, the evidence has been clear for many years, it’s high risk for no benefit. Those conducting this research are comparing the pap test records of young women with HPV vaccination records…this raises serious ethical questions IMO, we continue to pressure young women to have pap tests “knowing” they cannot benefit and that testing carries fairly high risk…we are screening without informed consent (and that’s all women, not just young women) and what about obtaining consent for the research project?
As a direct result of leaving the program unchanged, it means older women are still being urged to SERIOUSLY over-screen which means greater risk from false positives and over-treatment for NO additional benefit over 5 yearly screening from age 30. Over-treatment, especially cone biopsies and laser treatments can damage the cervix…so some of these women then have issues like premature babies, miscarriages, more c-sections etc
None of this is new, I simply don’t believe our doctors are so thick they need a decade longer to think about the options – we are known overseas for our excessive program, always excessive, but now more than a decade behind the evidence. Even the Americans have already wound back their recommendations, no longer testing those under 21 and increasing the screening interval and they must be the most excessive nation of earth when it comes to screening.
Any woman following our program is accepting a much higher risk of over-treatment for NO additional benefit over something like the Finnish program, 6-7 pap tests in total, 5 yearly from age 30 to 60.
I know some of our GPs are also concerned about the situation, they are caught between a rock and a hard place and with no real information around, it’s impossible for women to protect themselves from our program, an informed decision is difficult with no real information. Women in this country get misinformation, biased and incomplete information and are ordered into testing like ignorant sheep to achieve a govt-set target. This is not ethical cancer screening, IMO, men would never be treated this way. Risk information came out quickly for prostate screening and doctors were reminded to obtain informed consent. A double standard clearly exists…is our medical profession still very paternalistic?
I feel women have been abandoned by those who should be looking out for their health. The AMA and ANZCOG should have challenged this program years ago and forced change, instead they help do the dirty work, promoting this program. No one is warning women…
Population pap testing is now outdated anyway, we can identify the roughly 5% of women aged 30 and older who are HPV positive, they are the ONLY women who can benefit from a 5 yearly pap test. Why would a HPV negative woman who is not-at-risk accept a lifetime of unnecessary pap testing, excess biopsies and over-treatment?
I fear the influences that have kept excess in place for decades will prevail…we may end up with liquid pap testing for those 25 to 70 – more expensive and harmful excess when women under 30 don’t benefit from testing and 95% of those aged 30+ are not even at risk from this cancer, they’re HPV negative…they may “say” HPV primary testing is too expensive, but that’s hard to understand, if done properly it would identify the fairly small number actually at risk and spare HPV negative women (most women) from a lifetime of pointless pap testing and over-treatment. We’d also save more lives and IMO, it would save money in the long run. Of course, if excess is retained and we consider doing pap tests AND HPV tests on ALL women aged 25 to 70, that’s wasteful, unhelpful and leads to even more potentially harmful over-investigation. Also, by continuing to include those aged 25 to 29 they may rule out HPV primary testing as it’s not recommended for those under 30, but this is excess overriding what’s best for women, HPV primary triage testing for those aged 30+ enables them to obtain vitally important information: Am I HPV positive? If so, I have a small chance of benefiting from a 5 yearly pap test. If you’re HPV negative, you’re not currently at risk and should be offered another HPV primary test in 5 or 10 years (depending on your age) If you’re HPV negative and confidently monogamous or no longer sexually active, you can forget all further testing.
It’s also time the resistance to self-testing was broken down too, if we’re serious about reducing the rates of this rare cancer, then a reliable self-testing option must be included – the Delphi Screener is already being used in many countries.
I firmly believe an independent group needs to review our program, our program has never done what’s best for women. By hanging onto excess, we simply waste money, put most women through a lifetime of unnecessary invasive testing and keep excess biopsies and over-treatment rates high…now who benefits from that? Certainly not women…
Not sure if links are permitted, but if so, here are some references…
https://www.mja.com.au/journal/2002/176/11/cervical-screening-time-change-policy
http://www.abc.net.au/science/articles/2002/06/03/570221.htm (both articles are 10 years old now)
http://www.abc.net.au/science/articles/2009/07/29/2639772.htm
“The vaccine’s inventor, University of Queensland Professor Ian Frazer, says vaccination should have no impact on design of the screening program in the short to medium term as most at risk women have not been vaccinated or were vaccinated when they had the virus.
“Altering the current Australian screening program at the moment is probably unwise as it will be our best quality check on the efficacy of the vaccine program,” he says.
(taken from above article)
http://www.medicalobserver.com.au/news/no-delay-on-cervical-screening-review
(No delay – what a joke! The report is not due until mid 2014 and then women must wait for the Govt to make the changes – how many more women will be harmed over these years?)
http://www.australiandoctor.com.au/news/latest-news/cervical-screening-program-needs-urgent-review–ex
http://www.sciencedaily.com/releases/2011/10/111020163909.htm (women can self-test easily and reliably)
I’d urge all women to get informed and find a doctor prepared to put your health first. Our GPs receive target payments from the Govt, currently set at 70% of eligible patients, (PIP scheme and Financial Incentives legislation) so it’s important to find a doctor who’ll work with YOU.
As a low risk woman my risk of cc is near zero, I have always declined to test, the lifetime risk of referral for colposcopy/biopsy in this country (thanks to serious over-screening and including young women in the testing programs) is a whopping 77%…the risks were far too high for me. Shamefully, this information is not made available to women.
http://www.australiandoctor.com.au/news/latest-news/outgoing-boss-blasts-pap-screening
(2007 – 5 years ago now)
Ha. The first time I went to the gyn I was pregnant and 17. She just did the pap smear, no asking if it was okay, no explaining what was going on. She also did a rectal, again didn’t ask or explain. When I went again the next year and complained of HORRIBLE periods she just told me I had to wait until menopause. Oh, BTW the problems were being caused by thyroid disease. They’re okay giving you invasive, demeaning tests for an extremely rare cancer but won’t do a simple test to check for thyroid disease. And doctors are a lot of things, helpful isn’t one of them.