Getting Ready for the Exam
Schedule your appointment for a week after your period ends. If you’re due for your yearly checkup and pap smear, try to schedule it the week after your period or anytime you don’t expect to be menstruating. If you have irregular periods, call your gynecologist ahead of time to address that and see when they recommend giving you the exam. Your doctor may tell you it’s okay to do the test while you’re on your spotting or on your period, but it’s not ideal because it can skew the results. If you’re getting it done while you’re on your period, use pads instead of tampons the first 2 days before your appointment. If you're over 21, you should get a pap smear every 3 years. If you're over 30, you only need to get one every 5 years. However, depending on your circumstances (like if you’ve had a history of ovarian cancer), your doctor may suggest you get them more often. If you’ve had a complete hysterectomy (both your uterus and cervix removed), you don’t need a pap smear unless you’ve had surgery for cervical cancer or pre-cancer.
Avoid douching within 2 to 3 days before your exam. If you use douches, stop using them 2 to 3 days before your exam because it can wash away any abnormal cells your gynecologist is looking for. Douching can also increase your risk of infection by changing the bacteria in your vagina. Additionally, don’t use any spermicidal foams or vaginal medicines 2 days before the test because these can also skew the results of the pap smear.
Don’t have vaginal sex 48 hours before your exam. Be abstinent for 2 days before your exam. Sex can mask any abnormal cells in your vagina which will mess up the results of the pap smear. It’s okay to masturbate, just avoid using any lubricants if you do.
Be prepared to answer questions about your menstrual cycle. If you have a planner or calendar where you keep track of your period’s start and end dates, bring it to your appointment. Your doctor will ask you about the dates of your cycle, how heavy it is, and whether or not you have irregular spotting between periods. It may feel weird to talk about, but your doctor’s used to talking about these things—just be open and honest. Your doctor will also ask you about any pelvic pain you may experience during your period. If you’re on birth control, your doctor will probably check in with you about that too (i.e., how it has impacted your cycle and if you’re happy with the particular method of contraceptive).
Write down any questions you have before going to the doctor’s office. If you have questions for your doctor that you think of in the days before your exam, make sure to write them down so you remember to ask them (if you’re nervous, you might forget). You can also type them into a note-taking app on your phone. For example, you might ask general questions about your period like: “Is it normal to feel pain in my hip during my period?” or “I’m thinking about having a baby in the next few months. When should I stop taking my birth control?”
Wear comfortable clothes you can easily take off and put on. Be prepared to undress completely and put on a gown that opens from the front. You should also consider wearing loose pants or a skirt because the exam may cause you to feel a little discomfort or excess moisture when it’s over. A long skirt with a shirt, loose sweatpants, activewear, or soft jeans are good options. The excess moisture is from the lubricant the doctor will use on the speculum. It’ll feel normal again in a few hours but if it makes you feel more comfortable, you can always wipe and dry yourself with toilet paper.
Go to the bathroom right before your exam. Before you leave the house for your exam, go to the bathroom even if you don’t feel like you need to. If you’re driving over 10 to 15 minutes to your doctor’s office, plan to get there 5 to 10 minutes early so you have time to use their bathroom before you’re called in. You’ll feel some pressure on your pelvis during the exam which can make you feel like you have to pee right then and there, so peeing beforehand will make you more comfortable.
Talking to Your Doctor before the Exam
Feel free to ask your doctor questions during or before the exam. Don’t be afraid to speak up about anything that’s on your mind about the exam—hearing your doctor’s feedback can help calm your nerves. Most of the time, they’ll let you know what they’re doing as they’re doing it, but every doctor has a different approach. For instance, you might ask: “Is this going to hurt or just feel weird?” or “Do I need to wash my vagina afterward?” If you or anyone in your family has had breast cancer, you might also ask them how to perform a breast exam so you can do it yourself between appointments.
Discuss any changes you’ve noticed in your genital area. Regardless of whether or not you have had a pap smear in the past, tell your doctor about any changes you have noticed in your genital region. This includes any abnormal redness, itchy, swelling, or sores. It may be uncomfortable to talk about, but it’s necessary so you know you’re healthy in that region. Try to be as open and honest as you can—odds are, your gynecologist has heard and seen it all! This is especially important if you’ve had unprotected sex because itchiness, visible sores, or inflammation could be a sign of an STI.
Tell your doctor if you have had past issues with pelvic examinations. Let your doctor know if you’ve had any bad experiences in the past with examinations or if you’ve experienced any sexual trauma (like rape) that may affect your comfort level. It may be difficult to talk about (and you don’t have to go into details) but it’s worth doing so you can be as comfortable as possible. Your doctor will adjust their actions appropriately to suit your needs. For instance, you might say something like: “Before we do the exam, I need to mention that I have had sexual trauma in the past. Please let me know exactly what you’re doing when you’re doing it so I know what to expect and can be less uncomfortable.” If you have experienced sexual trauma and are seeing a new doctor, it may help to book a preliminary appointment to build trust and let them know what you are and aren't comfortable with. In some cases, your doctor may allow you to insert the speculum yourself if that makes you more comfortable.
Ask your doctor if someone else can be in the room with you if you’re nervous. If you’re feeling anxious about the exam, ask your doctor if a nurse can be in the room with you. If you came with a friend or family member, ask if they can come into the room to help calm your nerves. You can request that a female nurse come into the room if that makes you more comfortable.
During the Pap Smear
Undress to your comfort level and put on the open-front gown. If you are asked to undress completely, put on the hospital gown that the nurse gives you. Make sure the opening is in the front. If the nurse only tells you to undress from the waist down, you can leave your shirt on. If you are only getting a pap smear (and not a breast exam) you will most likely only be asked to get undressed from the waist down.
Lie down on the examination table and put your feet in the stirrups. Scoot down so your butt is just at the edge of the table—it may feel awkward but it’s easier to do the exam if your pelvis is closer to the end of the table. If it’ll be a while before your doctor comes into the room, it’s okay to position your legs however you like out of the stirrups so you’re more comfortable while you wait. The stirrups ensure that your legs are far enough apart that the doctor can perform the test comfortably.
Allow the doctor to insert the speculum into your vagina. Try to relax as you prepare for the doctor to place the plastic or metal instrument into your vagina. It might feel very cold at first as it goes inside of you but the initial chilliness will pass. Remind yourself that this part is necessary and every woman goes through this temporary discomfort. The doctor will lubricate the speculum beforehand to make it easier. The doctor may warm the speculum so you’re more comfortable. This instrument helps to hold your vaginal walls apart so that the doctor can access your cervix. Most offices post a funny picture or something on the ceiling above you for you to look at if you’re feeling awkward or nervous.
Stay still and breathe while the doctor scrapes the inside of your cervix. Take deep breaths to help you relax because you might feel some mild pressure and discomfort during this part. It’s not painful, it just feels weird. Try to think of something funny or anything to distract you so you’re not focused on how it feels. The doctor will likely check in with you to see if you’re feeling relatively comfortable. The scraping device is a soft brush that’s used to take a sample of your cervical cells. Feel free to talk to the doctor or nurse about anything to distract yourself—recent events, movies, music, or whatever you like!
Wait up to 2 weeks to get the results from your doctor. Expect to hear from your doctor anywhere between a few days and 2 weeks. The samples will have been sent to a lab and some labs take longer than others, so don’t think your doctor has forgotten or that you need to call to check in everyday. Your doctor will call you to talk about your results when they’re ready. EXPERT TIP Jennifer Butt, MD Jennifer Butt, MD Board Certified Obstetrician & Gynecologist Jennifer Butt, MD, is a board certified Obstetrician and Gynecologist operating her private practice, Upper East Side OB/GYN, in New York City, New York. She is affiliated with Lenox Hill Hospital. She earned a BA in Biological Studies from Rutgers University and an MD from Rutgers – Robert Wood Johnson Medical School. She then completed her residency in obstetrics and gynecology at Robert Wood Johnson University Hospital. Dr. Butt is board certified by the American Board of Obstetrics and Gynecology. She is a Fellow of the American College of Obstetricians and Gynecologists and a member of the American Medical Association. Jennifer Butt, MD Jennifer Butt, MD Board Certified Obstetrician & Gynecologist Did You Know? Just because you have an abnormal pap smear, it doesn't necessarily mean there's anything to worry about. As long as you have your pap smears doen regularly and you get the appropriate follow-up care, the chance of it actually evolving into something malignant or cancerous is pretty small.
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