What’s worse: A cold rod inserted briefly inside your vagina or cervical cancer?
The former is a key part of a pap smear, the cancer screening recommended every 3 to 5 years for people with a cervix under the age of 65.
Pap smears — which can be uncomfortable and even painful for some — have become the subject of a heated social media firestorm. Users have suggested that the exam is so unpleasant that they would rather go without it — and some even argued they would rather have cervical cancer than get a speculum stuck inside them.
”I’m sorry but you people act so odd whenever women express mild discomfort at the thought of a torture device being shoved into our cervix,” one user wrote on X, the social media platform formerly known as Twitter.
“I see a Pap smear as worse than my very, very low odds of getting cervical cancer,” read part of another post.
OBGYNS caution, though, that the risk of cervical cancer — and the treatment required if it’s not detected early — far outweigh the discomfort associated with the brief screening. And there are ways to make the cancer screening more comfortable if patients are concerned about pain.
In a pap smear, a speculum is attached to a brush that collects cells to test for abnormalities that could become cervical cancer; the test is part of a standard pelvic exam. The vast majority of cervical cancer cases are caused by sustained infections of human papillomavirus (HPV), a sexually transmitted infection that can often be prevented by childhood vaccination.
Pap smears famously aren’t fun for anyone. And they can be particularly difficult for people with medical or sexual trauma, who are unused to vaginal penetration, or who have conditions such as vaginismus, which involves involuntary vaginal muscle spasms.
Concerns about pap smear discomfort aren’t new — and in fact, they’ve long been a reason why people have avoided getting screened for cervical cancer. Research published in 2005 from a team of scholars at Duke University found that people concerned about painful pap smears were less likely to get their recommended screenings.
The risks of cervical cancer are substantial. When the cancer is detected early, patients can be treated with surgery — namely a hysterectomy, which removes the uterus. But if a cancer is detected later, patients can require chemotherapy and radiation, which can cause discomfort, sexual dysfunction and issues such as vaginal dryness.
“The side effects are certainly in my opinion worse than a speculum exam,” said Dr. Christine Conageski, a gynecologist at the University of Colorado who specializes in caring for lower genital tract infections.
That said, there are in fact ways for people to test early for cervical cancer without a speculum.
“If you’re going to see a gynecologist without symptoms and you’re just looking for screening — either sexually transmitted infection screening or cervical cancer screening — there are options that don’t necessarily have to include a speculum exam,” Conageski said.
Patients who aren’t experiencing symptoms can use self-screening kits to test for HPV, she said. The Food and Drug Administration has approved three different at-home HPV tests that patients can use. The American Cancer Society particularly recommends those as an alternative for patients who are unable to go to a doctors’ office or who are concerned about discomfort during a pelvic exam.
Those options are still relatively new, Conageski said, so patients may have to proactively seek them out. But those with concerns about a pelvic exam should be able to find a medical provider knowledgeable about home tests.
If a home test shows a patient is negative for HPV, there is no need to come in for a pap smear, Conageski said. A positive test, though, would require follow-up care that relies on a speculum.
“Finding ways to become comfortable with a speculum, and physicians you’re comfortable with talking through it, is going to be important, even in a self-collection world,” she said.
Only in recent years have medical providers and patients become more transparent about the pain associated with standard reproductive health procedures. That includes some practices offering sedation or local anesthetics for people receiving intrauterine devices.
In her own work overseeing OBGYN residents, Conageski said, she’s been working with medical trainees to incorporate a trauma-informed approach to reproductive health care. That work began only in the past five or six years, she said. But as medical programs like hers reorient young doctors to think critically about patients’ needs, more physicians are likely to be equipped to talk through ways to make the process more manageable.
She recalled one patient who recently required a speculum exam for a colposcopy, which is used when a pap smear or HPV test suggests abnormalities that could be precancerous. That patient communicated her concern about pain during the exam — and as a result, Conageski said, they were able to work together to develop strategies that might make the process less painful.
That included dimming the lights during the exam, applying a local anesthetic on the patient and on the speculum itself, and playing music of the patient’s choice from her phone. All of those made the process more comfortable for the patient, she said — and those kinds of options should be available for people looking to make an exam feel more manageable.
“If you’re considering having a speculum exam, any good provider should be able to walk you through it, making sure you, the patient, are in charge,” she said.