#PAP smear

[reasonsforhope]

Article

"Every year, over 350,000 women die from cervical cancer and another 660,000 are diagnosed. [Note: Plus trans men and other trans people with a cervix.] As a consequence, children are orphaned, families impoverished and communities diminished by the loss of mothers, wives, daughters and sisters. 

And yet, unlike most other cancers, almost all these cases and deaths can be averted. We have powerful vaccines that can prevent infection with the human papillomavirus (HPV) that causes cervical cancer; we have diagnostics to detect it early; and we have treatments for those it strikes. With these tools, cervical cancer can not only be stopped; it could become the first cancer to be eliminated. Some high-income countries are already close to elimination, meaning fewer than four cases per 100,000 women.

But in many low- and middle-income countries, these tools are still not available, which is why 94% of cervical cancer deaths occur in those countries. 

In 2018, WHO launched a global call to action to eliminate cervical cancer, which was followed in 2020 by the adoption by all 194 WHO Member States of a Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem. The strategy calls for countries to achieve three targets by 2030: 90% of girls fully immunised against HPV; 70% of women receiving timely screening; and 90% of those found with precancer or cancer accessing treatment.

These targets are not just aspirational, they are achievable, even in low- and middle-income countries.  Bhutan has already reached the targets, the first to do so in the South-East Asia region. 

Since introducing the HPV vaccine in 2011, Rwanda has reached vaccine coverage of 90%, and today announced its national goal to reach the 90-70-90 targets three years ahead of schedule, by 2027. Already, in two districts – Gicumbi and Karongi – Rwanda is meeting those goals. Nigeria, which introduced the HPV vaccine in October last year [2023], has already vaccinated 12.3 million girls.  

We have the tools and the opportunity to eliminate cervical cancer. 

Since WHO issued the global call to action in 2018, more than 60 countries have introduced the HPV vaccine into their immunisation programmes, bringing the total to 144 countries that are routinely protecting girls from cervical cancer in later life. With scientific advances, we can now prevent cervical cancer with just a single dose, which 60 countries are now doing.  

The largest provider of HPV vaccines to low- and middle-income countries is Gavi, the Vaccine Alliance, which plans to vaccinate 120 million children between now and 2030. But this plan requires that investments in health are sustained. We are also counting on manufacturers to confirm and honour their commitments to provide HPV vaccines to low- and middle-income countries in the coming years, to avoid the supply constraints that held back progress in the past.

But we cannot rely on vaccines alone. The impact of the rapid scale-up in vaccinating girls now will not be seen for decades, when they reach the adult years when cervical cancer typically appears. To save lives now, we must match the increase  in vaccination with increases in screening and treatment. 

Decades ago, as more women gained access to pap smears in developed countries, the mortality associated with cervical cancer dropped rapidly. Today, even better tests are available. Over 60 countries now include high-performance HPV tests as part of their screening programs. Women can even collect their own samples for HPV testing, removing more barriers to life-saving services. In Australia – which is on track to become one of the first countries in the world to achieve elimination – more than a quarter of all screening tests are now done this way...

Several countries are also investigating the use of artificial intelligence to enhance the accuracy of screening in resource-limited settings. When women are found with precancerous lesions, many are now treated with portable battery-powered devices, which can be operated in remote locations."

-via The Telegraph, November 18, 2024. Article written by Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO).

[so-i-did-this-thing]

Hi, so I'm not really sure how to ask this idk, it feels very personal and maybe tmi, and I guess it depends on one's level of bottom dysphoria, but basically, do you (or anyone else who wants to share) have any advice or anything with how to cope with having to go through a physical exam for bottom stuff/ a pap smear for the first time?

I'm asking this as someone who has and always has had severe bottom dysphoria to the point that I've never done anything with those parts and literally never even touched myself. I've just lived painfully aware that I have that stuff but simultaneously pretending as much as possible that I don't. So just the thought of "having to" get that done, being touched there by someone etc, makes me sick and gives me anxiety and I just full on do not want to do that. Ever. But apparently I have to if I'm ever gonna get a hysto, which I really really want.

So now I just feel like it's lose/lose. Either I have to let someone touch me in a way that just thinking about me makes me sick, or I can never get a part of transition that I've been wanting forever since I was kid and learned about my anatomy.

And I just.. mentally, emotionally, physically in every way just really don't know how to deal with that.

I guess it's not that big of a deal for people who don't have bottom dysphoria or not that much of it, and honestly sometimes I feel kinda alone (and almost guilty? Like it's wrong somehow?) in how extremely uncomfortable I am with bottom stuff compared to how I've seen other people be chill with it, but yeah.. idk what to do or how to cope with this.

Don't feel bad about feeling bad -- I may like my dick, but that hole gives me panic attacks and I'm not looking forward to my own exam coming up soon. I worry every time that I am going to kick someone in the face by accident. :/

A pelvic exam/pap is not required to begin HRT, but you will need one for most hystos. Plus, it's just good preventative care. Also, if you are young enough, get your HPV vaccine (a 2 shot series, iirc) to help prevent cervical cancer.

Things that have helped me during gyn exams:

Take the entire day off, if you can. Have a treat set up for after your appointment.

Go with a friend, if possible. They may not be able to be with you in the exam room, but they can at least drive you and wait for you.

Be firm that this is hard for you and anything they can do to make it easier will be helpful.

Put your shirt back on after the breast exam. I don't take "no" for an answer here. Having an extra bit of clothing on makes me feel better.

Ask for the "pediatric" speculum -- it's smaller and won't hurt as bad. Insist on it.

Have something you can grip to take your focus off below.

If they want to do a sonogram, refuse the transvaginal one. Do it the old fashioned way, which will require drinking a lot of water. They can deal.

Don't be embarrassed if your self-care afterwards requires crying, or similar. This is an exhausting thing to do, no matter how brave a face you put on in the exam room. I usually just crawl back into bed to sleep it off.

Above all, never take comments like "just man up" or whatever from the medical team. If that happens, be mean back, or simply get up, get dressed, and leave. Find someone else if you have to.

Scripts I have used. Workshop your own and practice them:

"This is my first time. I'm worried this will be a very uncomfortable exam physically and emotionally for me and I would appreciate anything you can do to make it easier. It helps me if you explain everything as we go."

"I do not have penetrative sex, so would like to try the smallest speculum lubed up best you can."

"I am going to put my shirt back on. It will help me be calmer for the rest of the exam."

If they are rude: "You are being unkind and I will walk out of here and find another provider if this attitude continues."

If they insist on a transvag sonogram: "I will only do an external sonogram. We can schedule it another day for me to prep, or give me time to drink the necessary water." (This is hard, btw -- it is enough water to make you vomit.)

Do whatever mental larping you need to do to get through it all. It's important to psych yourself up so you can control as much as possible. Remember, you can stop things whenever you want. If they are mean, all bets are off.

If you're like me, it will suck, but please try not to put it off. But getting through it means you can tackle anything else related to transition, should you go that route. Seriously, if you can do this, you are fucking golden. Take care. <3

(Additional stories/advice are welcome from folks, being trans masc not required!)

[angelnumber27]

If every club played solely crystal castles I would be a club grl but. They don’t

[imaginejolls]

so yesterday i got a fresh dose of gynaecological medical trauma (yay 🙃) & i had my cries about it & i'm feeling my feelings, but i just wanna ask the more experienced & knowledgeable uterus-havers how long i can expect to be ever so faintly spotting after a PAP smear

[ice-block]

Idk if anyone is interested but I thought I’d put it out there because the other day I was talking w my therapist and she said when people have a negative experience with something they’re WAY more likely to tell everyone they know and when they have a good or neutral experience they don’t think much of it SO I’d like to put something positive out there for anyone who might be in the position I was in.

So anyway here’s my experience getting my first pap smear, as someone with an INSANE amount of anxiety about it:

I try to keep some less than pleasant personal stuff off this blog but I’ve got a decently sized medical phobia, general mistrust of gynecology after reading too many horror stories, and some weirdness about gender/sexuality/body (???) I don’t entirely understand myself. I also understand that maintaining personal health is important even if it’s scary so when my doctor told me it was time to make an appointment with a gynecologist, I did it, then spent the next 3 weeks having nightmares, anxiety attacks, and experiencing a general sense of impending doom as the appointment approached.

Things my therapist and I talked about before hand included:

1.) save your stress for the future, if it goes good, great! If it goes poorly, you’re allowed to be stressed then . Don’t make yourself suffer unless you need to.

2.) know what accommodations you want and be prepared to ask for them confidently and clearly. I wanted the smallest speculum, a warning BEFORE any and all touching, and to be able to stop at any moment.

The appointment eventually did arrive and while I was still a ball of nerves I got myself there and obediently went through the steps of registering as a patient and remaining sane in the waiting room, I was called to the back (if you have a support person you want to bring with you you can but I went alone) and chatted with the nurse about health history etc, this pretty much resembled your standard doctors appointment, they take your heart rate, BP, etc. the nurse wrapped up and told me the doctor would be in in a minute, I should undress from the waist down, and showed me a cloth (which was basically a really big napkin) I could cover my lap with. I definitely went pale at this and if my high blood pressure didn’t tip her off she definitely knew I was internally freaking out. She offered to have the doctor come in first if that would make me more comfortable and I declined.

I was left alone to undress, it feels really weird to take off your pants in an office with fluorescent lighting, after a minute the doctor knocked then came in (there’s also a curtain in front of the door so nobody walking past can just see you pants-less) she was a very kind woman who asked me some questions about it being my first time, at this point I was prepared to say my demands but I was very shocked when she beat me to it! She outright offered the smallest speculum and said “I’m going to show you the tools, we’ll talk through the procedure, and we’ll decide if a Pap smear is something we want to do today” which made me instantly feel so much better. My other surprise was how SMALL the smallest speculum was! It was about the size of my pointer finger. If it had been larger I honestly don’t know if I could have done the procedure but once I realized it was tiny I knew it’d be ok. (Also side note: it feels really weird to talk with someone while pants-less and holding a big napkin over your crotch)

I was instructed to lay on the exam table, which was really low to the ground when I got on it then raised up like a dentists chair, the little foot holds popped out from underneath it and I was instructed to put my feet in the holds and scoot all the way to the edge, I kept looking at the doctor through this and was told that during the exam I would have to look up at the ceiling. She warned me before even the slightest touch (“I’m going to put my hand on your thigh now”) asked if I was ready, when I said yes she inserted the speculum, which felt weird but not painful, it didn’t even feel painful when it opened. Just strange. Then the doctor took a cell scraping which felt REALLY weird for a part of the body not used to that sensation at all. It felt scratchy and then for a brief second their was a bit of pain (I’d rate like a 3 out of 10) and I thought “if this lasts any longer I can’t do this” but it was really only a split second and the worst moment was also the end. The speculum was quickly removed making the Pap smear a total of like 30 seconds max. Then the doctor told me she would check my uterus and ovaries and (still maintaining consent and giving warning) inserted a finger and pressed with her other hand hard on my stomach, this didn’t hurt either and the pressure/rubbing on my stomach made it so I wasn’t thinking about her other hand at all! Then I was allowed to sit up again, close my legs, the doctor asked if I had any questions and I was out of there!

Anyway hopefully this can help someone out there I tried to include all the details I had wanted while doing frantic research before hand, if you’re in the same boat, you can do this!

[thescrumblingmidwife]

Hi! I know other people have sent similar asks before but I thought I'd send my own just to be sure. I can't fit more than a finger... up there. And even then its a tight fit. That's enough for me but I'm worried about if I go for a pap smear (I think that's what its called, I have a bad memory): something has to go up there right? Will it fit? What happens if it doesn't? Is it going to be a hassle to request a woman? How much do I need to "clean up"? No pressure to respond right away, I get that you're busy. I just wanna know what to expect. Thank you! 😊❤

Hi Anon!

How old are you? You don't need a pap smear until 21, and you don't need a pelvic exam at all before then unless you've got some kind of complaint or you want to get fitted for an IUD. If you are 21+ and have had zero sexual contact, you can discuss a modified schedule with your provider.

PELVIC EXAMS

Reminder - pelvic exam is when the doctor/midwife examines your pelvic area and vagina. This can include the use of a speculum or not, and be done for a number of reasons. Pap smear is a screening test where we take a cell sample (like a cheek swab) from your cervix to check for HPV/precancerous lesions. A pap smear is usually conducted in conjunction with a pelvic exam, but not all pelvic exams include a pap smear, as you don't usually need one every year.

Let's go through your questions one by one. But first I want to start by saying that medical consent is the same as regular consent - you have a right to refuse or defer any procedure or examination, or to stop one at any time. You have the right to fully understand everything you're consenting to, and ask as many questions as you need to feel comfortable. If you make an initial appointment with an OBGYN or midwife, and she doesn't pass the vibe check, you are not obligated to go through with the exam. It can be scary to stand up to someone who seems like they're in a position of power, but you should know that you can.

"Something has to go up there, right?"

At your first GYN appointment, nothing has to go anywhere. You'll meet with a provider, she'll take your full medical history, your menstrual and sexual history, your family history, ask if there are any concerns you want to discuss. At this point, you should talk to her about your issues with insertion and your anxiety about it. She may want to have a look (literally just eyeballs) to ensure there's nothing going on, but she will ask permission before doing any touching, and explain everything she's doing. If she thinks it's worth attempting a pelvic exam, she would start very slowly and only with your full buy-in. It may be necessary to try to figure out if you've got an underlying problem.

When a pelvic exam is warranted (like when you need a pap), the provider may first insert fingers while pressing on your belly (called a bimanual exam) to assess your anatomy, and then use a device called a speculum, which allows us to actually see the inside of the vagina (speculum exam). The speculum will be lubricated, and the provider will coach you through the insertion process. You can also ask about inserting it yourself. Usually, you lie back and put your legs up in stirrups, and are coached to let your knees fall out and give a deep breath out, so as to relax your pelvic floor muscles, while the speculum is inserted down and back (towards your tailbone) in a smooth motion. You'll then feel a bit of pressure as the blades of the speculum are slowly opened so the provider can peek through. It shouldn't hurt, but it can be uncomfortable. I don't know anyone who actively enjoys speculum exams, but most people would say they're not too bad. The whole thing is over in a matter of seconds.

"Will it fit?"

Speculums come in a wide range of sizes, in plastic or metal (if metal, it will be warmed). You can ask for the smallest speculum they have (they make pediatric-sized speculums, so there are definitely small ones - see middle device in the image below, about the size of a finger). The provider will use one that should fit based on your history, anxiety/preferences, and her visual inspection of you - but don't be afraid to speak up.

"What happens if it doesn't?"

If you have an anatomical variation that means even a pediatric speculum could not fit, the provider will likely catch this before you get to the speculum stage. If you've got something going on like vaginismus, this will help her diagnose you. The most likely scenario is that you just need a competent and compassionate provider you trust and some good coaching. But what will NOT happen is the provider trying to jam something into you that doesn't fit!

"Is it going to be a hassle to request a woman?"

Absolutely not. It's very normal to have gender preferences with medical providers, especially for something so sensitive. Just ask for a female provider when you're requesting your appointment. You can also ask to see a midwife -- we're something like 96-99% female-identified, with most of the rest being AFAB trans/GNC/NB. (There ARE a few male midwives, but they're really rare).

"How much do I need to 'clean up'?"

If you've got time and it would make you feel better, take a shower before you come, wash with soap and water like normal. But if you can only get in on your lunch break or something, that's fine. Otherwise, you don't need to do anything! I promise your pubic hair is not so forest-like that we will not be able to examine you. Don't douche, or use any fragrances or lotions unless you would like some patient education about how you should not use "feminine products."

Okay Anon, that's an initial GYN visit in a nutshell!

[lxrnawhxre]

I have a biopsy coming up, yay(!)

for fucks sake.

[figowl]

Yesterday I was explaining a slightly abnormal pap smear to a patient, and what the next steps for follow up would be. Toward the end of the call, I meant to say that would send info and links to the patient's MyChart.

What came out was: "...and I'll send some more information right to your cervix!" 🤦🏼

[pawfulofwaffles]

i thought a pap smear was some kind of specific way to spread jam

[wallerina]

saw a post abt this earlier that triggered me and fucked me up rly bad so tw for discussions of pap smears and sexual trauma

im 21 which means im supposed to start getting pap smears but i honestly feel like id rather die im so terrified but everyones always like "its uncomfy but you have to do it" "well some people have slight discomfort but its not supposed to hurt if done properly" "its a widdle akward but its over in no time 🥰"

like no you dont understand i have cptsd and just the thought of it makes me want to very very literally kill myself. also i cant even insert a fucking pinkie finger without searing pain. so exactly how the fuck am i supposed to lay on my back with my legs spread and let a complete stranger hold my vagina apart with a speculum and then scrape my fucking insides with a tool. "they can talk you through it" oh yeah thatll fix it. ive had full blown panic attacks just thinking about it and it makes me feel sick enough to vomit id rather die. and it makes me so fucking angry too like you mean to tell me none of these motherfuckers have bothered to find a different way to do this? too busy creating erection pill number 10,000? okay

[derrydeer]

adam looks like what i think a pap smear feels like

[bobfloydsbabe]

listen, pap smears are necessary but they suck

[humboldtiihognoseclover]

Has getting a pap smear ever sent anyone into an existential crisis?

[the-cheshire-cat-grin]

Ok i need to open up about something extremely traumatic. Trigger warning for pap smears and talking about vaginas i guess.

So friday i got my first pap smear, which i fully expected to be pretty uncomfortable, but i genuinely have never experienced that kind of pain. Nothing, and i mean nothing, could have prepared me for it. It was the kinda of pain that made me think i was dying. Even now this is hard to type because all i can think about is screaming and sobbing in that drs office, and as gentle and kind as my dr was, i felt so so alone. I wanted my mother. I wanted to die. It was a nightmare. I sobbed in my coworkers arms 30 minutes later because i had to go to work after.

But what i need to know is, is that normal? Because everyone ive talked to said that it was uncomfortable and weird, but i genuinely felt like she was ripping me open. Being stabbed would have hurt less. Is it supposed to be that painful or is there something wrong with me?

[millenialcringe]

Hospital.

[sapphic-sex-ed]

wasn’t a pap smear the procedure that a lot of people say are really painful? or is that something else? i know iud insertion can be very painful but i thought there was some kind of test procedure that also was

IUD insertion can be painful, yes. I would say that pap smears are the most invasive test as for other STIs you get your blood drawn or have a genital swab or urine sample. I only write from my experience, but I found that while it wasn’t painful it wasn’t comfortable at all either. There’s a feeling of pressure that my body wanted to get away from and the discomfort feels sort of like… this isn’t painful but if I stay here it very much probably will be. It’s not pleasant but I wouldn’t say painful.

Of course, again, that’s my experience having done it twice by now. Other people may very well have had different experiences, but it’s not a topic I’ve discussed a lot so I don’t know much about others’ experiences. Do please share here in the replies if you’ve had a Pap smear. Was it painful for you? Was it not? How did it feel?

-mod liz