Pap Smears: Preparation & Empowerment

By: Riley Fortier, M.Ed., Sexuality Educator

CW: medical procedure, medical racism

What are Pap Smears?

Pap smears (short for Papanicolaou test), test for cervical cancer in people who have cervixes. The cervix is the lower part of the uterus in which semen enters to join with an egg, and which a baby first exits during childbirth. The way this tests for cervical cancer is by collecting a small sample of cells from your cervix with a tool called a spatula. (No, not the kitchen utensil).  

Pap smears are typically done in conjunction with a pelvic exam. Generally, doctors recommend getting Pap smears done regularly (usually every 3 years) starting at age 21, even if you are not sexually active. 

What To Expect

This test only takes a few minutes. You will get undressed from the waist down, lay back on a medical examination table, and the doctor will perform the test by first inserting a speculum inside your vagina to open/widen the vaginal opening so that the doctor can briefly look at the lining of your vagina. Then, the doctor will take a small spatula to scrape some tissue off of your cervix to use as the sample. Then the doctor closes the speculum and takes out the spatula. Finally, the cell sample will be sent to a lab to scan for any abnormal cells. 

Knowledge and Empowerment

Pap smears are preventative care and can alert doctors to potential abnormal cells that could be indicative of cancer. However, it is also important to note that the beginnings of gynecology are rooted in racism and medical abuse. (Read more about that HERE and HERE). That makes it even more important for folks getting Pap smears and needing gynecological healthcare to be both knowledgeable and empowered before, during, and after your visit.

It can’t be unsaid that positionalities like race, socioeconomic status, location, and ability are all factors in how patients are treated. For example, a white woman using the following tips might be received better than a Black trans man going in for the same care. With that being said, below are some ways to navigate your knowledge and power during a Pap smear. 

Tips and Tricks

Before Visit

• Before your appointment, ask if there is a doctor that patients recommend to make sure you get the best care that you can.
• Do something cozy or some other self-care activity the day before or the day of to get yourself in a better headspace. This could look like: taking a bath, treating yourself to a fancy coffee drink, talking with a loved one, etc.
• If you are worried about pain during your visit, you can take two ibuprofen about 30 minutes before you’re seen as a preventative. (This is especially helpful for folks with larger or partially-covered hymens, or for those who have pelvic pain).

During Visit 

• You can use your headphones/earbuds to listen to music, a podcast, a guided meditation, or have a friend on the line if that would be helpful for you.
• When the doctor comes in, you can ask for them to verbally go through the visit with you, what will happen, and for them to verbally tell you what they’re going to do before they do it. This way, there are no surprises and you can have at least a bit of preparedness.
• Let the doctor know that you’re nervous! A good doctor will likely change the way they approach the appointment if they know that you’re nervous. 
• There are different sized speculums! Not every office carries different sizes, so be sure to ask if they do and to use the smallest size speculum if pain related to your anatomy is a concern.
• Some speculums are metal and some are plastic. There are pros and cons to both! Ask your doctor what they use and if you have an option to choose.
• Ask to pause to take a few deep breaths before the speculum is inserted, turned, and a sample is taken. Having your muscles more relaxed can help there be less discomfort.
• If at any point you need to stop for any reason, you can ask to stop!
• DON’T FORGET TO BREATHE! Your brain needs oxygen to not feel faint, as well as trying to keep your muscles as relaxed as you can.

After Visit

• Do something that makes you feel good or something that is comforting to you. Snuggle up on the couch with your cat, watch your favorite show, take a bath, go for a walk, etc. 
• Many large practices use online surveys about your visit. Fill these out! Feedback is an important aspect for doctors to create change in the way they do things.
• If your doctor’s office doesn’t offer this and you’d like to provide feedback on your visit, you can call them and ask the best way for you to do that. 

Reminders

• Typically, Pap smears are every three years if results come back “negative.” Otherwise, they are typically recommended every year. Make sure to check in with your doctor to schedule in a way that’s best for you!
• Someone’s identities and positionality can impact the care they receive.
• Knowledge is power. Know what your choices and options are during your visit.