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What is a pap smear?
A pap smear is a procedure that collects cells from the cervix to screen for cervical cancer. Since a pap smear can detect pre-cancerous cells as well as cancerous ones, it is an important screening tool to detect and even prevent cervical cancer. A pap smear may also include a test for human papillomavirus, or HPV, a virus passed through sexual contact that causes most cervical cancers.A pap smear is typically conducted during a routine pelvic exam by inserting a speculum inside the vagina to visualize the cervix. A provider will use a small brush to obtain cell and mucus samples from both outside and inside of the cervix which are then sent to a lab for testing.
Who should get a pap smear?
Generally, it is recommended that anyone with a cervix obtain their first pap smear at age 21. Starting at age 25, patients can be co-tested for both cervical cancer and HPV. Co-testing is recommended every 5 years until age 65. If a person has certain risk factors, such as a history of cervical cancer, precancerous cells, or a weakened immune system, the provider may recommend more frequent pap smears.Disparities among queer people
LGBTQIA+ folks are less likely to obtain timely pap smears compared to cisgender, heterosexual patients. In a recent study, queer cisgender women were 10% less likely to be up-to-date on cervical cancer screening compared to their cisgender, heterosexual peers. This rate is even higher for women of color, especially Black queer women. Additionally, transgender men are less likely to obtain timely pap smears and more likely to have inadequate pap results if on testosterone therapy, resulting in further delayed or avoided screening care.
Why do queer people need pap smears?
Generally, society has a perception that HPV is contracted via sexual intercourse involving a penis and a vagina. However, HPV can be transmitted through any genital skin-to-skin contact or transferred via shared sex toys or hand to genital contact. It has even been detected in patients who are not sexually active. Most people who have HPV will not have symptoms, so following routine screening guidelines is important for early detection.How should I prepare for a pap smear?
We know pap smears may feel invasive, at best, or traumatic, at worst. At Atrius Health, our Pride+ Care clinicians want to make sure you have a supportive experience. Here are some tips for preparing for your pap smear:- Schedule a pap smear for when you are not menstruating to increase the likelihood an adequate sample is obtained on the first try.
- Ask your provider how they typically approach pap smears and what you can expect from the procedure.
- Ask your provider what options they have for reducing anxiety and pain during the procedure if you are nervous or have had painful pap smears in the past.
- If you are on testosterone for gender-affirming hormone therapy, talk to your provider about options to increase the likelihood of having a successful pap smear on the first try. Some providers may prescribe a topical estrogen cream to use several days prior to the procedure.
- You can bring a support person to any of your doctor’s appointments. This support person does not have to be related to you.
- Advocate for what’s right for you – it’s okay to wait until you feel prepared to have the procedure.
What about the HPV vaccine?
As of 2006, a highly effective and safe HPV vaccine was developed, which has led to a nearly 90% reduction in cervical cancer rates. Receiving this vaccine protects against the 9 viral strains that have the highest risk of causing cervical cancer. If you did not receive this vaccine as an adolescent, you can still be vaccinated as an adult! This involves 3 doses of the vaccine over the course of 6 months. It is now covered by insurance up until age 45 for all genders, so make sure to ask your provider about it at your next visit.Pride+ Care and Atrius Health Gynecology
At Atrius Health, we are committed to offering supportive and inclusive gynecological care. For routine pap smears, patients can obtain these through their primary care team or their gynecologist.Visit the Pride+ Care page to learn more about LGBTQIA+ affirming care at Atrius Health.
