All Your Most Personal Pap Smear and Pelvic Examination Questions, Answered

by Dr Tina Ashrafzadeh D.O.

This has been a record-breaking year for women. Women all over the world are making huge gains in leadership, business, political activism and more.

This is the year that the film Wonder Woman, directed by Patty Jenkins, a female director, broke records. Indeed, women are breaking glass ceilings every day. Female empowerment is vital and important for all of us as women ⏤ as sisters, mothers, spouses, partners, and friends. Empowerment of self in the business and professional world begins with the empowerment of Mind, Body, and Spirit.

This means understanding our health physically, emotionally and spiritually. Let’s begin with our physical health. Are you going to the doctor annually? Are you making sure to check in with your physician? Are you taking the steps to make sure you’re healthy inside and out?

One dreaded, but extremely important examination is the Pap Smear and Pelvic Examination. This is an examination of the cervix for cancer cells as well as a manual examination of the vagina, cervix, and ovaries for any abnormalities including but not limited to ovarian tumors, and cysts. Early detection is key to improved outcomes. The pap smear examination may also include a screening for High-risk HPV (Human Papilloma Virus).

Have questions? Lucky for you, I like to answer them. Ahead, I share my answers to all your pap questions.

WHEN? WHO DECIDES?

According to the United States Preventative Services Test Force (USPSTF), American Cancer Society (ACS) and the American College of Obstetricians and Gynecologists (ACOG), Women under the age of 21 are not recommended to get pap tests.

Pap testing is recommended to begin at age 21, and for women aged 21-29. This test is recommended to be done every 3 years. For women ages 30-65, the recommendation is co testing of Pap and HPV every 5 years. Women in this age group may also consider Pap test alone every 3 years. Women over the age of 65 are recommended to discontinue Pap and HPV testing if a history of Pap tests and screening have been negative. (Varies with history of previous Cervical Cancer). The High-risk HPV exam is done ordered when there is an issue with the pap test results.

WHAT ARE SOME QUESTIONS I MAY BE ASKED?

Last menstrual period: You’ll likely be asked when your last menstrual period (also known as LMP) was. It is important for your provider to know this info for many reasons, including giving insight into possible pregnancy status. In addition, it gives the provider information about the frequency of your periods. Be prepared to share if you are having heavy periods or periods that are very painful. Make notes if you’re having to bleed between periods. This is important information to share.

The Number of Sexual Partners: This allows your provider to understand and evaluate possible risks associated with Sexually Transmitted Infections, including HIV risk and exposure. Providers will ask about sexual relationships with men, women, or both. This is an opportunity to advocate for yourself and receive vital information about maintaining your sexual health. Ditch any sense of shame or hesitation and be completely candid with your provider.

Type of Birth Control Method Used: Again, the provider will be able to evaluate if you’re happy with your current method, and also make sure that the method used is providing adequate protection from Sexually Transmitted Infections including HIV. It is wise to prepare questions regarding satisfaction with the current method. Are you wondering about another method? Preparing a list of questions regarding your concerns is a wonderful way to aid your provider in giving you the guidance you need to empower this very important decision.

WHAT EXACTLY WILL BE DONE?

During a Pap Test, you will be in an examination room and asked to wear paper garments during the examination. The medical provider, physician, nurse practitioner, or physician assistant, will enter the room often with an assistant. The provider will use a medical device called a speculum which is inserted into the vagina. The speculum may be plastic or metal. This varies depending on the clinic. The purpose of this device is to create a visual opening for the provider to examine the cervix and vaginal walls. The provider will look to make sure everything appears healthy. Next, the provider will insert a small brush or spatula into the opening to evaluate the cells on the cervix. These cells are gently brushed or scraped from the cervix and placed in a specimen container. These cells are sent to a lab for evaluation of cellular health and to rule out abnormalities of varying degrees.

Once the speculum is removed, the provider will place two gloved fingers inside the vagina and evaluate for pain.This is the bimanual Pelvic Exam. The provider will examine if your cervix is painful to motion, an indication of a possibly dangerous infection. The provider will also evaluate the ovaries at this time. The ovaries are palpated to evaluate size, shape, and tenderness. After this portion of the examination is completed, you will be asked to get dressed as the provider and the assistant leaves the room. Now you get to celebrate! Celebrate? Yes!! Give yourself some well-deserved acknowledgment for advocating for your own health and seeing a medical provider. Preventative healthcare is an important tool of empowerment. Staying informed about your body and health will help you continue catapulting through those glass ceilings.

Dr. Tina Ashrafzadeh D.O. completed a 3-year residency program in Osteopathic Family Medicine at Pacific Hospital Of Long Beach. She is Board Certified in Family Practice and OMT(Osteopathic Manipulative Treatment). Dr. Ashrafzadeh is a credentialed Clinical Faculty Member at Western University/COMP and enjoys teaching medical students as well as Residents. Her private practice focuses on Holistic Healing and focuses on Women’s Health and Pediatrics. Her hobbies include cooking, spending time outdoors with her husband and three children, traveling, and writing.