I was today years old when I learned the 'why' behind getting a pap smear. I always used to look at it as one of my annuals that I booked an appointment for, propped up my legs, braced for the discomfort of the speculum, and just did. I knew it was for my health but for some reason, it never clicked for me that a pap smear had everything to do with being preventative and was mostly about your cervix. Even as a 31-year-old who had a LEEP procedure done to remove precancerous cells nearly a decade ago, the dots never totally connected for me that ‘pap smear’ is to the cervix and cervical cancer as ‘mammogram’ is to breasts and breast cancer. Don’t come for me, but I was simply doing what I was ‘supposed’ to do without thinking of the bigger picture as it relates to my health and preventative measures like annual pap smears.
Coming to terms with that realization is actually what led me to write this piece. I realized that there was probably someone like me who was simply rolling with the punches of booking yearly doctor exams, or even someone who might not even go because they may believe going to a gynecologist is only for people who have “an issue” down there. I’m here to demystify some of the myths around pap smears. In honor of it being Cervical Cancer Awareness Month, I am here to also do my part in empowering women to advocate for their health needs, especially when it comes to a form of cancer with a 92% survival rate when diagnosed in its earliest stages. And do you know the easiest way to detect cervical cancer before it becomes cancerous? If you said ‘pap smear,’ you are right on the money.
I spoke with Dr. Janelle Howell, DPT, WCS, also known as the Vagina Rehab Doctor to help spill the deets on what you need to know about pap smears and cervical health.
What is a pap smear?
Perhaps it's elementary, my dear Watson, but I wanted to cover all of my bases when breaking down pap smears for this piece. A pap smear, or a pap test, is short for the Papanicolaou test. It is a diagnostic procedure that tests for cervical cancer in women. A doctor takes a small instrument to brush sample cells on the cervix and then sends those samples to a lab for the results. Once the samples have been tested, a patient can either get a normal test result (which literally means everything is all good under the hood) or an abnormal result (which could signify abnormal changes found on the cervix).
Depending on your doctor, they might suggest doing a colposcopy or a biopsy to ensure that the abnormal test result is not due to the presence of precancerous cells. If it is due to precancerous cells, the next step might be scheduling a procedure like a LEEP to remove those cells from the cervix. Your gynecologist will know best in regards to formulating a treatment plan that works best for you.
How often should you be getting a pap smear?
The answer to this question may differ depending on your medical history, but Dr. Howell shares that "generally speaking, about every three years is a good frequency to get one." She also adds that every five years, it is recommended to get an HPV test for the human papillomavirus, which is what leads to cervical cancer.
While Dr. Howell suggests people visit their gynos yearly, pap smear or no pap smear, she says that ultimately your specific gynecologist will be able to tell you how often you should visit and what the plan should be if you do have an abnormal pap test result.
When should we visit the gynecologist and what should we expect?
Although there are some people who prioritize regular checkups, there are others who do not have the privilege of accessible healthcare. There are also folks who might not resort to visits with healthcare professionals unless there is a problem or an issue. Such is the case sometimes with gynecologists. As previously mentioned, Dr. Howell advises women to visit their gynecologist yearly even if they don't have a pap smear or a symptomatic health issue or concern. During those routine wellness checks with your gynos, you are able to get things done like a pelvic exam where they exam the vulva as well as the internal reproductive organs, which includes the cervix. Dr. Howell adds that during these exams, gynecologists usually "do an internal exam, apply manual pressure along the abdomen to see if you have tenderness along the uterine border, and order any other needed tests or measures, like a pelvic ultrasound."
She also shares that even if they don't go through the uncomfortable steps of giving you a pap smear, they will look at the cervix and the vaginal canal. "Think about it like getting an oil change. You gotta pop in there every now and then, especially if you are sexually active. You want to make sure you are staying on top of your pelvic health, your reproductive health, and all of that because we are getting our periods monthly, we are in our reproductive ages, and we still have our uterus that needs to be checked on."
"If we are having a lot of clotting, if we are having a lot of pain with our periods, or having missing periods or irregular periods -- those are things that we want to be updating our gynecologist on, so they can make sure nothing more serious is going on causing those symptoms," Dr. Howell concludes.
At what age should you start getting pap smears?
The most common age to start getting pap smears is 21, but typically when a patient is sexually active, they are advised to start getting pap smears then. Of note, just because you aren't sexually active doesn't mean you shouldn't be getting regular pap smears, especially if you are over the age of 21.
This brings us to our next question and answer...
Should you get a pap smear even if you're not sexually active?
Sometimes, we look at doctor's visits from a lens of reactivity versus proactivity. Such is the case with gyno appointments. Sexual activity and/or vaginal health issues are not a prerequisite for gynecologist visits. But Dr. Howell encourages everyone to see the importance of getting pap smears, and even HPV tests, even if you aren't sexually active. "HPV can be transferred, not just from internal sources [like the penis and vagina] but you can get HPV just from skin-to-skin contact."
She states this to emphasize the point that sex is not the only way to get HPV, which is ultimately what leads to cervical cancer. "You can literally just have someone’s skin who has HPV contact your skin, then you are at risk of getting it. There are HPV cells that live on the vulva, that live on the penis, that live on the groin. There’s also oral HPV," she continues, "You don’t have to have sex to get it. So be aware of that."
HPV can even be transferred from mother to child through the vaginal tract, so children can get it from their mothers if their mothers have it. The bottom line is, just because you aren't sexually active doesn't mean you shouldn't be getting pap smears and regularly testing for HPV.
How can you advocate for your cervical health in relationships and gyno visits?
If you are sexually active, the number one thing you can do to better support your cervical health is to use protection. Dr. Howell notes that using condoms during sex is "one of the most basic, affordable, and safe ways" to guard the cervix. By practicing safe sex "we are limiting the amount of exposure to bodily fluids and bacteria on someone’s genital skin that can impact our cervix. Exposure to someone’s bodily fluid or [the] skin of someone who has HPV is a common way to become infected. We generally get it from another person."
In instances where women want to feel empowered to go beyond the routine pap smear, Dr. Howell wants you to advocate for your cervical health by doing your research and talking to your doctor openly in order to feel confident and comfortable with your cervical health status.
What are some holistic ways to support your cervical health?
Supporting your cervical health can go beyond regular doctor visits, getting pap smears, and using protection during sex. It also looks like having strong sexual health boundaries overall, as well as making better lifestyle choices. "If our diet is filled with more inflammatory foods than anti-inflammatory foods, then that is not going to necessarily help the cervix. So like processed foods, those things are more inflammatory than fresh foods."
For that reason, Dr. Howell suggests doing things like adding "color to your diet." She goes on to say, "You want to make sure that you are getting more color in your diet from plants, which help us to fight inflammation and fight disease. That’s the whole purpose of food, to nourish our bodies." Speaking of diet, another key to nourishing your cervical health is by decreasing your sugar intake. "When I am saying sugar, I am talking about artificial sugar like the sugar that we are putting in our coffee, or the sugar that is in juice; it’s concentrated into one small cup. Artificial sugar and high amounts of it, have been associated with just more inflammation in the body, which includes the cervix."
In addition to watching the amount of sugar you consume, she suggests observing your vitamin A and vitamin D levels as they are "protective for the cervix." "We are eating every day anyway, so you might as well eat foods that help your body to thrive." And for a beta-carotene-rich food that is accessible as it is nutritious, Dr. Howell looks to carrots and says one carrot a day is enough to assist with vitamin A levels which are necessary for cervical health.
As a Pelvic Floor Physical Therapist, Dr. Howell knows the importance of considering the pelvic floor as a way to support the cervix. "Your pelvic floor includes all the muscles that support your cervix and supports your uterus to prevent prolapse. So, checking in on your pelvic floor for pelvic floor symptoms, like urinary leakage, a bulge in the vagina, a 'heaviness' in your vagina, or constipation -- these are things you want to consider in terms of your pelvic floor. Seeing a pelvic floor physical therapist is crucial to helping you overcome those symptoms and take care of your pelvic floor muscles, which are by far the most important muscle group for supporting the position of your cervix and uterus."
For more of Dr. Howell, follow her on Instagram @vaginarehabdoctor.
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