By the time you’re in your thirties and forties, Pap smears are just a necessary annoyance. You still kind of hate them, but you’ve probably endured more difficult things at the doctor’s office (ahem, childbirth). But nobody starts out that way: The first Pap smear is a milestone that is seriously unnerving.
Although nothing dangerous happens during a Pap smear, it can be socially awkward. “You should start getting Pap smears at age 21,” says Joy’El Ballard, a board-certified gynecologist in private practice with Annapolis OB/GYN. “No matter what age, you never really get used to it. But if you know what to expect, it can make the process a little bit easier to tolerate.”
Here are tips to make that first Pap smear a bit less intimidating.
1. You don’t need to reschedule if you have your period (usually).
Previously, doctors would recommend avoiding the week of your period when scheduling your Pap smear. This may not be necessary anymore, according to Rebecca Teng, MD, board-certified OB/GYN in Round Rock, TX. “The newer liquid-based Pap smear methods are less affected by the period than the older slide-based Pap smear method,” says Dr. Teng.
However, it’s a good idea to check with your clinic anyway, especially if your flow is a little heavier. “At times, blood can make it more difficult to interpret the Pap smear result and there may be a slightly higher risk of an unsatisfactory or difficult-to-interpret Pap,” says Dr. Teng.
Oh, and don’t be embarrassed: Menstruation is NBD to an OB/GYN. Says Dr. Ballard, “You will be more bothered by it than your doctor.”
2. Yes, you’re gonna be in an awkward position.
There’s no getting around this—sorry. The Pap smear “starts with you putting your heels in stirrups at the end of a table in your doctor’s office,” says Dr. Ballard. “You will be instructed to move your bottom to the edge of the table until you feel like you’re going to fall off it.”
Usually, you’ll have a sheet draped over your legs at first while you get into position. Your doctor will ask you to let your legs fall open to your sides, and yes, it will feel weird and vulnerable.
“As a gynecologist, I try to make this experience as comfortable as possible,” says Dr. Ballard, “so I encourage patients to talk to me about happy things to distract them from what I’m doing or wiggle their toes, which could be another distraction.”
3. You’ll feel “pressure,” but probably not pain.
The point of a Pap smear is to collect cells from the cervix, which sits at the top of the vagina. “Using a speculum, an instrument that helps visualize the cervix and inside of the vagina, a clinician can sample the cells of the cervix using a thin brush and spatula,” explains Dr. Teng.
The discomfort of a Pap smear mainly occurs from the speculum, which causes a sensation of pressure when it is inserted and then widened to gently push open the sides of the vagina. “While each person may differ in their level of discomfort with speculum exams, many patients describe Pap smears as mildly uncomfortable or crampy,” says Dr. Teng.
Once the speculum is inserted, your doctor uses the tiny brush to “scrape” off cells from the cervix (and some people barely feel this part). And that’s it: The speculum is gently removed, and you’re done.
After that, the cells are sent to a laboratory to be inspected by a pathologist, who is checking for “cellular changes” that may indicate a problem, such as squamous cell carcinoma or cervical cancer, according to Christine Noga Booth, MD, FCAP, board-certified pathologist, and chair of the College of American Pathologist's Cytopathology Committee. “In addition to cervical carcinoma and its precursors, organisms that cause cervical infections [such as HPV] and inflammation can also be seen on Pap test slides,” says Dr. Booth.
The newer HPV test could possibly replace the Pap smear one day. However, Dr. Booth notes that co-testing with both a Pap test and a HPV test can minimize the risk for false negative results, which could help save lives. “Women who undergo regular cervical cancer screening have greatly reduced mortality from cervical cancer,” says Dr. Booth.
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Pap and HPV tests. Washington, DC: Office on Women’s Health. (Accessed on at January 18, 2022 https://www.womenshealth.gov/a-z-topics/pap-hpv-tests.)
Well-woman visit. Washington, DC: Planned Parenthood. (Accessed on January 18, 2022 at https://www.plannedparenthood.org/learn/health-and-wellness/well-woman-visit.)
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