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I’m nervous about the Pap test. What can I do?

The question: I am booked for a Pap test next week and I'm very nervous. My last test wasn't a comfortable experience and I am tempted to cancel my appointment. Any tips on how to make this easier?

The answer: Even though a Pap test is important, many struggle with getting it done due to negative experiences or hearing stories of discomfort from their friends or family.

A Pap test involves gently inserting a speculum, a metal or plastic medical tool, into the vagina to directly visualize the cervix and sample the cells. While it may feel much longer, it should only take a minute or two to complete.

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Pap tests are an important tool that can pick up early changes in the cells of the cervix that over time can lead to cancer. Cervical cancer has a significant impact on women in Canada. In 2013, 1,400 Canadian women were diagnosed with cervical cancer and 350 died from the disease. Having regular testing increases the chances of picking up precancerous changes early. Without any history of abnormalities or symptoms, most provinces recommend having a Pap test every three years for women and transgender men.

In preparation for your appointment next week, here are a few tips that may help increase your comfort.

First things first, it's very important to have trust in your healthcare provider (doctor or nurse practitioner) who is doing your Pap test. If you are seeing a new doctor, let him know that you're nervous. Sharing your concerns will alert the doctor to take extra time to support you. If you had a previous painful experience, he can take additional steps such as warming up the speculum, using enough lubrication and taking the time to talk you through the test.

If you are not comfortable with your doctor, find a clinic that has expertise in sexual health. Most larger cities will have sexual health clinics that offer Pap tests and STI screening. These clinics will often carry different sized speculums including extra-small versions that can be used if it's your first Pap or if you've had discomfort in the past.

At your appointment, it's important that you get into a comfortable position. When we're nervous, our muscles tense, including the ones in the vagina. This can make inserting the speculum difficult and the test will be more uncomfortable as a result. I encourage my patients to do whatever helps them feel most comfortable. I suggest they breathe slowly and visualize their muscles relaxing. Some of my patients find it helpful to distract themselves by wiggling their toes, talking through the test or having a loved one in the room. Your doctor should use either warm water or lubrication to help insert the speculum more comfortably. While a Pap test may be uncomfortable, it should not be painful. I always tell my patients that they are in control of the situation and the same holds true for you, so if it becomes too uncomfortable either emotionally or physically, tell your doctor to stop.

Finally there are some steps you can take to improve the reliability of the Pap test so your doctor gets the most accurate results possible. Don't use any vaginal douches or creams within 48 hours and limit sexual activity within 24 hours of the test. Don't schedule the test during your period; mid-cycle is best. If you're being treated for an infection, book at a later time as it can alter the test results.

Dr. Sheila Wijayasinghe is the medical director at the Immigrant Womens' Health Centre, works as a staff physician at St. Michael's Hospital in their Family Practice Unit and at Hassle Free Clinic, and established and runs an on-site clinic at Women's Habitat Shelter in Etobicoke.

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