Pap Tests - why they can hurt and how pelvic floor physiotherapy can help
By Amy Price, PT
Getting a reminder that you’re due for a Pap test, or cervical screening, can cause reactions that range from minor annoyance to very anxiety-inducing, depending on the person and their prior experience. Many individuals can experience discomfort, pain, or negative feelings with Pap tests, and this can even cause avoidance of routine pelvic exams and screenings. However, these exams are very important to monitor your health and to potentially identify conditions that may require treatment. Luckily pelvic floor physiotherapy can be a helpful way to make Pap tests more comfortable, and to reduce anxiety and fear around these important routine pelvic exams.
What is a Pap Test?
A Pap test is a pelvic examination that involves removing a small sample of cells from the cervix, which are then tested for potential changes or abnormalities. Pap tests are done to screen for or diagnose precancerous conditions. The can also be used to identify if there’s infection or inflammation present in the lower reproductive tract. This screening is very important because it’s effective at identifying changes in the cells hat occur before cancer develops, therefore preventing serious illness and saving lives. Generally Pap tests will be performed every 3 years, but if you’ve had an abnormal finding previously they may be done more frequently to monitor. During a Pap test, a doctor or nurse inserts a speculum, which is a plastic or metal device that keeps the vagina open so that they can visualize the cervix. Then, using a small spatula or brush, they gently scrape the cervix to obtain the sample of cells. The collected cells are then sent off to a lab to be looked at for abnormalities. Overall this exam should only take a few minutes, and although feelings of pressure or discomfort are common and expected, it should not cause pain during or after.
Why can they hurt?
Although Pap tests are routine procedures, there are a number of reasons why some people may find this experience painful or distressing, beyond the expected level of “mild discomfort”. Conditions like vaginismus, vulvodynia, endometriosis, and others that involve increased pelvic floor muscle tension can contribute to difficulty and pain with vaginal insertion. Additionally, individuals who have had trauma to the pelvic region can similarly have pain with vaginal insertion. People with these conditions of pelvic floor dysfunction can experience pain with the insertion and opening of the speculum during the exam. Anxiety or fear around pelvic exams can create additional tension in the pelvic floor muscles which only makes the situation more distressing and painful.
How Pelvic Floor Physiotherapy can help?
Luckily, pelvic floor physiotherapy can help to prepare you for your Pap test and can even help to reduce pain associated with the procedure itself. With the help of a pelvic floor physiotherapist you can learn to relax your pelvic floor muscles and improve their flexibility, making insertion of the speculum much easier and more comfortable. Strategies to help with this can include deep diaphragmatic breathing, relaxation techniques, and manual therapy to the pelvic floor muscles to improve tissue mobility. Repetition of pain free vaginal insertion helps to not only improve the tone of the pelvic floor muscles but also increases your confidence and reduces stress and anxiety around pelvic examinations. Practicing insertion of vaginal dilators of increasing size can help to gradually increase tolerance for vaginal insertion, or you can even practice inserting a speculum with your pelvic floor physiotherapist to practice and feel comfortable and confident leading up to a Pap test.
In summary, Pap tests are important routine screenings that are helpful to monitor your health and prevent issues. Although they can be uncomfortable, they should never be painful or something that makes you feel anxious or want to avoid. If you’ve had painful Pap tests before, pelvic floor physiotherapy can help you to improve that moving forward and facilitate having a positive experience. At Proactive Pelvic Health Centre, out pelvic floor physiotherapists are well equipped to help you prepare for and feel confident about a pain free Pap test.
References
https://cancer.ca/en/treatments/tests-and-procedures/pap-test
https://www.vuvatech.com/blogs/care/why-was-my-pap-smear-test-painful