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.
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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.
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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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Let me start this off by saying that of course, to a certain extent, the answer is subjective because it’s mostly opinion-rather-than-fact driven. However, I personally think that sex is hella impactful, which is why I hope that my personal breakdown will at least cause you to want to think about what you do, who you do it with, and why, more than you may have in the past.
Because although, at the end of the day, the physical aspects of making love, having sex, and f-cking are very similar, you’d be amazed by how drastically different they are in other ways…at the very same time.
Making Love
GiphyBack when I wrote my first book, I wasn’t even 30 at the time and still, one of the things that I said in it is, I pretty much can’t stand the term “make love.” Way back then, I stated that sex between two people who truly love each other and are committed for the long haul, when it comes to what they do in the bedroom, it’s so much more about CELEBRATING love than MAKING it. To make means “to produce” or “to bring into existence;” to celebrate means “to commemorate,” “to perform” or “to have or participate in a party, drinking spree, or uninhibited good time.”
The act of sex, standing alone? It can’t make love happen and honestly, believing otherwise is how a lot of people find themselves getting…got.
What do I mean? Tell me how in the world, you meet a guy, talk to him for a few weeks, don’t even know his middle name or where he was born and yet somehow, you choose to call the first time you have sex with him (under those conditions) “making love.” You don’t love him. You don’t know him well enough to love him. He doesn’t love you either (for the same reason). And yet you’re making love? How sway? Oh, but let that sex be bomb and those oxytocin highs might have you tempted to think that’s what’s happening — and that is emotionally dangerous. And yes, I mean, literally.
If I’ve said it once, I’ve said it a thousand times before, that one of the reasons why I like that the Bible defines sex between a husband and his wife is by using the word “know” (Genesis 4:1) is because, well, I think that is what celebrating love is all about — we know each other well enough to know that we love each other, we know each other well enough to know that we aren’t going anywhere, and that knowing is what makes us want to celebrate that union by getting as close to one another and bringing as much physical pleasure to each other as we possibly can…as often as absolutely possible.
To me, that is what the peak of physical intimacy is all about — and the people who choose to use the term “make love,” it should be seen through this type of lens. When this type of mental and emotional bond comes together via each other’s bodies, they are amplifying love, enjoying love, embracing love.
Making it, though? Chile, the love has already been made. Sex is just the icing on the cake.
Having Sex
GiphyA few nights ago, I found myself rewatching this movie called Four of Hearts (which you can currently view on yep, you guessed it: Tubi). It’s about two married couples — one that is in an open marriage and another that isn’t although they somehow thought that sharing a night with the other couple would be a good idea (chile). Anyway, as one of the partners found themselves getting low-key sprung, the one they fell for said in one of the scenes, “It wasn’t a connection. It was just sex.” JUST. SEX.
Listen, when you decide to let a man put an entire part of his body inside of you at the risk of potentially getting an STI/STD or pregnant (because no form of birth control is 100 percent except for abstinence), it can never be “just sex” (somebody really needed to hear that too). At the same time, though, I got the character’s point because, if one or both people do not love each other or even deeply care for one another and/or sex is treated as an activity more than an act to establish a worthwhile connection and/or you and the person you are sleeping with have not really discussed what you are expecting from sex besides the act itself — you’re definitely not making/celebrating love.
Not by a long shot. What can make things get a bit complicated, though, is you’re doing the same act that “love makers” do without the same mental and emotional ties…or (sometimes) expectations.
You know, back when I decided to put all of my business out there via the piece “14 Lessons I've Learned From 14 Sex Partners,” now more than ever, I am quite clear that most of those guys fell into the “having sex” category. I wasn’t in the type of relationship with them where “making love” even made sense; however, because I was friends with most of them, we weren’t exactly f-cking (which I will get to in just a moment) either. We had a connection of some sort for the bedroom yet not enough to be together in the other rooms of the house.
We were really attracted and curious, so we decided to act on that. Oftentimes, the sex was good and so we rationalized that “having sex” was enough because if the friendship was, eh, “sound enough”, that we could justify the physical pleasure.
And y’all, that’s kind of what having sex is — it’s the limbo (or purgatory, depending on your situation) between making love and f-cking. The thing about limbo ish is it’s a lot like something being lukewarm: it’s not really one thing or another which means that it can completely blindside you, if you’re not careful (and totally honest with yourself as well as your partner(s)).
So, if you are contemplating having sex, I really — REALLY — recommend that you figure out how you feel, what you want (outside of the act itself) and if you are prepared for what “not quites” can bring. My mother used to say that the consequences of sex don’t change just because the circumstances do — and there is some solid “wow” to that, if you really stop to think about it.
GiphyAnd finally, f-ck. Although most experts on the word (and yes, there are some) agree that its origin is rooted somewhere within the German language (although some say that it might’ve come from Middle English words like fyke or fike which mean “to move about restlessly” or the Norwegian word fukka which means “to copulate”), you might have also heard that it is an acronym that once stood for “Fornication Under Consent of the King”; and there is actually some data that is connected to that as well.
Legend has it that way back in the day, in order to keep reproduction rates where a particular king wanted them to be, he would instruct his residents to have sex with each other — whether they were married or not (hence, the word “fornication” being in the acronym). However, because sex outside of marriage was taken far more seriously at the time, residents had to apply for a permit to participate so that the king could determine if things like their occupation and lineage would prove to be beneficial for the kingdom overall. F-ck: no love; just necessity. And although some believe this to be more myth than fact, what is certain is it was only over time that f-ck was seen as a profane/swear/cuss word — a word that was perceived to be so offensive, in fact, that between the years 1795-1965, it didn’t even appear in dictionaries.
Personally, when I think of this four-letter word, the first thing that actually comes to my mind is animals. Take a dog being in heat, for instance. That’s basically when a female dog is ovulating and wants to have sex the most. It’s not because they are “in love” with another dog; they are simply doing what instinctively comes to them — and since animals do not reason or feel at the same capacity that humans do, although they science says that many of them do experience pleasure when they engage in their version of sexual activity, it’s not nearly as layered or even profound as what we experience.
Let’s keep going. Another reason why f-cking makes me think of animals is due to the doggy style position. Hear me out. Ain’t it wild how, most of us pretty much know that the term comes from how dogs have sex, even though most animals have sex that same way — and think about it: Doggy style doesn’t consist of making eye contact or kissing while having intercourse. It’s “hitting from behind” without much emotional energy or effort at all. Just how animals do it. And so, yeah, f-cking does seem to be more about pure animal — or in our case, mammal — instinct. I don’t need to feel anything for someone, so long as the sexual desire is there. Hmph.
Something else that I find to be interesting about f-cking is how dictionaries choose to define it. Many of them are going to provide you with two definitions: “to have sexual intercourse with” and “to treat unfairly or harshly (usually followed by over)” and that definitely makes me think of another term — casual sex and words that define casual like apathetic, careless and without serious or definite intention. So, the dictionary says that while f-cking is about having sexual intercourse — just like making love and having sex is — it goes a step further and says that it can include being treated unfairly or harshly.
And although that can make you think of assault on the surface, for sure — sometimes being treated unfairly or harshly is simply feeling like someone had sex AT you and not really WITH you; instinct (i.e., getting off) and that’s about it. Yeah, the way this puzzle is coming together, f-cking seems to be more about lust and self and not much else.
Now That You Know the Difference, What to Keep in Mind
Y’all, this is definitely the kind of topic that I could expound on until each and every cow comes home. That said, here’s hoping that I provided enough perspective on each act to close this out by encouraging you to keep the following three things to keep in mind:
1. Before you engage in copulation, be honest with yourself about what you’re ACTUALLY doing — and that your partner agrees with you. You know, they say that our brain is our biggest sex organ and honestly, breaking down the differences between making love, having sex and f-cking helps to prove that fact. I say that because, although the sex act itself is pretty much the same across the board, you and your partner’s mindset can make the experience completely different. That said, if you think that you are making love and they think y’all are just having sex — stuff can get pretty dicey. Bottom line: communicate in the bedroom before attempting to connect outside of it. It’s always worth it when you do.
2. Yes, you can feel one way and do something else. I can just about guess what some of y’all are on: Shellie, we can love our partner and still just want to f-ck. If what you are saying is you can emotionally love someone and physically lust them and want to act sometimes on the lust without really factoring in the love — yes, I agree. Doggy style continues to be a favorite sex position for people, in general, and I’m more than confident that many of the participants polled are in a serious relationship. However, having lust-filled sex with someone who you know loves you is vastly different than doing it with someone who you have no clue what they think about you or you barely know at all. Y’all, please just make sure that you know…what you should know. Sex is too amazing to have a lot of regret after it.
3. Have realistic expectations about sex. Listen, so much of my life consists of writing and talking about sex that I will be the first one to say that it deserves a ton of props for what it is able to do, in a wonderful way, for people mentally, emotionally and physically. Yet again, I’m not a fan of “make love” because something that feels really good doesn’t always mean that it is good for you. Meaning, you’ve got to be real about what sex with someone will do to your mind and spirit — not just what it will do for your body. An author by the name of Gabriel García Márquez once said, “Sex is the consolation you have when you can't have love.” For no one, should this be a constant norm. Feel me? I hope you do.
____
One act. Three very different experiences.
It’s kind of wild that sex has the ability to create that — and yet, clearly, it does.
Please just make sure that you know which experience you’re signing up for.
So that you’re having sex (you know, in general) instead of sex having you. Real talk.
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