Pap Smears | The Conversation Too Many of Us Avoid

No one wants to get a Pap smear. It’s not exactly a fun appointment, and for many, it comes with a little (or a lot) of anxiety. The thought of lying on an exam table, feet in stirrups, while a speculum makes its grand entrance is enough to make anyone cringe. But beyond the brief discomfort, there’s often a deeper fear: what if the results aren’t normal? What if this routine test, the one you scheduled just to check a box, comes back with bad news? It’s an unsettling thought, and for some, the fear of what might be found is enough to make them avoid the test altogether.

But here’s the thing: avoiding a Pap smear doesn’t make a problem go away, it only delays finding out about it. And when it comes to cervical health, early detection is everything. Most cervical abnormalities start as small, manageable changes that, if caught early, can be treated long before they become serious. A Pap smear also isn’t just about detecting cancer, it can pick up precancerous cells, HPV-related changes, infections, or even benign issues that might need a little attention. In many cases, an abnormal result doesn’t mean anything dangerous or scary, just that your doctor needs a closer look. But without regular screening, a minor issue that could be handled easily might turn into something much harder to treat. 

The truth is, getting a Pap smear might be nerve-wracking, but the real risk lies in not getting one at all.

It’s Okay to Be Nervous. Do It Anyway. 

I’ve had some terrible experiences with doctors, so many of us have, and it can be enough to put you off seeing a doctor when you need to, and even more likely to make you avoid any appointments that don’t feel necessary. Paps are vulnerable appointments, that’s undeniable, and being scared or nervous is normal. 

For survivors of sexual assault, even the briefest of medical exams, especially those involving pelvic exams like a Pap smear, can be deeply triggering. The combination of physical vulnerability, unfamiliar sensations, and medical authority figures can evoke white coat syndrome, a condition where anxiety causes increased heart rate, blood pressure spikes, or even panic responses in medical settings. For some survivors, the fear isn’t just about the test results, it’s about the process itself: being touched without full control, the sensation of the speculum, or even just the power dynamic between patient and provider can feel like too much to handle.

This anxiety is completely valid. Trauma lives in the body, and even if a person feels emotionally “fine” about their past, a medical setting can bring up unexpected reactions. Some people experience dissociation during exams, where they mentally “check out” as a protective mechanism. Others may avoid screenings altogether, knowing that the discomfort, both physical and emotional, feels unbearable. But skipping Pap smears due to past trauma can come at a cost, potentially delaying the detection of precancerous changes, HPV, or infections that could otherwise be treated early.

If medical anxiety or trauma makes the thought of Pap smears difficult, there are ways to make the experience more manageable. 

• Choose a trauma-informed provider
• Bring a support person
• Ask them for a step-by-step explanation of the processor before they start the exam
• Know that you have the control to stop the exam at any time

Some people also find grounding techniques, deep breathing, or using a mirror to watch the procedure helpful. The most important thing? You deserve compassionate care that prioritises your comfort. If a Pap smear feels impossible, it’s okay to have a conversation with your provider about alternatives or gradual steps to make it feel less overwhelming.

Why Pap Smears Are So Important

The Pap smear is named after Dr. George Papanicolaou, the Greek doctor who developed the test in the 1920s. He discovered that examining cervical cells under a microscope could help detect precancerous and cancerous changes long before symptoms appeared. His groundbreaking work revolutionized cervical cancer screening, drastically reducing death rates from the disease. The word “smear” comes from the original method of spreading collected cells onto a glass slide for examination. While modern techniques sometimes use liquid-based cytology (where cells are suspended in a vial instead of smeared on a slide), the name “Pap smear” has stuck.

A Pap smear might not be the most exciting appointment on your calendar, but it’s one of the most important when it comes to preventative healthcare. Cervical cancer is one of the most preventable cancers, and regular Pap tests are the key to catching abnormal cell changes before they turn into something more serious. Since early-stage cervical abnormalities don’t usually cause symptoms, you wouldn’t know anything was wrong without screening. A few minutes of mild discomfort during a Pap test could literally save your life.

Beyond just cancer prevention, Pap smears are an important checkpoint for your overall gynaecological health. They’re a great reason to check in with your doctor, ask questions about your cycle, your sexual health, or anything else that’s been on your mind. It’s easy to put off, especially if you’re busy or feeling fine, but prioritising regular screenings is a small act of self-care with a big impact. Your body does so much for you, why not return the favour by staying on top of routine care?

What to Expect During a Pap smear

Someone on Threads asked if I could describe/explain the whole process from end to end because they’d never had one, and they were anxious, not knowing what to expect. I’ve had many pelvic exams and Paps over the years and they have all followed the same procedure and the same instructions. It’s a brief, painless exam and there’s nothing about it that you need to fear. Let’s walk through the whole procedure, step by step!

Step 1: Booking the Appointment

• A Pap smear is typically scheduled as part of a routine cervical screening or gynaecological exam.
• It is recommended for individuals with a cervix, usually starting at around age 18 and continuing at regular intervals (e.g., every 1-3 years, or based on healthcare guidelines specific to your body. If you have a family history of cervical, uterine, or other reproductive cancers, your Pap schedule may be more regular than someone who does not have that genetic history).
• You should get your first Pap when you become sexually active, or by the time you’re 18, whichever comes first.
• If you have a condition like vaginismus, or you’ve had trouble with penetration being painful or difficult (not just during intercourse but with tampons, fingers, etc.) let your health team know in advance so they can approach your Pap with those limitations in mind.

Step 2: Preparation for the Test

• When you book the appointment you may be advised to avoid intercourse, douching, or using vaginal products (such as tampons or medications) for 24-48 hours before the test, as these can affect results.
• The test can be performed at a GP’s office, a gynaecology clinic, or a sexual health clinic (like Planned Parenthood, etc.)
• A doctor may provide the examination, but it’s not unusual for registered nurses to complete Pap smears.
• You can have a Pap if you’re on your period, but it’s not ideal as menstrual blood can interfere with the results and cause a re-test (which means repeating the Pap). If your period is light, or just finishing, it’s usually fine, but it’s better to plan the appointment for a menstruation-free day if you can. 
• Wear something comfy that you can change out of easily. You’ll be undressed from the waist down and personally, I always find exam rooms chilly so I usually wear socks and a hoodie or something warm on top. (Bonus, if you’re like me, being chilled increases my anxiety, so strategizing how to be as warm and comfortable as possible is worth planning ahead.)
• You’ll feel most comfortable and confident if you shower the day of your appointment but don’t worry about things like body hair, blemishes, etc. The doctor/nurse has seen it all and they won’t notice or care if you didn’t shave your legs or you have a pimple on your bum cheek.

Step 3: Entering the Exam Room

• You’ll be asked to undress from the waist down and they’ll give you a gown or something to drape over yourself. They will leave the room while you change and they will ask you to lie down on the examination table before they come back into the room.
• Don’t worry about where to put your feet, etc. The doctor/nurse will help you get into the right position. 
• They will take a seat on a stool at the end of the examination table by your feet. They will have you scoot yourself as close to the end of the table as you can be and help you put your feet up into the ‘stirrups’.
• You may have an idea about the stirrups and that your feet will be up high and you’ll be stuck in them, when in fact, most “stirrups” are just little cups to set your heels in that fold out from the sides of the exam table. 
• Let your hips relax and let your knees sort of fall open
• Take a few deep breaths
• Once you’re in position and the doctor or nurse starts the exam, it’s only a couple minutes until it’s over. You can do this!

Step 4: Inserting the Speculum

• The doctor or nurse will wear gloves, and they generally communicate verbally before touching you. They may do a brief, cursory examination of your vulva, to look for irregularities.
• The process of a Pap smear would be impossible without the help of a specific tool: the speculum
• This is a speculum:

• Speculums can be plastic or metal, and they are used to hold the walls of the vagina open to gain access to your cervix, which is where they take the test sample from.
• The doctor or nurse will lubricate the speculum before gently inserting it. If it is metal, they often run it under warm water so it isn’t shockingly cold.
• The speculum may feel slightly cool from the lube or slightly uncomfortable but should not be painful
• The hinged end of the speculum allows the open end to widen and then locks it in place. You may hear and feel the “click” as it ratchets open, but again, this should not be painful

Step 5: Collecting the Cervical Cells

• Once the speculum is in place and the cervix is located and accessible, the doctor or nurse will use a small, soft brush, tiny spatula, or a super-long Q-tip to gently scrape or swab the cervix, collecting a sample of cells.
• This part of the process may cause a brief sensation of pressure or mild discomfort but is very quick, literally seconds. 
• Cervixes are sensitive, so the swabbing may be strange and unpleasant, or make you feel a bit icky for a moment. It always gives me sort of a weird, shivery sensation, but honestly, it’s over as fast as it’s begun. 
• The sample cell collection shouldn’t be painful, it’s the same sort of swabbing that a doctor would do for strep throat, or something like that: brief and gentle.

Step 6: Removing the Speculum & Concluding the Exam

• Guess what? You did it! That’s all there is to it!
• The doctor or nurse will carefully remove the speculum and ensure that you’re comfortable and feeling okay.
• You might feel a bit woozy if you found the process overwhelming, that can happen, but you should be fine to sit up and get changed again. 
• They will leave you to change back into your clothes. You may want to wipe off any excess lubricant.

Step 7: Sending the Sample for Analysis

• The collected cells are sent to a laboratory for analysis, where they are examined under a microscope for any abnormalities, such as precancerous changes or HPV-related cell changes.

Step 8: Receiving Results

• Results typically take a few days to a couple of weeks.
• If results are normal, no immediate follow-up is needed other than routine screening. For most people that means an annual Pap. If you’ve had a few annual Paps with no abnormalities you may be able to go longer between appointments but it’s essential that you do go because regular screening is crucial for early detection of cervical cancer and other potential issues.
• If abnormal cells or HPV is detected, you may need further testing (such as a colposcopy or biopsy) to determine the next steps.
  

You Had an Abnormal Pap. Now What?

First off, don’t freak out. An abnormal Pap smear doesn’t necessarily mean cancer, it just means that some cell changes were found that need further evaluation. One common cause is HPV (human papillomavirus), especially high-risk strains (that can potentially lead to cervical cancer over time.) However, a Pap can also detect other non-cancerous issues, such as inflammation or infections (like bacterial vaginosis, yeast infections, or STIs such as trichomoniasis). Hormonal changes, particularly low oestrogen levels in postmenopausal people, can also cause cellular abnormalities. Sometimes, an abnormal result is due to benign cervical cell changes (like reactive or atypical cells), which can occur after recent intercourse, pregnancy, or even an intrauterine device (aka an IUD). In many cases, mild abnormalities resolve on their own, but follow-up testing, such as a repeat Pap, HPV test, or colposcopy, helps determine if further action is needed.

HPV (human papillomavirus)

HPV is a common sexually transmitted infection (STI) that affects nearly everyone at some point in their lives. There are over 100 strains of HPV, but only a handful are considered high-risk for causing cervical cancer and other genital cancers. Other strains cause things like genital warts, while most clear up on their own without causing any issues.

HPV & Pap Smears: How They’re Connected

• A Pap smear looks for abnormal cervical cells that could indicate precancerous changes.
• An HPV test (often done alongside a Pap) checks specifically for high-risk HPV strains that can lead to these abnormal cells.
• If HPV is detected but the Pap smear is normal, your doctor may recommend monitoring rather than immediate treatment since many HPV infections clear on their own.

Why HPV Testing Matters

Since HPV is the leading cause of cervical cancer, testing for it helps identify who may be at higher risk. Some screening guidelines now use HPV testing as the primary method, with Pap smears as a follow-up if needed. This is because persistent HPV infections, especially from strains 16 and 18, are responsible for about 70% of cervical cancers.

What Happens If You Test Positive for HPV?

• If high-risk HPV is found, but your Pap smear is normal, your doctor may recommend more frequent screenings to watch for any cell changes.
• If HPV is found and your Pap shows abnormal cells, further testing like a colposcopy (a closer examination of the cervix) may be needed. Colposcopy often includes a biopsy (a procedure where a small sample of tissue is taken from the body to be examined under a microscope). In the context of cervical health, a cervical biopsy is usually done if a Pap smear or HPV test shows abnormal results. This helps doctors determine if the abnormal cells are precancerous, cancerous, or benign.)
• In many cases, the body clears HPV naturally within a couple of years, especially in younger people.

The HPV vaccine (such as Gardasil 9) protects against the most dangerous strains, significantly reducing the risk of cervical cancer. It’s most effective when given before exposure to the virus, but even adults who are sexually active can benefit from it.

I Had An Abnormal Pap Result

This is the part where I say: please do as I say and not as I do, because I avoided my last Pap, and when I finally got it done, it came back abnormal.

Because of the ways in which it was abnormal, my doctor referred me for a colposcopy. And then I avoided that. Once I had the colposcopy, I was referred for a LEEP (Loop Electrosurgical Excision Procedure) procedure because I did, in fact, have precancerous cells, and I do, in fact, have HPV. 

The colposcopy was much more invasive, as was the LEEP, but you know what they are better than having? Cancer.

The LEEP results have not come back yet and I have a second colposcopy booked for 6 months from now to follow up. The LEEP surgeon was confident that it will be a successful treatment and my colposcopy will be clear. Fingers crossed. Could that have been prevented if I had not avoided my Pap? Likely. I have had intense medical anxiety, which I have worked on with my doctor, but the combination of anxiety, avoidance, and fear let me lose sight of the importance of medical maintenance. 

Being a Canadian*, with socialized healthcare, these appointments cost me nothing but the price of parking, and that is such a colossal privilege. Likewise, the level of care is so high, and even though we love to complain about wait times, we have some of the best medical care in the world. So many people have so little access, and at such great cost, I have come to feel that it’s almost unconscionable for me to allow my anxiety to take these privileges for granted. Now, when I’m afraid, I remember how many people suffer from lack of care, and how it serves no one to avoid it. 

Now I book the appointments. I take a deep breath, I push past the discomfort, and I show up: for myself, for my health, for the future version of me who will be grateful that I did. When it comes to cervical health, a few minutes of unease is nothing compared to the peace of mind that comes from knowing you’re taking care of yourself. Remember, you can do scary things, and you can do just about anything for just a few minutes. Book your Pap. Show up for your appointments. 

Because fear is fleeting, but knowledge is power. 

*It is important to note that this is my personal experience, as a Canadian, in the province of Alberta. Your doctor or gynecologist might do things differently, or your experiences may be different. Please do not take my explanation and description of the process as universal.