Vaginal health is perhaps the last health taboo. We’re happy to discuss our skincare routines and which workouts we’re trying. But even among those close to us, we don't want to ask questions like, 'what is a pap smear?' Understanding vaginal health is crucial, and talking with friends or health professionals about it shouldn't be a cause for embarrassment.
However, there’s far more to vaginal health than knowing how to do kegel exercises or investing in the best period products. Knowing the warning signs, risks, and what a ‘normal vagina’ should look like is a big part of staying healthy. Gynecological health concerns half the world’s population so knowing how to tell if something is wrong down there and who to talk to about it could save your life.
According to the Centers for Disease Control and Prevention, 34% of women in the US miss their pap smears every year. Even though cervical cancer is the fourth most common cancer in women worldwide, many women don’t realize how significantly these tests reduce the risk of cancer by catching cell changes early. To help you understand what a pap smear is and how to prepare for your next test, we spoke to the experts.
What is a pap smear and what does it test for?
Cervical cancer is primarily caused by a virus called HPV (Human Papillomavirus). A pap smear is a test that determines the presence of high-risk strains of HPV in the body and checks for cell irregularity on the cervix. To do this, your nurse or doctor will take a small sample of cells from your cervix and send them to a lab for testing.
Eighty percent of sexually active Americans have HPV and many aren’t even aware they have it. But, this is no cause for alarm. HPV is a common virus the human body is able to fight off and in many cases, has no effect on the carrier. Our immune systems are built to fight viruses such as this and there’s a chance you may never even come into contact with it.
However, having a pap smear allows you to screen for the presence of the virus and to see the cells of the cervix that give an early indication of changes that could lead to cervical cancer, Dr Enam Abood of The Harley Health Centre tells us.
"Presence of a high-risk subtype will change the frequency you need to have a cervical smear test and may result in a referral for a simple procedure to better identify abnormal cells in your cervix," Dr Abood adds.
The current guidelines from the American Cancer Society recommend you book your first pap smear three years after becoming sexually active, or by the age of 21, whichever comes first for you. In the UK, the NHS will send a letter to your home after you turn 25 inviting you to attend your first screening. This will take place at your local GP surgery or your closest hospital.
“HPV is passed on through body fluids so that means oral sex, transferring vaginal fluids on hands and fingers, or sharing sex toys,” says Dr Abood. “If you have not had penetrative sex, you are at low risk of cervical cancer but not at no risk.” This means whether you practice abstinence, or regularly have lots of sexual partners of any gender, attending your screening is just as necessary for good health.
Sexual orientation makes no difference when it comes to the transmission of viruses like HPV. The best way to avoid HPV is to use a condom or dental dam during sex. There's also an HPV vaccination given to young people in order to boost the body’s immunity to the virus. You can opt to have this vaccination as an adult, but it’s unlikely to be as impactful if you're already sexually active and over the age of 26.
How long does a pap smear take and who does it?
The pap smear procedure is a quick one, taking between five and ten minutes. It’s usually carried out by a practice nurse, doctor or dedicated OBGYN. It’s not possible to perform a pap smear yourself as this is not the same thing as an HPV test. If you’ve had an HPV self-testing kit delivered to your home, you’ll still need to attend your cervical screening carried out by a medical professional.
“It’s completely normal to feel apprehensive before your first smear test but honestly, it’s never as bad as you think it might be,” says GP and women’s health specialist, Dr Jane Leonard. “The person carrying out the screening will be a professional and will help to make you feel comfortable. You can ask them at any time to stop and if you need to, you can do breathing exercises to help relieve any anxiety during the procedure."
What to expect before a pap smear
Whether you've never had a pap smear, or you've had a screening multiple times, nerves are normal. It’s not every day you have a pelvic examination, but rest assured the person carrying it out will know exactly what they’re doing.
“Sometimes it’s easier to write down how you feel ahead of time and have this to hand to read to the nurse or doctor. You can also call the team at Ask Eve where our experts will be on hand to support you and listen confidentially to your individual questions or concerns," says gynecological cancer nurse specialist Tracie Miles of The Eve Appeal.
Don’t worry about shaving or waxing before your appointment, your doctor doesn’t care about your body hair. Just make sure you’ve washed your vagina and are clean and dry. Don’t douche before your appointment and avoid using any internal lubricants that could interfere with your test results. Your doctor needs to test your cervix in its natural state.
Before your procedure, you’ll have to discuss your medical history with your health professional. They’ll ask for your date of birth, whether you’re sexually active, whether you’ve had children and whether you’ve been experiencing any issues, such as a sore vagina, pelvic pain or spotting outside of your period. This discussion is totally confidential so is also a good time to ask any questions you might have.
You should discuss any points that may make your screening more difficult, such as sexual anxiety, PTSD, or vaginismus. Your doctor or nurse will talk through some options with you in order to make your experience more comfortable. You may be offered relaxants or be able to have a friend or family member accompany you.
You may also be asked if a medical student can observe your pap smear test taking place. This is totally your decision. If you’re not comfortable, and would only like your health practitioner and yourself to be present, you can make this clear. It can sometimes be more stressful having additional people in the room but some people find this distraction helpful if they're experiencing nerves. What you do is totally your choice.
What to expect during a pap smear
Before your pap smear, the medical professional will discuss the procedure with you and answer any questions you have. You'll then step into a private area, or they will leave the room, to allow you time to take off your underwear and lie or sit on an examination table. If you can, it's best to wear a skirt or dress to easily lift up for the screening.
You’ll be asked to lie on your back, bend your knees and let your legs relax wide. If this is uncomfortable, you may be offered the use of support stirrups to hold your legs up and apart comfortably. A medical professional will take a small sample of cells directly from your cervix and send them to a lab for testing. To take the sample, they will insert a speculum into the vagina canal to access the cervix.
A speculum is essentially a plastic clamp with a slim end shaped like the vaginal canal. The doctor will insert this into the vagina and slowly open it in order to look inside the vagina. A speculum isn’t designed to open further than the vagina will naturally allow, but should it feel uncomfortable, you can ask for a smaller size, to go slower or to take a break. If you happen to suffer from a condition like vaginismus or vulvodynia, you can discuss this with your practitioner ahead of the examination and explore your options.
“A speculum will be coated with a small amount of lubricant to make the procedure more comfortable,” says Dr Leonard. “A speculum is important because your healthcare provider needs to be able to see the cervix to make sure it's healthy and fully in view before the sample can be taken.” If you’re concerned the lubricant used won’t be one of the best lubes for you, bring your own if this will make you feel more comfortable.
Next, a small swab brush is used in circular sweep movements to take a sample of the cells from the cervix. This is going to feel strange as the cervix isn’t used to direct stimulation of this sort. It shouldn’t hurt but it will feel peculiar and may cause you to feel a little squeamish or perhaps a little achy following the procedure.
Sometimes the cervix can be hard to find. Depending on your body shape inside, it can sometimes be low down, tilted or tucked away. In order to see it better, your practitioner may ask you to raise your hips and they may tilt the speculum down and open it a little wider. Once your cervix is visible, you’ll feel the little brush and then the speculum will be closed and removed. You’ll then be able to privately take a moment and put your underwear and clothing back on.
“Having a cervical smear isn’t fun but it shouldn't be painful. Some women may have heard horror stories from friends or read them online. If your nurse or doctor is doing their job correctly, they will slowly talk you through the process and you should feel no more than a light scrubbing feeling in your cervix," says Dr Abood.
What to expect after a pap smear
Before you leave, ask when you can expect the results for your test and how you will receive them. Also, find out what you should do if you do not receive your results within four weeks.
After your smear, you’ll be able to go about your day as normal. Some people feel comfortable going straight back to work or picking up the kids from school. For others, the uncomfortable feeling is best offset by a couple of hours of self-care—be that a nap, going out for ice cream, meditation or a mani-pedi.
You may experience an aching sensation for a few hours after the procedure but nothing more. You might also experience some light spotting so wearing a pair of period pants (see our guide to the best period underwear for recommendations) might be useful. You can have sex after a smear test, and you can masturbate if you like. Some of the best sex toys are external only so opting for a session with a body wand vibrator may feel more comfortable than a toy that offers penetration.
How long do results from a pap smear take?
Receiving your results can take up to four weeks so during this time, try not to worry. If you do receive an abnormal result, this does NOT mean you have cancer. The next steps will be further scans and to remove any suspicious cells from your cervix in a simple procedure. If your results are abnormal, stay calm, remember this is what cervical screenings are for, and make a follow-up appointment. (see more about pap smear results and what they mean)
Your doctor will be able to advise you how often you should be screened, based on your age. Usually, you’ll need a screening every three years. However, some people are screened more or less frequently depending on their health status.
"It’s important to attend regular cervical screenings because cervical screening offers the greatest protection against cervical cancer, with smear tests preventing 75% of cases,” says women’s health expert, Dr Shirin Lakhani. If you're worried about your cervical health, HPV or are experiencing symptoms such as vaginal bleeding, pain during sex or spotting after sex, bleeding after you’ve been through menopause or unusual discharge, you can make an appointment to have a pap smear test.
The American Cancer Society estimates about 14,480 new cases of invasive cervical cancer will be diagnosed in 2021. Without a pap smear, these cases would go undiagnosed. Routine cervical smear testing is the best way to avoid cervical cancer and the earlier a concerning result is spotted, the easier it is to treat.
Emilie Lavinia is a writer, entrepreneur and women’s wellbeing advocate. She is passionate about femtech, closing the gender health gap and campaigning for education and transparency across mental, physical and sexual health.
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