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The Pap test

Currently, the most reliable method of finding cervical cancer early is the Pap test. A Pap test is a procedure that gently removes 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.

Who needs to get screened?
What is a Pap test?
What happens during a Pap test?
Does it hurt?
How do I prepare for the test?
How can I make a Pap test more comfortable physically and emotionally?
How do I book a Pap test?
How will I get the test results?

Who needs to get screened?

If you are between 21 – 69 years old, have a cervix, and are or have ever been sexually active, get a Pap test every three years.

If you’re over 69, talk to your doctor about whether or not it’s appropriate to continue having Pap tests. The decision to stop is often based on having two or three normal Pap tests over the last ten years.

Get screened even if you:

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

If you have received abnormal test results in the past, you may need to get screened more frequently. Your health care provider will let you know.

Check out 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, is the screening test that examines cervical cells to check for abnormal changes. Abnormal cells can, over time, change and become cancerous, often without any symptoms at all. If abnormalities are found early and monitored, they are usually easily treatable. Regular Pap tests are the most effective way to protect yourself from cervical cancer.

The Pap test is very quick, and often accompanied by a pelvic exam. The test allows a health care 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 three instruments: a speculum, a brush and a spatula.

  • 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 either made of plastic or metal.
  • A small wooden stick or spatula is used to gently scrape the surface of the lower part of the cervix to pick up cells.
  • A special brush is used to very gently swab the cervix for cells from the inner part of the cervix leading to the uterus.
  • The cells are then sent to a lab for analysis.

What happens during a Pap test?

The Pap test usually takes 2 – 3 minutes.

Your healthcare provider will ask you about your health history, including your sexual health history. Your healthcare provider will likely ask you the date of your last period (the day it started), whether or not you are sexually active, if you’re using birth control, if you’re having any problems with your period such as pain or spotting, 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. This is a great time to discuss any specific needs you may have about how to make the Pap test more comfortable for you. If the healthcare provider is male, you may request a female staff person to sit in on the session or request a female health care provider.

Procedures may vary from place to place but generally you will be asked to remove your clothes from the waist down and be provided with a paper gown or sheet. 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. They may ask you to place your feet in stirrups to help your healthcare provider ensure 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 upper part of the vagina and cervix are directly viewable by the healthcare provider. The healthcare provider will then use the wooden spatula to gently scrape cells from the outside of the cervix, and then use a brush to scrape cells from the 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 procedure and you may also experience vaginal bleeding for 1-2 days after a Pap test.

Does it hurt?

A Pap test can be uncomfortable, but usually doesn’t hurt. The cervix does not have a lot of nerve endings, which means that there are fewer receptors available to feel sensation, so pain is less likely. It may be uncomfortable or painful to have a speculum inserted into your vagina, but it can help to take deep breaths to relax your pelvic floor muscles and ease tension. If you are experiencing pain during your test, let your healthcare provider know.

How do I prepare for the test?

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

  • book your Pap on a day when you won’t have your period.
  • for best results, the test should be done in the middle of your menstrual cycle, so 10 to 20 days after the first day of your period.
  • do not douche for 48 hours before your Pap.
  • do not use contraceptive creams or jellies or vaginal medications, unless directed by your doctor, 48 hours before your Pap. These products can wash away or hide abnormal cells.
  • do not have penetrative vaginal sex 48 hours before the test. This means not having vaginal sex with fingers, fists, toys or penises.

How can I make a Pap test more comfortable physically and emotionally?

  • It may help to call the clinic or doctor’s office to speak to a receptionist to discuss what practices are in place to make the reception area, change room, waiting area and test as stress free as possible for you. You can also ask about how they will accommodate any of your access needs.
  • Ask your friends or family about their experiences with getting a Pap. Hearing about it from someone you trust can increase your confidence.
  • It may help to have a supportive friend attend the appointment with you.
  • For some LGBTQ people, being out to our doctor is important to getting the health care that we need. To others, it can make getting adequate health care more difficult, because of the fear of experiencing homophobia/ transphobia and or provider misinformation. Coming out is your personal decision. Some health care providers will ask about sexual orientation or gender identity during the interview process of the Pap test, so it might be helpful to think through how you will respond before getting screened.
  • You may want to ask your healthcare provider to walk you through the process of getting a Pap before it starts. They can tell you step by step what they will be doing. 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.”
  • Ask your healthcare provider if they will warm up the speculum under water for you.
  • During the interview portion of the 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.
  • If you’re scared about the speculum, talk to your healthcare provider about using the smallest size available, as well as the possibility of using lubricant. Some lubricants can distort lab test results, so you will have to speak with your healthcare provider about whether or not this is an option.
  • It can be helpful to wear separates for your clothing, with a top and a bottom, so that you only have to remove your bottom for your Pap.
  • For some people, it’s more comfortable to empty your bladder before a Pap. This is especially true if you’re also getting a pelvic exam.
  • During the Pap, it often helps to take deep breaths and relax the muscles.

How do I book a Pap test?

In Ontario, you can get a Pap test from your family doctor, a gynecologist, a nurse or nurse practitioner. You can also get one at most sexual health clinics. You can get information on finding a health care provider who is also knowledgeable about lesbian, gay, bisexual, transgender and queer health care by visiting the Rainbow Health Ontario provider directory.

How will I get the test results?

Ask your healthcare provider when you can expect to get your results. Generally, you will only be contacted if your test results are abnormal. If you don’t hear from your healthcare provider, it’s likely because your results are normal.

You may feel anxious or nervous about receiving your test results. Remember, cervical cancer is rare. There are many reasons why someone might have an abnormal Pap test, and most often, it isn’t cancer.

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

If your test results are positive, this means that some of your cervical cells are abnormal, and that you will likely need further testing. While this may sound scary, further testing will help your provider find out more information about the cervical cell changes.

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