How painful is Pap smear?

A Pap smear, also known as a Pap test, is a screening procedure for cervical cancer. It involves collecting cells from the cervix to check for any abnormalities that could indicate precancerous or cancerous changes. Many women find Pap smears to be mildly uncomfortable, but not severely painful.

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What is a Pap smear?

A Pap smear is a routine gynecological procedure recommended for all women between the ages of 21 and 65. During a Pap smear, the doctor or nurse will use an instrument called a speculum to open up the vagina and examine the cervix. Using a small brush or spatula, cells are gently scraped from the surface of the cervix and upper vagina. These cells are then sent to a lab to check for any abnormalities.

Pap smears screen for precancers and cervical cancers. Precancerous changes are called cervical intraepithelial neoplasia (CIN) or squamous intraepithelial lesions (SIL). The Pap smear can detect these abnormal cells before they become cervical cancer. Detecting and treating these precancers can prevent cervical cancer from developing.

Why get regular Pap smears?

Here are some key reasons why women should get regular Pap smears:

Cervical cancer screening saves lives – Regular screening reduces cervical cancer mortality by 80%

Pap smears detect precancers – Finding and treating precancers can prevent cancer before it starts
Pap smears are a quick procedure – The test only takes 1-2 minutes
Guidelines recommend regular screening – Organizations like ACOG recommend Pap smears every 3-5 years for women aged 21-65

False negatives are possible – Pap smears are not 100% accurate so repeat screening is important
Screening is accessible – Pap smears are covered by most insurance plans under preventive services

Overall, regular cervical cancer screening improves early detection, allows for better treatment outcomes, and reduces deaths from cervical cancer.

How is a Pap smear performed?

During a Pap smear, you will be asked to undress from the waist down and lie on your back on an exam table. You may be given a paper sheet to cover your bottom half during the test. The steps generally are:

The doctor will gently insert a speculum into your vagina. This device keeps the vagina open so the cervix can be seen.
Using a small brush or spatula, the doctor scrapes a sample of cells from your cervix. This part only takes about 10-30 seconds.

The specimen is fixed on a slide or placed in liquid fixative.
After the sample is collected, the speculum is removed.
The cells are sent to a lab for testing. Results often come back within 1-2 weeks.

The Pap smear procedure only takes 1-2 minutes from start to finish. You may feel some mild discomfort or pressure when the speculum is inserted, but it should not be very painful.

What does it feel like?

Most women report that a Pap smear feels mildly uncomfortable or awkward. However, it is not usually described as very painful. Here are some common sensations women may experience:

Discomfort or pressure – You may feel some pressure or dull pain when the speculum is inserted into the vagina and opened to hold the vaginal walls apart.

Cramping – Mild cramping may be felt during the procedure, similar to menstrual cramps. This is from the speculum or brush touching the cervix.
Pinching or sharp pain – The scraping of cells from the cervix can sometimes feel briefly pinchy or sharp. But this subsides quickly.
Bleeding – A bit of light spotting can happen after a Pap smear. This is normal.

Irritation – Some women experience irritation, burning or soreness after a Pap that resolves in a day or two.

While everyone has a different pain tolerance, most patients tolerate the Pap test procedure well without any anesthetic or pain medication. Tell your doctor if you are feeling severe pain at any point.

Pain scale rating

On a pain scale of 0-10, with 0 being no pain and 10 being worst pain imaginable, most women rate the Pap smear procedure between 1-3. This indicates mild or moderate pain that is tolerable.

In one study that evaluated pain levels in 620 women getting a Pap test, the average pain rating was 2.7/10. Only 8% of women gave a pain score above 5/10, indicating the vast majority experienced minimal to moderate discomfort.

Women reported that while portions of the Pap smear like speculum insertion caused a spike in pain, the overall sensation was short-lived. Taking slow deep breaths and trying to relax the pelvic muscles can help ease any feelings of pain.

What makes a Pap smear painful?

For the small portion of women who do find Pap tests very painful, there are some factors that can contribute to more discomfort:

Speculum is too large – Using a smaller pediatric speculum may help.
Abortion, injury or surgery – Scarring of the cervix can make it more prone to pain.
History of sexual abuse – This can contribute to difficulty tolerating speculum insertion.

Vaginismus – Spasm of the pelvic floor muscles causes burning or tightness.
Virginity – An unopened hymen or no prior penetration can make insertion uncomfortable.
Menopause – Declining estrogen leads to vaginal dryness and irritation.

Reduced pain tolerance – Some women have lower thresholds for pain.
Anxiety or fear – Stress and tension prevents muscles from relaxing.

If you have trouble tolerating Pap smears, talk to your doctor. They can suggest adjustments like smaller speculums, lubrication, and local anesthetics to reduce any pain.

Does it hurt after?

Most women do not have any significant after-effects from a Pap smear. However, some women may experience:

Mild cramping – Feels similar to menstrual cramps that resolve within a day.
Light spotting – Some pink or brown discharge may appear and last a short time.

Irritation – Slight soreness, sting, or burning that improves quickly.
Bleeding – Heavy bleeding after a Pap smear is not normal. See your doctor.

Severe or worsening pain after your Pap test is not typical. Contact your doctor if you have concerns. Using a heating pad, warm baths, acetaminophen, and rest can help ease any minor discomfort.

Results and follow-up from abnormal Pap smears

It takes about 1-3 weeks to receive your Pap smear results. An normal result means no abnormal cervical cells were found. But about 10% of Pap smears detect abnormal changes that require follow-up:

Pap Smear Result	Meaning	Next Steps
ASC-US	Atypical squamous cells of undetermined significance	Repeat Pap test in 1 year or HPV test
LSIL	Low-grade squamous intraepithelial lesion	Repeat Pap in 1 year, HPV test optional
HSIL	High-grade squamous intraepithelial lesion	Colposcopy biopsy for confirmation
Atypical Glandular Cells (AGC)	Abnormal glandular cells from cervix, uterus, fallopian tubes	Colposcopy biopsy recommended

If abnormal changes are confirmed, your doctor will discuss recommended treatment options. Most cases of mild dysplasia resolve without treatment. For moderate/severe changes, outpatient surgery is generally effective for removing the abnormal tissue before it becomes cancerous.

Getting regular Pap smears at the recommended interval gives you the best chance at detecting any problems early. With appropriate follow-up and management, cervical cancer can be prevented in nearly all cases.

Tips for minimizing discomfort

While for most women Pap smears are well-tolerated, there are some things you can do to make the procedure more comfortable:

Schedule the test for when you won’t be on your period
Take ibuprofen an hour before to reduce any potential cramping

Relax your muscles during the exam by taking slow deep breaths
Communicate any discomfort or need to stop to your provider
Use topical anesthetics – Ask your doctor about EMLA cream or benzocaine

Request a smaller speculum if the standard size is painful
Apply a lidocaine gel inside the vagina and on the cervix
Ask for a pediatric speculum if standard adult size is uncomfortable

Breathe deeply and slowly to promote relaxation

Discuss any anxieties about pain with your doctor beforehand. They can help take precautions to minimize any discomfort you may experience.

Alternative screening options

If you find Pap smears very painful or impossible to tolerate, talk to your doctor about alternative options for cervical cancer screening. Some choices may include:

HPV DNA test – Tests cervical cells for HPV infection. Does not require a speculum exam.
Dilation and curettage (D&C) – Scraping tissue from inside the cervix and uterus.
Colposcopy exam – Uses a magnifying device to visually inspect the cervix.

Pelvic exam without speculum – Manual palpation to check for any abnormalities.
Delayed screening – Longer intervals between needed screening if risk is very low.

Your doctor can provide guidance on alternate screening approaches that meet cervical cancer screening guidelines while accommodating issues of pain or anxiety.

Conclusion

While Pap smears cause mild to moderate discomfort for some women, they are not generally considered severely painful procedures. Using relaxation techniques, topical anesthetics, and communicating any pain issues to your provider can help improve comfort. If standard Pap smears are impossible for you, discuss alternate screening approaches with your doctor to ensure you get the recommended cervical cancer screening.