The Pap test

Tell yourself that you’re having the screening test to look after yourself, that you have a right to have cancer screening, and that it’s important. Remember that cervical cancer is very treatable and even preventable — if it’s caught early. Alf

Currently, the most reliable method of finding *cervical cancer early is the Pap test. A Pap test is a procedure that gently collects a small sample of cells from the cervix so they can be examined for changes. A Pap test is the main tool used to screen for cervical cancer because it can detect changes early, before cancer develops.

Here is some information to help you be prepared for your Pap test.

Who needs to get screened?

If you’re age 21 and over, have a cervix, and are or have ever been sexually active, current guidelines in Ontario recommend that you get screened by having a Pap test every three years.

Get screened even if you:

• have no symptoms
• are no longer sexually active
• have had only one sexual partner in your lifetime
• have been through menopause
• have had the HPV vaccine
• have no family history of cervical cancer

Get screened no matter who you have sex with: you can get HPV from genital skin-to-skin contact from a partner of any gender!

If you’ve had abnormal Pap test results in the past, you may need to get screened more frequently. Your healthcare provider will let you know how often you should be screened.

Check out our frequently asked questions for more information on who needs to get screened.

What is a Pap test?

A Pap test, also known as a Pap smear, examines cervical cells to check for abnormal changes. Over time, abnormal cells can become cancerous, often without any symptoms. But if a Pap test finds abnormal cells early, they can usually be monitored/or and treated easily and successfully. That’s why regular Pap tests are the most effective way to protect yourself against cervical cancer.

The Pap test is very quick, and often accompanied by a pelvic exam. The test allows a healthcare provider to look at the cells of the cervix as well as collect a sample to test for any cell changes.

The Pap test generally involves two instruments — a speculum and a brush:

• The speculum is used to keep the walls of the vagina open so that the healthcare provider can see the upper part of the vagina and cervix. The speculum is made of either plastic or metal.
• A special brush is used to gently collect samples of cells from the cervix. Some healthcare providers also use a small wooden stick or spatula to help collect cells from the cervix.
• The cells are then sent to a lab for analysis.

What happens during a Pap test?

A Pap test usually takes two or three minutes.

Before you have the Pap test, your healthcare provider will ask you about your health history, including your sexual health history. Many people prefer to keep their regular clothes on for this part of the appointment, and to change after the interview. If you think that you might find it difficult to have a Pap test, you might consider booking the interview on one day and your actual Pap test on a different day. This can give you time to get familiar with the clinic and the healthcare provider.

This interview is a great time to discuss any specific needs you may have about how to make the Pap test more comfortable for you. For example, many of the interview questions refer to menstruation (for example, the date of your last period or if you have any problems with your period such as pain or spotting). These kinds of questions can be uncomfortable or traumatic for trans guys who do not have monthly bleeding or who would prefer terminology like “bleeding.” At the beginning of the interview, you can let your healthcare provider know whether or not you have monthly bleeding and the terms that make most sense for you.

Your healthcare provider will also likely ask whether you’re sexually active, if you’re using birth control, if there’s a possibility you might be pregnant, and other questions related to your sexual and reproductive health. You may also be asked about your sexual orientation or gender identity.

During the Pap test, you can have a friend, partner, family member, nurse or clinic staff in the room. Some healthcare providers routinely have a staff person in the room for Pap tests and other more intimate exams. If you're not comfortable having someone else in the room, you can ask that they leave.

You will be asked to remove your clothes from the waist down and be provided with a paper gown or sheet to cover yourself. The healthcare provider will leave the room or draw a curtain so that you can get changed in privacy. You will be asked to lie down on an examination table, with your bottom to the very edge of the table. You may be asked to place your feet in stirrups to help your healthcare provider get a good view of the cervix.

Using gloved hands, your healthcare provider will gently insert a small instrument, called a speculum, into your vagina. Once inserted, the speculum gently pushes apart the walls of the vagina so that the healthcare provider can view the cervix and the area around it. The healthcare provider will then use a brush (and possibly a small wooden stick or spatula) to gently collect cells from the outside and inside of the cervix. The cells get put into a vial of liquid, and are sent to the lab for analysis.

Sometimes people experience discomfort, pressure or cramping during the Pap test. You may also have vaginal bleeding for one or two days after a Pap test.

Does it hurt?

I did not find my Pap test experiences that positive, but they were not that negative either. Once I was on testosterone, I would say the typical feeling I had was a pinching sensation when they took the sample. Overall the experience was mild, although the part where they took the sample was definitely stronger than mild. –Zack

The answer to this question is different for different people. Generally, Pap tests may be uncomfortable but they shouldn't hurt. If you're taking T, your tissues may be drier or less elastic than they were before you started on hormones, which can make inserting a speculum less comfortable. The good news is that the cervix itself doesn’t have many nerve endings, so it’s less likely to feel much pain. Some people reported pinching sensation when the cells are collected.

See How can I make a Pap test more comfortable physically?

How can I make a Pap test more comfortable physically?

Take some time to think through what’s going to make it the least stressful for you. And then be entitled to ask for what you want. We’re not all the same and you’re not more trans or less trans or a better dude or whatever if you want this rather than that. –Fred 

It’s true: a Pap test is an intimate procedure. And while for most people a Pap test shouldn’t be painful, it can sometimes be uncomfortable, especially if you’re feeling nervous or tense. Here are some ways you can make the Pap test more physically comfortable:

• If you’re nervous about the speculum or think that you might find it uncomfortable, talk to your healthcare provider about using the smallest size available, as well as the possibility of using a water-based lubricant.
• If you think you might experience pain during the Pap test, or if you’re in pain, let your healthcare provider know. Together, you can come up with a pain management plan.
• For some people, it’s more comfortable to empty your bladder before a Pap test. This is especially true if you’re also getting a pelvic exam.
• Ask your healthcare provider if they will warm up the speculum under water for you.
• During the Pap test, it often helps to take deep breaths and relax the muscles. Remember, the test takes only a minute or two.
• You can tell your provider to stop Pap the test at any time if you’re feeling pain or discomfort.

How can I make a Pap test more comfortable emotionally?

I’ve heard of people walking in there with blaring music on their headphones. Other people have gone in with a partner and actually held their hand through it. Whatever works for you. But I guess, just keep in mind that it takes just a fraction of time every three years. And that ten minutes isn’t nearly as bad as say, how many months of having to treat something if they do find something that you didn’t bother looking for. –Rhys

For many trans men, getting a Pap test is no big deal — just one more medical test in the grand scheme of things. For some of us, it’s even a positive event: a reminder that we’re taking care of ourselves.

Others of us can find Pap tests uncomfortable or upsetting. For many of us, the test is an unwelcome reminder of health procedures or parts of our bodies typically associated with women. Some of us may feel vulnerable, self-conscious or exposed during the Pap test. Survivors of sexual abuse may find Pap tests traumatic.

If you’re feeling emotionally uncomfortable about having a Pap test, here are some suggestions for ways to prepare yourself and make the experience as positive as possible:

• If you aren’t already getting the Pap test from a healthcare provider you know and trust, see if you can find a provider who is trans friendly. Ask your friends if they have any recommendations. You can get information on finding a healthcare provider who is also knowledgeable about trans healthcare by visiting the Rainbow Health Ontario provider directory.
• Coming out as trans for your Pap test is a personal decision. If you do decide to be out (or if your gender presentation makes it difficult not to be out), it can be helpful to come out in advance. You can call the clinic or healthcare provider’s office ahead of time to speak to a booking clerk, receptionist or technician about what practices are in place to make the reception area, changing room, waiting area and procedure as stress-free as possible for you. Is there a private place to change? Is the waiting room welcoming to people of all genders? Have the clinic staff gone through sensitivity training for trans issues? You can also ask about how they will accommodate any of your access needs.

A very friendly phone call just saying, “I’m coming in and I’m a trans person and I just want to be sure people aren’t surprised by it,” or something very straightforward like that I think can ease the way a lot. Anything not to surprise people. And if you don’t feel up to doing that yourself maybe you have a family member or a good friend who would do that for you.–Fred

• If the name on your health card isn’t the name you use, again, it can be helpful to call the healthcare provider or the screening clinic in advance to let them know the name you prefer them to use. Ask them to write your correct name on the front of your file, rather than inside it: it’s too easy for a healthcare provider or a receptionist to call out the wrong name, and then open the file and discover their mistake.
• Clinics in larger urban centres may offer trans-friendly or LGBTQ+ cervical screening times. You may be more comfortable booking an appointment during these hours. If you’re being screened somewhere that does not have queer- or trans-specific appointment times, or does not have private or gender-neutral change rooms and waiting rooms, you can ask for an appointment at the very beginning or the very end of the day, when waiting times may be shorter and there may be fewer people around.
• Ask your friends or family about their experiences with getting a Pap test. Hearing about it from someone you trust can increase your confidence.
• You may feel more empowered if you keep your clothing on for the interview part of the appointment.
• During the interview portion of the Pap test, you can let the healthcare provider know what you will need to make your test more comfortable for you. For example, if it’s difficult for you to get touched in a certain place, let the doctor or nurse know that. If you would like your body parts to be called by a different name than what the healthcare provider uses, then this would be a good time to let them know. It will likely be more comfortable for you to tell them what you need before you change into the paper gown, since we often feel more empowered with our own clothes on.
• It may help to have a supportive friend or partner attend the appointment with you. You can also request to have a chaperone — that is, another healthcare provider or clinic staff member — in the room during the Pap test.
• If you use them, you can take your anti-anxiety medications before the Pap test, or consider asking your healthcare provider to prescribe some to help make you more comfortable during the test.
• You may want to ask your healthcare provider to describe the process of getting a Pap test before it starts. They can tell you step by step what they will be doing. During the Pap test, you can also ask them to tell you what they are doing as they are doing it, e.g.: “I am now inserting the speculum.” Or, you may just prefer silence, or to chat about day-to-day topics! It’s up to you.
• You can ask to hold a speculum to see what it feels like.
• Remember, you have the right to tell the healthcare provider to stop at any time. It may be helpful to tell the doctor or nurse, “I may need to tell you to stop. Or I may just hold up my hand for you to stop.”
• During the test, it can be helpful to practice deep breathing or other relaxation exercises. You may want to repeat a phrase in your head, such as “I can get through this,” or “I’m taking good care of myself.”
• If you’re worried that you may disassociate during the Pap test, it can help to keep your eyes open: that keeps you in the present moment. It can also help to sit up a bit and so that you can see the healthcare provider.
• Be prepared for the possibility that you might experience a patch of increased gender dysphoria or discomfort with your body after the Pap test. It can help to think through in advance what helps you deal best with dysphoria: going to the gym? Being alone in nature? Snuggling up with someone you love and trust?
• Plan to do something you enjoy immediately after your appointment, like going for a coffee with a friend, seeing a movie, going for a hike. During the Pap test, you can focus on what you’ll be doing right after. If you think the Pap test will be particularly upsetting, you may want to make sure that you’ve got an appointment with a therapist or counsellor in the not-to-distant future.

How do I prepare for the Pap test?

Before you book your Pap test, here are some things to think about:

• If you bleed monthly, book your Pap test on a day when you won’t be bleeding.
• If you bleed monthly, the Pap test should ideally be done in the middle of your cycle, so 10 to 20 days after the day you begin to bleed.
• Do not douche for 48 hours before your Pap test.
• Do not use contraceptive creams or jellies or vaginal medications, unless directed by your healthcare provider, 48 hours before your Pap test. These products can wash away or hide abnormal cells.
• Do not have penetrative frontal sex 24 hours before the test. This means not having frontal sex with fingers, fists, toys or penises.

How will I get the Pap test results?

You can get your results one or two ways: from your doctor or healthcare provider, and through the Ontario Cervical Screening Program (OCSP).

• You can ask your healthcare provider when you can expect to get your results. Generally, your doctor or nurse practitioner will contact you only if your test results are abnormal. If you don’t hear from your healthcare provider, it’s likely because your results are normal. You can always call your healthcare provider’s office if you’d like to know your results. It may take up to a few weeks for the results of your test to arrive.
• As of fall 2013, the Ontario Cervical Screening Program (OCSP) will send letters to eligible people living in Ontario to invite them for Pap testing, let them know their test results and remind them when it’s time for the next Pap test. After your Pap test, you’ll receive a letter letting you know of your result. You should expect to receive a letter from the OCSP within 30 to 60 days of having your Pap test. Unless you opt out of receiving correspondence from the OCSP, you will also receive a letter reminding you when it’s time for your next Pap test. (Note: if you have a male designation on your health card, you may not receive correspondence from the OCSP. This can be a barrier to screening for some trans men.)

If your test results are negative, this means that your cervical cells collected were normal and that you can come back in three years to get another Pap test.

Getting a positive result can be scary. It can help to remember that most of the time, a positive Pap test does not mean that you have cervical cancer. Positive tests can also be the result of:

• infections, such as yeast infections
• inflammation
• an intrauterine device (IUD), which is a form of birth control
• precancerous cell changes, which will need to be treated.

If you have a positive test, you will likely need further testing.

*A note on terminology: On this website, we refer to some body parts, including the cervix, vagina and uterus, in order to discuss cervical cancer. We do recognize that many trans men and people on the trans masculine/ female-to-male (FtM) spectrum may feel ambivalent about or distanced from these terms or prefer other terms, such as “front hole.” We minimize our use of these terms wherever possible, while also acknowledging and attempting to normalize the reality that men can have these body parts too.