I talk to a lot of women about some not-so-talked-about subjects. We talk about their bodies, doctor's appointments, procedures, hormones, diagnoses, sex, pregnancy, birth, parenting. There's no topic off limits.
So it's probably no surprise that, "when was your last Pap smear?" is one of the first questions I ask my patients. Unfortunately, I find there's a ton of confusion among women about Pap smears and why they are so important.
This breaks my heart because I see it as part of a larger epidemic of misinformation about women's health, an epidemic which we must eradicate by decimating proper health education.
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) via a quick swab. This 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.
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 or treatment for an STI, may opt for well women exams 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 have access to an extensive well women exam every year, but they end up skipping the standard Pap smears along with them. Even though Pap smears are only recommended every 3 years, they are still important preventative care, no excuses!
With that said, here are the 7 most common myths I hear about Pap smears, and why none of them are good enough reasons to skip an overdue exam.
I don't want one because it will hurt
The Pap smear procedure may be uncomfortable, but should not be painful. 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.
If you have a smaller and/or tighter vagina than most women (signs might include difficulty using regular sized tampons or difficulty having penetrative vaginal sex) it may be more uncomfortable or yes, even a bit painful, but requesting a child-sized speculum may make all the difference.
I don't want one because it will show something scary
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.
I don't need one because..I've never had penetrative vaginal sex
Penetrative vaginal sex isn't the only way HPV is contracted, it can be transmitted via skin-to-skin contact in the genital area.
Even if you've never had sexual contract, it's recommended to start getting Pap smears at age 21.
I haven't been sexually active for a while
HPV is capable of laying dormant for years before becoming active in the body.
I've never been with anyone who has HPV
80% of sexually active adults will be infected by HPV at some points in their lives. Men are often asymptomatic, and because it is difficult to test for HPV in men they may become carriers, meaning they can transmit it to their partner(s) without ever knowing they have it.
Women may also have and transmit HPV without knowing they have it. Even if they are diligent about regular Pap smears, if they aren't screened for HPV specifically it is possible for a women to be an asymptomatic carrier as well.
I'm in a committed relationship
If you're assuming your partner is HPV-free then see the myth directly above about how common it is to have without knowing. Don't assume anyone is HPV negative until they have been tested specifically for it, yourself included.
It's worth noting that it's also possible for some women to never contract HPV from their HPV positive partner, some contract it immediately, while in others it may show up spontaneously after years of sexual contact.
Still, an HPV infection, even frequent HPV infections, may not result in abnormal cervical cell growth, but regular Pap smear screen for them just in case.
I can't get one because don't have a Gynecologist
I'll tell you from personal experience, you don't need a gynecologist to get regular Pap smears. They are actually a quite common procedure.
Real talk, here are some of the various places I've gotten Pap smears:
- The student health center on my college campus
- A hospital
- An urgent care center
- A naturopath's office
- From a midwife I worked with
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. If there's a Planned Parenthood near you that is another great resource, they even take insurance!
Of course you can also get your Pap smear from an OBGYN, Gynecologist, or Licensed Midwife. It's often offered as part of a full well women exam, and therefore a bit more expensive than from your general practice doctor, but worth it if you need a more extensive exam than a Pap smear alone.