Getting a Pap test | Check it out

Having a Pap test is not always easy for lesbian, bisexual, queer, gay and other women who have sex with women. We may not be out about our sexuality with our health care providers, and doctors and nurses are often unclear about our health needs and sexual practices, or they may even be outright homophobic. Some of us have experienced sexual abuse and trauma in the past, which can make getting Pap tests difficult. But Pap tests are important for our health, so below are some tips that can help make getting the test just a little bit easier.

What happens during a Pap test?

The Pap test usually takes 2-3 minutes.
The doctor or nurse will ask you to remove your clothing from the waist down. You can leave your socks on. They will give you a sheet or gown to cover yourself with. The doctor or nurse usually leaves the room while you do this.
They will ask you to lie on the examination table on your back with your knees up and bent and your feet in stirrups (foot rests).
While you are lying on an examination table, the doctor or nurse will put on latex or vinyl gloves and then carefully insert a small metal or plastic instrument, called a speculum, into your vagina to open it so that the walls of the vagina and cervix can be seen clearly. Ideally, the speculum should be the smallest size needed to examine your vagina and should be warm to touch.

The doctor or nurse will take a small sample of cells from the cervix using a little broom-like device, or occasionally a brush, and then put the cells into a container with a preserving liquid in it.
The sample is then sent to a lab, where a cytologist (a specialist trained to look at cells and interpret a Pap test) reviews it.
You may feel some discomfort or pressure during a Pap test, but it should not be painful. However, for some women, especially those who have experienced sexual abuse or assault, or women who have never experienced, and never want to experience, penetration, the procedure can hurt. Read on for some tips on how to make getting a Pap test easier for you.

Preparing for your Pap test

Book your Pap test for a day when you are not menstruating.
If it will make you feel more comfortable, ask for a female doctor or nurse when you book your appointment.
If possible, avoid the following for 2 days before the Pap test to increase the accuracy of the test:
- Vaginal medications (unless advised by your doctor)
- Douches
- Vaginal contraceptives such as spermicidal jellies, gels or foams
- Vaginal sex with fingers, toys or penises (avoid for 24 hours prior).
You may find it helpful to talk with someone you know who has had a Pap test.
If you are not used to penetration, getting comfortable with it at home either on your own or with a partner before you get a Pap test can help. Many sex toy shops and clinics will give/sell you a disposable plastic speculum you can experiment with at home, or you can try small sex toys and/or fingers.

Getting through the Pap test

You can bring a friend or family member to stay with you during the test. Let them know in advance what you would like them to do: hold your hand? Tell you stories to distract you? Remind you to breathe?
Give yourself a pep talk: you are doing this for your health, it only takes a few minutes, etc.
No matter who your health care provider is, there is no guarantee you are going to like their personality or their approach to giving Paps. The best you can do is ask for what you need as explicitly as you can.
Tell the doctor or nurse if this is your first Pap test, so they know to be extra gentle.
Don't take your clothes off until you have to. Ask the doctor or nurse if they are doing a patient interview first, and if so, request that you do the interview before you take your clothes off.
During the interview, you can decide whether or not to disclose your sexual orientation and practices. Disclosing can result in a better and more informed health care experience. It also, however, can put you at risk of homophobia and discrimination. The choice to disclose is yours and yours alone. If you feel you are being treated badly, you can stop the examination at any time and leave.
If you are not comfortable with terms like vagina, labia, etc. being used, ask the practitioner to use terms that you prefer.
Speculums can look scary, especially the metal ones. Some clinics use plastic speculums instead because they are disposable. Remember that a speculum is just a tool: your doctor or nurse needs it to hold the walls of your vagina open so they can see your cervix.
Ask the doctor or nurse if it is possible to raise the back of the exam table so you can be more upright during the exam. This will give you a better view of the process and can help you feel more in control.
Just like with vaginal sex, taking long, slow, deep breaths can help you relax the muscles inside your vagina and help it to open up.
You can ask the doctor or nurse to explain what they are doing as they do it, ie: “You will feel me inserting the speculum”, etc. Or, if you prefer, ask the doctor or nurse to talk about something totally unrelated or to simply be quiet.
Distract yourself: count the ceiling tiles, make your grocery list, or chat with the doctor or nurse or your companion.
Pap tests can be uncomfortable, but they should not hurt or cause significant pain. However, if you have survived sexual abuse or assault or if you have never experienced, and never want to experience, penetration, the procedure can hurt. If anything feels uncomfortable, tell the practitioner. If at any time you need the exam to stop, tell the practitioner to stop and withdraw the speculum.
Lube is not traditionally used during Pap tests because labs prefer it not be used. However, if you would really prefer that lube be used, you can ask the practitioner.

After the test

Appreciate practitioners for doing things right. If they took extra time, were extra gentle or particularly respectful, let them know: this reinforces their good work and makes it more likely that you, and other patients, will experience the same good treatment next time.
Treat yourself afterwards: take yourself out for breakfast, go for a walk with a friend or rent your favourite movie.
Ask the doctor or nurse how long it will take to get your results back and how you will be notified. It can take several weeks.
Follow-up and results
A negative or normal test finding means that all the cells in the sample are of a healthy size and shape.
A positive or abnormal test finding means that the test found cell changes or cells of a different size and/or shape than normal cervical cells.
Each clinic has its own practice, but usually if there is a negative or normal test, you will not be contacted.
If the results are abnormal, your doctor or nurse will contact you either by letter or by phone. For peace of mind, you can also call the clinic to get the results.
If you get an abnormal result, it is really important to follow-up to make sure you get any treatment that is required.
Remember: abnormal Pap test results are common — cervical cancer is not. There are many reasons a Pap test result could come back abnormal, and there are different types of abnormal results.
If there are changes in the cells of your cervix, this does not mean you have cancer. These early cell changes are called abnormal cells, not cancer. For most women, the abnormal cells change back to normal on their own.
At this stage, your doctor or nurse will likely have you come back for a repeat test. Repeat Pap tests often come back normal. Depending on the results of the repeat test, you may be required to have further follow-up.
Some women choose to go see a naturopathic health care provider when they find out they have cervical cell changes. This kind of health care is not covered by the Ontario Health Insurance Plan (OHIP). And remember, it is still important to follow-up with repeat Pap tests.

Frequently asked questions about Pap tests