microscope looking at a pap smear sample
Illustration by Marta Pucci

Tense When Getting a Smear?

Photo of Dr Katherine Hertlein
Reviewed by Dr Katherine Hertlein,
created by Blueheart
created by Josh Green
created by Sophie Browness
Date published:
8/1/2022
Last updated:
8/1/2022
Photo of Dr Katherine Hertlein
Reviewed by Dr Laura Vowels,
created by Blueheart
created by Josh Green
created by Sophie Browness
Date published:
8/1/2022
Last updated:
8/1/2022

If you've ever experienced fear and anxiety about cervical cancer screening you’re not alone. You might be feeling anxious about the outcome of the Pap test itself or just tense about the process of cervical examination.

Many women feel nervous. That's normal.

Some feel uncomfortable about being touched intimately by medical professionals. They may have had a bad experience with cervical smears previously. This anxiety can lead to fear, which makes your whole body tight. And when your body is tense, your vaginal muscles clam shut, which is literally the worst way to prepare for having a vaginal speculum inserted. This process can feel traumatic.

If Pap smears are painful and unpleasant for you, your mind will make connections which can leave you with a bad association around your body being touched. Letting this seep into your personal life can have a harmful effect. But there are things you can do to take control. 

So we have pulled together some resources to help you feel at ease while getting a smear.  Following these tips can help to minimize the impact of this treatment and prevent you carrying discomfort forward into your intimate life.

What is a Pap test and why have it?

Knowing what to expect from your test is useful. Understanding what awaits you at the gynae clinic means you can be mentally and physically prepared to help your body relax. 

A Pap test involves a healthcare professional using a vaginal speculum to take a sample of cells from the cervix to check for the presence of abnormal cells. Cervical cancer is one of the most aggressive types of cancer, and early identification of the growth of cancer cells can prevent the treatment of cancer ever becoming necessary. 

Despite widespread awareness of the importance of checking for abnormal cells, many women feel nervous about attending their regular Pap test. Yes, cervical screening is uncomfortable but it can also provide a high level of protection. It works by detecting precancerous cells, especially when combined with Human Papillomavirus (HPV) screening. This is often a cause of cervical cancer spread through anal or genital contact. 

Most healthcare providers advise that smear tests are best started around the age of 21 but should be carried out by all women, even after menopause. They give you with the best protection by looking for cervical cells which could develop into cancer if left untreated. 

Whatever your age, Pap smears shouldn't be missed even if you feel anxious about it. There are ways to help you prepare in mind and body as this treatment could save your life.  

No-one is suggesting that smear tests are fun but preparation ahead of your appointment can reduce the fear you may feel.

You may find it useful to book an appointment with your nurse or GP beforehand to raise any questions and express your concerns. Ask your physician to explain step by step what will happen during your appointment.

Outline from the moment they come into the room, who will be present, how the procedure will be carried out and exactly what to expect. Talking it through and asking questions can help you eliminate your fear of the unknown.

If you've previously had a bad experience with any kind of screening or experienced sexual violence, sexual assault, trauma or pain, it can feel even worse. Ask the health team for their advice on how to deal with your psychological trauma and anxiety. You might want to request extra time for your appointment or ask specifically for a female doctor or nurse. 

Practical tips for your test 

There are things you can do to arrive prepared on the day. Try to avoid having your smear during your period as blood cells can affect cell samples and alter the accuracy of the results from the laboratory.

Also think about what to wear. You will be asked to remove your undergarments and clothing from the waist down before lying on the examination table. Choosing a skirt can be a modest option to help you feel less exposed and more relaxed. 

What to expect at your appointment

Your nurse or doctor will start by putting you at ease. They will take a brief medical history. They may make notes on your menstrual cycle, ask about any issues with your reproductive organs or yeast infections, and ask if you have any concerns. This is all perfectly normal. 

You will be invited to lie back on an examination table with bent knees so the nurse can reach your cervix more easily. 

The healthcare practitioner will usually use some lubricant to counteract vaginal dryness and slowly insert a speculum, either plastic or metal, into your vagina. They will open the speculum slightly and use a small implement to gather cervical cells for examination. 

Once the cell sample is taken, they will leave the room to allow you to get dressed in private. 

How to relax during your smear

If reading about this procedure makes your body tighten with anxiety there are a few things you can do to help you relax before, during and after your screening.

Practice relaxing and tightening your pelvic floor muscles in the days and moments before.  The nurse will tell you exactly what they are doing so you can get ready to focus on your breathing and relax your vaginal muscles ready for speculum insertion. Focusing on these tasks takes your attention away from what's happening to help calm your mind and relax your body.

Embrace positive inner talk as you do so. Tell yourself how well you are doing in valuing your body and taking care of it by making sure any cell changes are caught early and you can avoid cancer treatments.

Focus on a picture or window on the wall and practice square breathing. Let your eyes work around the frame focusing up, across, down and around the sides of a picture or window. If there isn't one you can imagine it. Inhale for four, hold for four, exhale for four, then rest for four. This is a brilliant way to reduce stress and lower your heart rate through breathwork.

Try distraction. Watch a video clip or listen to music on your phone. You are replacing  discomfort with a positive sensory experience in fixing on something you love. 

Use Sensate focus learnings

This is a way of carrying forward the concept of Sensate focus therapy we share to associate good and relaxing experiences with touch. You can use these tools to reduce any negativity or anxiety that you associate with touch. During the process, think only about the texture, temperature and pressure you feel.

Pay attention to the positive in the whole experience and simply focus on what feels good.

Once you've learned how to relax for a pelvic exam, you should treat yourself to something you love. Go out for dinner or take a long walk. However you want to celebrate facing your fear and making a Pap smear easier.

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