A Plea For The Pap Test
By A.Z., an early 30s former NY-er who loves going on long walks with her dog.
In 2017, I went to my OBGYN for my annual Pap test. To my surprise my doctor told me that I didn’t need to get screened because the guidelines had changed to every three years. Since my previous tests had been normal, I was told that I could wait three years for my next Pap smear. The practitioner calmly explained that the current research showed that they were administering unnecessary annual Pap tests to women. I was frustrated to hear her say this because three years is a long time. How will they know if my cervix is healthy? She administered a physical exam and told me to wait until 2019–three years after my initial ”‘normal” test result.
Three years is a long time for me because when I was in my early 20s I experienced some irregular spotting for some months and my healthcare provider at the time recommended that I get an intra-vaginal ultrasound and a colposcopy. I don’t recall all of the details as to why, but I was very worried as it was my first serious medical procedure. My thoughts were: I’m too young to be tested for cancer, I don’t have any STDs, I got the gardasil shot my freshman year of college, and I just started having sex like two years ago, why is this happening to me?
The ultrasound showed that I had a small cyst in my left ovary that my doctor said would probably go away on its own over time. Then I had to have a colposcopy where another doctor took a biopsy of my cervix to test the cells. She was kind and asked me what I did for work and then she took a skinny knife to my cervix to cut a teeny sample off. It is a painful experience that feels like being cut from the inside. I felt fragile when it was over. I then had to wait a few weeks to be told in-person by a medical assistant that my cells were healthy and not cancerous. I was elated at this news, but this experience showed me that even if I try to do what’s right to protect my reproductive health I can’t control everything about my body.
Fast-forward to 33 when my doctor in New York City tells me that the annual Pap tests are unnecessary. Unnecessary for doctors or patients? When I told her about my biopsy in my early 20s, she said as long as my most recent Pap test is normal, and I’m not experiencing anything out of the ordinary that I should still wait. I scheduled another Pap a month later and was told the same thing, so I resolved to wait. (When I told a friend this, she recommended that I go see a new doctor all together).
A Pap test (also known as a Pap smear) is a screening test for cervical cancer. A doctor or nurse practitioner will swab the cervix and then send the sample to a lab to detect if the cervical cells are precancerous or cancerous. Prior to 2012, the recommendation was to start testing at age 21 regardless of sexual activity. Today if a patient in their 20s has a “normal” Pap test and doesn’t have HPV, they can get screened every three years depending on their history. For a person who is 30-65, it is recommended that they get a Pap test every three years, and an HPV test every five years; or both a Pap and HPV test every five years.
HPV (Human Papillomavirus) is a sexually transmitted virus that is very common and can spread through intimate skin-to-skin contact with someone who has the virus. According to the CDC, nearly everyone will get HPV at some point in their lives. There are high-risk strains of HPV that can lead to cancer in both men and women, as well as low-risk infections that the body can fight. Most people (9 out of 10) clear the virus within two years.
I finally got my Pap test in 2019, it was normal, but I tested positive for HPV for the first time. It was then recommended that I have a colposcopy done, and see if I needed a possible biopsy. I was able to take a pain reliever before the procedure, but I still felt the sharp stinging pain from the knife and experienced intense cramping. My doctor painted a liquid bandage that would help stop the bleeding and help me heal from the procedure. It felt like she was using a nail polish paint brush to apply the coat of antiseptic to my cervix. The doctor recommended that I not exercise or lift anything heavy for at least a week because I was going to be sore. A few weeks later the results of the biopsy showed some concerning cells, which she said that she would recommend having a LEEP procedure done. She said that there is a chance that my body will clear those concerning cells. Since I am still young and healthy, and I haven’t had kids, she recommended that I get a Pap test in six months to see how I’m doing before scheduling to undergo a LEEP procedure.
Six months later my Pap test was normal, but I had to have another colpo/biopsy to check those concerning cells. After the colpo/biopsy, I received a call from my practitioner’s receptionist saying that the cells were benign and that I tested negative for HPV. I cried, telling the receptionist “this is great news.”
I’m back to having an annual Pap test which is where I want to be. Along this medical journey I consulted an acupuncturist, talked to my close friends, and even opened up to my parents about what was going on with my health. I felt less isolated and more supported, which empowered me to slow down, get enough rest, and advocate for my body.
What can you do to prepare for your next OBGYN check-up? Ask questions. Ask if these routine guidelines are what’s best for you. Talk to your doctor about your medical history and be sure to include any health changes, and get checked regularly for STIs/STDs if you’re sexually active. Also, a Pap test and an HPV test can both screen for cervical cancer and you can discuss which options are best for you.
The American College of Obstetricians and Gynecologists
How Often Should You Get a Pap Smear?
Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society