Pap Smears and Sexual Health – A Conversation with Dr Carmen

“Aren’t pap smears for like… old people?” My exact reaction! 

Over the Summer break, I went for a check-up at my family GP, so that she could check that I had been adjusting to the pill, which I started at the beginning of 2019. During my consultation, she asked if I knew what a pap smear was, and that I was ‘eligible’ to have one. 

Besides the few Cosmo snapchat stories I’d read, I didn’t really know much about the procedure and its importance. After chatting to a few of my friends it turns out NEITHER DID THEY! Some of them hadn’t even heard of it, until I’d asked them if they had gone for one. 

I was quite taken aback by how many women, me included, had so little information on a procedure that could have a huge impact on your sexual and reproductive health. I reached out to Dr Carmen James to learn more about what the ‘mysterious’ pap smear was all about.

Dr Carmen James is a general practitioner and certified health and wellness coach, with further certifications in integrative medicine, which takes a holistic approach to healing. Dr Carmen is “passionate about educating and empowering others on how to live a healthy lifestyle,” which she achieves through keynotes and interactive workshops held privately and publicly for schools, places of worship and corporate clients. Apart from being an all-round awesome human, Dr Carmen has an active Instagram and YouTube account that create a positive and safe space for learning about wellness and health from acne, sleep deprivation and self-love, to PCO’s and endometriosis, which I enjoy learning from.

So, lets get down to the nitty gritty!

What is a pap smear test?

Dr Carmen: A pap smear test is a procedure performed in women in which a small brush or spatula is used to collect cells from the cervix (the entrance or mouth of the womb). The cells are then examined under a microscope to look for abnormal cells which may develop into cervical cancer if not treated appropriately.

Why is it done?

Dr Carmen: The pap smear is used to screen for cervical cancer – a common type of cancer in women which is the leading cause of female cancer deaths in South Africa. Cervical cancer can usually be prevented by early detection of abnormal cells on a pap smear. The test is able to detect “pre-cancerous” changes in the cells of the cervix. These changes are abnormalities that occur in the cells of the cervix before cancer fully develops. 

The pap smear test is also helpful to detect infections, including some sexually transmitted infections, and inflammation of the cervix. HPV or Human Papilloma Virus infection is often associated with cervical cancer. This is a group of viruses that can cause warts, including genital warts. There are many different strains or types of HPV. Strains 16 and 18 are the most common types associated with the development of cervical cancer. In addition to examining the cells for abnormal changes, it is now possible to test for HPV DNA which enables practitioners to determine whether high risk strains like HPV 16 or 18 are present in the sample.

How often it needs to be done and why?

Dr Carmen: The recommendation for how often pap smear should be performed has been reviewed and changed over the years. The current recommendation is that routine screening pap smears be performed every 3 years in “low risk” women.

What is a low-risk or high-risk woman?

Dr Carmen: This includes women with no symptoms (abnormal bleeding, offensive vaginal discharge etc.), and who have had normal pap smears before. More frequent testing is advised in women who are considered to be at high-risk for cervical cancer, including the HIV positive population, women with reduced immunity, sex workers and those with abnormal cells detected on previous pap smears.

Is there a certain age one should do a pap smear?

Dr Carmen: Pap smears are performed in women over the age of 21 years, or 3 years after their first sexual intercourse, regardless of sexual orientation. The test is discontinued over the age of 65, provided no abnormalities have been detected on prior tests.

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My GP, who is fairly old recommended that once you’ve had sex, a pap smear should be done every year, even though I’m under 21, have not been sexually active for three years, and have no history of cervical cancer in my family. This makes me a generally low-risk woman.  However, as Dr Carmen said, the recommendations regarding age and how often one should be tested have been “reviewed and changed over the years.” Different general practitioners may have varying opinions or could still be using an older frame of reference

I was a bit worried, at first, that I had done a pap smear too early, but Dr Carmen reassured me that there was really no harm in doing the test. However, because I am a low risk woman she wouldn’t, generally, recommend me doing the test every year. So, if you’re in a similar situation, there is nothing to worry about. Chat to your GP or gynaecologist about what you’ve heard and come to an understanding. There’s no need to be scared when it comes to your sexual health.

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What is the general procedure? (walk through)

Dr Carmen: The test is performed while lying down with the knees bent and legs apart. A lubricated plastic or metal speculum (a device shaped like a bird’s beak which is used to open the vagina) is then inserted into the vagina in order to visualise the cervix. A small brush or spatula is then used to gently scrape in and around the cervix to obtain a sample. The speculum is then removed, and the sample is either smeared on a slide or the brush is sent in bottle to the lab. The procedure is usually performed within a few minutes, provided that the cervix is visualised easily. 

How much is it?

Dr Carmen: In South Africa, pap smears are available free of charge at public primary health care clinics. Most medical aids cover the cost of pap smears as part of their screening or preventative benefits. The cost of the test, if performed privately, varies from lab to lab and is also dependent on the doctor’s consultation fee and possible additional charges for performing the test. On average, a pap smear could cost anything from R500 to R2000 – all inclusive. In addition, should your practitioner request HPV DNA testing, the cost will increase dramatically.

Do you need to prepare or abstain from anything before the test?

Dr Carmen: Pap smears should not be performed while menstruating. The following should also be avoided 2 days prior to testing:  

• Sexual intercourse
• Tampons
• Douching
• Vaginal creams, jellies or medications 

Does it hurt?

Dr Carmen: The pap smear can be uncomfortable; however, it should not be painful. Women who experience pain are usually very tense during the procedure. In addition, those who experience pelvic pain or inflammation in the genital area may also experience more pain or discomfort during the test. 

Now that you gals are more acquainted with what the hay a pap smear is, be sure to check in with your gynaecologist or GP if you are due for a pap smear and, especially, if your family has a history of cervical cancer or you fall into the high-risk column.  It’s important to take responsibility for your sexual health. Also, don’t be afraid and if you’re not open about your sexuality you can always get a friend to tag along, if you’re not comfortable telling your parents. Your sexual health is a major part of your life, so spread the word and share the article to your girl squad (yes, that whatsapp group!!) or your family. Taking responsibility for your sexual health is absolutely nothing to be embarrassed or ashamed of and neither is sharing your experiences with the women and men around you. 

I hope this article helped, and a big shoutout to the amazing Dr Carmen for providing us with this information about our sexual health!

“I believe that our health is our wealth and I am on a mission to help others to live a healthy, happy life.” – Dr Carmen James

• feminine health