PAINFUL PAP SMEAR EXAM

There is an alternative to these uncomfortable exams, self testing for HPV. Most women are HPV negative and cannot benefit from pap testing, but many countries do not have evidence based screening and still use population pap testing (and over-screen) and this means frequent pap tests with the high risk of false positives and potential harmful over-treatment. The States and Australia seriously over-screen women sending risk way up - the more often you screen, the more likely you'll produce a false positive, and there is no difference in terms of benefit between 2 and 5 yearly testing. No country in the world has shown a benefit pap testing those under 30, but this group produce the most false positives. The Finns have the lowest rates of cc in the world and refer far fewer women for colposcopy/biopsy; (fewer false positives) since the 1960s they've offered 7 pap tests, 5 yearly from 30 to 60. So this is not new evidence. The Dutch have the same program, but the Health Council of the Netherlands has recommended scrapping population pap testing and moving with the evidence, the new program will be 5 hrHPV primary triage tests (or self test) at ages 30,35,40,50 and 60 and only the roughly 5% who are HPV+ and at risk will be offered a 5 yearly pap test. These are the only women who can benefit from pap testing. This will save more lives and spare the vast majority of women from a lifetime of unnecessary pap testing with the high risk of excess biopsies and over-treatment. Women will have to demand HPV primary testing and HPV self testing, unfortunately, there are powerful political and vested interests in women's healthcare that will keep population pap testing and excess in place for as long as possible. Most women cannot benefit from pap testing (they're HPV negative) and are enduring 15-26+ pap tests unnecessarily and many end up being over-treated. HPV negative women should simply be offered infrequent HPV primary testing or self-testing for those who prefer it. Those no longer sexually active and HPV negative might choose to stop all further testing. The lifetime risk of cc is 0.65%, it's rare, always was and was in natural decline. There was never a need to harm so many, to help so few as Finland and the Netherlands have shown....the self testing device is also being used in Singapore, Malaysia and elsewhere. Countries that over-screen will be reluctant to adopt evidence based screening and give women a self-test option...enormous amounts of money are made from well-woman exams and over-treatment. It will be up to individual women to refuse the excess and lobby for something better, in the best interests of women. I'm 54 and have never screened, I made an informed decision as a low risk woman, my risk of cc is near zero, the risks were too high for me - here in Australia women are seriously over-screened and the lifetime risk of referral is a huge 77%...most of this is avoidable with evidence based testing. (The States would have a similar referral rate or higher as some of your women are still having annual pap testing) I know some American doctors do HPV tests AND pap tests, this is unnecessary and creates confusion and generates the most over-treatment/over-investigation, the HPV primary test should stand alone. The routine pelvic and breast exam are not evidence based and are not recommended here and in many other countries. The CBE - no evidence of benefit, but it leads to excess biopsies. RPE - poor clinical value in symptom-free women, it is not a screening test for ovarian cancer and it carries risk, even unnecessary surgery. Your Dr Carolyn Westhoff partly blames this exam for your high hysterectomy rates and for the loss of healthy ovaries, both more than twice the rate of countries who do not do routine pelvic exams...you'll find her articles online, Hope this helps some of you. HPV Today, Edition 24, sets out the new Dutch program. Delphi Bioscience site provides information on HPV self testing

I just had a pap smear today and it wax excruciatingly painful. It felt like she was stabbing me with a needle on my cervix. I have bleeding too as a result. I was screaming and swearing during this ordeal and then had a good sob afterwards. I felt so weird like there was something wrong with me, but reading these posts has helped me alot to realize that this can be common. I am 55. Next time I will need to go in with a few shots of whisky and a valium to help me relax. Because without that, I just can't go through that again!

how hard is it for a doctor to explain the info. above to their patients? I know I would have benefitted from a brief explanation..thank you!

I am 47 and went through early menapause 3 years ago. My previous doctor chose not to give me Hormone Replacement Therapy. The hotflashes, Insomnia and other menapausal symptoms have become unbearable. The symptoms are dibiitating and destroying my life.  Sex is painful. So of course the Pap Smear was excruciating. I have been through every kind of infertility treatment and test there is and I have never experienced something as bad as this. I have had children. I do not think this is something that makes a difference of having a baby or not. At the appointment my doctor could not complete the pap smear. She said the cervix was too dry. She gave me a prescription for Estrogen and Progesterone. Then she gave me a suppository cream to help with the dryness. This is what worked for me.

For those of you who have not had sex in many years, it is understandable that the paps would be bad. It's likely that if you attempted sex, it would too be painful if paps are painful.  If you read all of the posts they are ALL from post menapausal women. Vaginal dryness is different from cervical dryness. Also, aren't other parts of your skin drying also? (i.e. face, scalp, elbows, eyes, etc). If your exterior skin is drying due to menapause, then it only makes sense that your interior skin is also drying.

Good Luck to all of you and all future readers of this thread. Try HRT, it is a miracle.

Please don't assume your experience is everyone's experience. We are not wimps or children. I've had PAP tests that did not hurt (when I was younger), PAP tests that were mildly uncomfortable, PAP tests that were painful and the most recent one that hurt like H--L. I shouted "OW, OW, OW!" quite involuntarily. I'm pretty sure I looked like I might go into shock as the nurse started watching me very carefully and the doctor asked me not to sit up right away when he was done. I don't want to use any hormonal creams given the increased risk of cancer. Years ago a local drug store used to sell a "surgical lubricant" that had an anesthetic in it. I'm planning to ask the doctor about that as well as the idea of a thinner instrument.

I've had the same experience of paps becoming increasingly painful as I approached menopause and since I reached menopuase. And it's very regretable that not a single gyn I saw ever bothered to explain why! Which made me feel like there was something wrong with me. Here is what I know now and along with a few suggestions that might help (though in my experience, nothing really helps much:

1. Ask the doctor to use a pediatric speculum.

2. Ask them to open the speculum slowly (though they will need to open it enough to get the tool in to get tissue samples).

3. Understand that if you are post menopause (or approaching menopause) your vaginal tissue is thinning and becoming more dry, which is part of what is causing the pain. A local estrogen product used a couple of weeks leading up to the exam can help. And I you're having general issues w/dryness and cutting glass-like pain, it can be helpful to use on an ongoing basis. (There is a pill form of the suppository called Vagifem. There is also a cream form. But the pill form is the lowest dose you can use and is usually prescibed to be used 10 mg (1 pill) 2x/week). There is usually a period of 2-3 weeks leading up to that when it is prescribed to be used daily. It's highly effective because it puts the estrogen exactly where it's needed, the dose is incredibly small, and the amount that gets absorbed into your system is minimal.

4. Once you hit menopause, the cervix starts to close. If you've never had children, it will be even harder and tighter. This means getting a tissue sample is very difficult = painful. I recommend using a gyn and not a primary care doctor for paps or phv tests once you are at this stage of life since primary care doctors perform this procedure less often and may be less skilled at getting enough tissue which will mean you have to go back. ARGH!

5. If you don't have intercourse often, if at all, the opening to your vagina will become more constricted. If you use a product like Vagifem along with diliators, you can work on opening it more over a period of time.

6. If you are around menopause or post-menopause, are in good health, and don't have a family history that puts you in a high risk group for cervical cancer, you should only need to have a pap and/or hpv done every 3 yrs. However, we all need to have pelvic exams annually. A speculum is used for those, as well, but the doctor doesn't need to open it as wide as for a pap.

7. Pray. Breathe. Bring music. Remember it will be over in less than 10 minutes, even if it feels like an eternity. Treat yourself to something nice after the appointment. And remember that what you're experiencing is very normal, if not quite painful.

Sorry for typos in my post. And one more idea: Your body position can make a slight difference. Most doctors have us laying completely flat, but it helps a little (emphasis on "little") if your torso is propped up a bit. Also, it can help relax the leg muscles if instead of having stirrups for your feet (which is the common set up) there is a trough-like thing in which to rest your thigh (w/the calf just dangling). This helps you avoid tensing as you try to maintain that most awkward of positons because you can just let your legs relax. Very few gyn's have this, but some do and it's way better than the typical stirrup set up. Every little bit helps!

Not true.  My pap smear was painful the whole time.  The Dr used gel and was being gentle.  It felt as though someone was pinching and twisting the area all around my clitoris.  I was sweating and shaking.  Almost cried.  The relief was instant the moment that the speculum was removed.  That is the last time I will ever have a pap smear.

I am 36 and had a pap smear yesterday with a new gyno. It was the most painful experience I've EVER had at a doctor's office-- and this was after I told the doctor that the last pap I'd had 15 months before was very painful and caused me to bleed. I also told her I had not had sex in over 5 years and have never been pregnant. She used the smallest speculum she had and perhaps KY gelly (not sure). I screamed, literally. From the second the speculum entered my vagina it felt like the canal was being ripped open. I still have significant uterine and vaginal pain 30 hrs later.

Prior to the exam when she took my medical history I told her that I have: Hashimoto's Disease, Celiac's Disease, and am taking replacement cortef, T3 and T4, progesterone, DHEA, and pregnenolone due to idiopathic endocrinopathy. After the exam, I asked why it hurt so much and she said because I'm thin and perhaps because of my thyroid disease. I am not that thin. 140lbs-- I used to be much thinner as an athlete in high school and college and never had a problem with a pap smear then, much less blood and lingering pain afterward.

Can someone tell me how long my utuerus and vagina will hurt for?? What should I do? I'm a little leary about going back to her as she never mentioned vaginal atrophy, which it sounds like I maybe have given my very low hormone levels and infrequent periods even with hormone replacement.

Any help or response would be gratefully received. Thanks.

I had it done every to years regularly. It was always uncomfortable, but wasn't too bad. It has always been performed by the GP.Unfortunately this time I went to see a different GP who referred me to the nurse, claiming she was very nice and very experienced! What a load of bull! The nurse was nice, that's true, but experienced? Never felt such excruciating pain before!!! Like a truck was running through me! If you wanted to know which medical centre it was, it's called omega health centre, Cairns, the name of the GP is Jennifer, the nurse I can't remember.If you had a bad experience you should speak up, because it's NOT OK to be referred and treated by unprofessional butchers. I learnt it the hard way, when it comes to invasive tests, make sure you done your research before, not after like I did. Do not trust anyone, just because a GP said so.And speak up!

HI valmart...
Your post has been over a year but I couldnt stop my tear when I read your experience. It is same for me. I am 50 and I am soooooo freaked out of paps. God Bless. You might not need another pap in your life!

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I do not know what the hell causes this but dear god it really hurts. I had one yesterday after many years of avoiding it and I still hurt. The doc was really nice about it, but sheesh, not doing that again ever if this one turns out fine. That hurt!!

I'm 50, post-menopausal. Last had a pap in 2012. They've always been painful, so at that time I asked the gyno if she had a smaller speculum, but she said no. Needless to say, the pain was excruciating. It was so bad that I didn't want to get another. Unfortunately, my Mom recently passed away due to cervical cancer, so I went back today for a pap. This time I asked the nurse if they had a pediatric speculum. Thankfully she found one. When the dr. Came in I told her to lube it up. The experience was night and day. 

My last pap smear was absolutely horrendous. Horribly painful. So much so that I tensed so hard from trying to deal with the pain that I hurt my back. So now I'm in chiropractor treatments. I'm only in my lower 30s. I've experienced painful ones but never like this. I feel so tramatized and angry and hurt. The worst part is thinking of having to do this again next year.

I went to the veterans clinic in Galveston for pap smear and it hurt so bad from the very start she did insert the speculum. I never had this kind of pain before eith male gynecologist specialist. I'll never have another pap with that LADY Doctor again, if i ever go I would go to an ob-gyn specialist.