What your doctor is thinking during a pap smear.

Image via iStock. 

Want to know what really happens before, during and after a pap smear? Dr Evelyn Lewin takes you behind the scenes to find out.

Let’s start with some basics. A pap smear is a simple medical procedure that can be performed by your GP. The whole point of a pap smear is to take cells from the lining of your cervix (the cervix is the opening of your uterus). These cells are then sent off to a lab to be analysed for changes that may lead to cervical cancer (or for cancer itself).

Why do I have to have one? Can’t I just do a blood test or something instead?

Because your cervix is located at the end of the vaginal canal, the only way to access it is through (you guessed it) the vagina. So while having a pap smear isn’t fun, it’s necessary.

And while having pap smears doesn’t change your risk of getting cervical cancer, monitoring your cervix regularly means that if an abnormality does occur it can hopefully be detected and treated early, before the abnormality turns into cancer.

Look, I’ve been monogamous for 10 years and never had a problem. Can’t I stop getting them now?

If you’re a female aged 18 or over who has ever been sexually active then you need to have one. Obstetrician and Gynaecologist Dr Michael van der Griend says you should start getting them within 12 months of becoming sexually active if you’re older than 18. Oh, and you still need to have regular pap smears even if you’ve had the HPV vaccine. Sorry. (Dr Ginny and Shelly Horton talk about what a “normal” vagina looks like. Post continues after video.)

OK, I get that pap smears are important. And I know I’m a grown woman, but I’m still kind of embarrassed about having one.

Let me tell you something: almost everyone gets a bit embarrassed about having a pap smear. Even doctors. But that’s no reason to actually avoid having one. After all, there are lots of things we do in life that we don’t want to, and most of them don’t have the potential to save your life!

Do I need to warn my doctor that that’s why I’m coming in?

When you turn up on the day, simply tell your GP you’re there for a pap smear. She will ask you a few questions (things like, when was your last pap smear? Have they all been normal? Do you have any abnormal vaginal bleeding?). Then she’ll give you some privacy (usually behind some curtains) to get ready for the procedure.

You’ll need to take the bottom half of your clothing off (you can leave your shoes and socks on if you like). Then, you need to lie down on the bed. You’ll most likely be given a towel or sheet to cover yourself with.

Some women prefer to wear dresses or skirts to their appointment so they simply pop their undies off and pull their dress/skirt down until it’s time to get started. Once you’re lying down, just tell your GP you’re ready (or as ready as you’ll ever be!).

Does my doctor care that I haven’t waxed?

Just remember, your doctor does pap smears all the time. And when she’s performing yours she’s not looking at your bikini line, she’s simply trying to do her job.

So what is my doctor actually doing down there?

While you’re getting undressed, your GP will most likely be preparing her equipment. Once she’s ready she’ll focus a light on your nether regions (sorry, there’s no delicate way of saying that).

She’ll also explain what position she’d like you to get into so she can do the procedure most easily. It’s nothing tricky – usually it’s just about putting your ankles together and letting your knees flop apart (which kind of looks like you’ve got frog legs).

She’ll then insert a speculum into your vagina. A speculum is a plastic or metal piece of equipment designed to push apart the walls of the vagina so your doctor can see your cervix (which is located at the base of your uterus, right at the end of the vaginal canal).

Putting in the speculum can be uncomfortable but it shouldn’t hurt. If it does, simply tell your doctor so she can stop.

Once your doctor can see your cervix she will then take swabs from your cervix using a small spatula and/or brush. While that sounds really invasive, in truth it’s just about gently rotating the swab at the opening of your cervix, much like gently cleaning your ears with a cotton bud (not that doctors recommend cleaning your ears with cotton buds, but you get the picture).

This part can also be a bit uncomfortable but again, it shouldn’t hurt. Because the cervix is quite sensitive, you may have a bit of spotting afterwards.

After the swabs are taken the speculum is removed and voila, the whole thing is over within minutes.

Then what happens

Once she’s taken the swab, your GP will then smear those cells onto a glass slide and spray it with fixative. That slide is then sent off to a lab to be analysed for abnormalities.

The results will then be sent to your GP. If your results are normal, you should receive a letter in the mail about two weeks after your test, telling you that and advising you to return in two years. If you don’t receive a letter, call your doctor’s clinic to check on your results.

If your results are abnormal (and most of these are just minor abnormalities), your doctor will want you to come back in to discuss them. She may then refer you to a specialist for further tests or treatment as needed. (Post continues after gallery.)

How often do I need to get a pap smear?

If your smears are all normal, you need to have further smears every two years. This is because abnormal changes grow slowly, so it’s generally recommended that you don’t need testing more often than that. If your results are abnormal, you may need more regular smears or further tests.

You need to keep having pap smears until you’re 70 (though some people may need to have them a bit longer than that) or until you’ve been told you no longer need them (say, if you’ve had your whole uterus and cervix removed).

This article was kindly fact-checked by Sydney-based Obstetrician and Gynaecologist Dr Michael van der Griend (www.drvandergriend.com.au)