A Pap smear shouldn't be a traumatic experience. But I have seen many patients for whom has become a dreaded yearly ritual. And this may lead women to avoid a very important screening test.
Let's review why you need a pap in the first place. A pap is a screening test for cervical cancer. As a part of the pap, a small brush is used to collect cells from the lower part of the uterus, also known as the cervix. The cells are sent to the lab where they are examined under a microscope to see if there are any abnormal cells. 99% of cervical cancers are caused by cells being infected with human papilloma virus (HPV). HPV is extremely common and if you have every been sexually active, it's likely that you have been exposed to it.
There are many many types of HPV but only a few that are high risk for cervical cancer. So it's common for the lab to also test your cells for high risk strains of HPV.
Understand how often you actually need a pap smear. Even though we call it the annual exam, most women don't need a pap every year. That's because the the cellular changes that lead to cervical cancer occur slowly and the immune system will often clear HPV (the virus that causes cervical cancer) and abnormal cells on its own, especially in younger women. We often assume that more testing is better but research has shown that there are health risks to over-testing, like unnecessary biopsies. There are detailed Pap guidelines by age and health status that all practitioners should be aware of, so ask and discuss this with your doctor. I should note that there are other reasons to come annually for a check-up and that any new symptoms or problems that arise should be addressed as soon as possible.
Soothe the nervous system. Get as physically comfortable as possible while in the exam room. Breathe and stay present in your body. Consider taking herbs like passionflower, kava or California poppy before your appointment.
Get to the root of pain or discomfort. If the speculum insertion is painful, you may simply need a smaller size. This is particularly important in the post-menopausal years when there may be narrowing of the vaginal opening, thinning of tissue and dryness. If it is difficult or painful to insert even the smallest speculum due to atrophy, I will often prescribe a topical low dose hormonal or non-hormonal cream or suppositories to help support tissue health for a few weeks prior to an exam.
Acknowledge and address a history of trauma and/or abuse. Some women may need extra support like counseling, visualization, or Holistic Pelvic Care, which can help address the mental-emotional-spiritual issues involved with pelvic floor pain and trauma.
I had the HPV vaccine so I'm good, right? You will still need to get a pap smear even if you've had the vaccine. While in theory the vaccine will reduce or eliminate the risk of developing cervical cancer, there are still a number of young women who completed the vaccine series and still develop HPV infections and abnormal pap smears. HPV is a virus with many strains. Viruses change and mutate and some strains may become more 'virulent' or dangerous over time. So keep up with regular paps to protect yourself.