Ask the doctors: At-home Pap smear on the horizon

Dear Doctors: It’s time for my daughter to have a Pap smear, but she’s putting it off because it was so painful last time. I wonder if switching to a female doctor might help? It’s a very unpleasant test and I do sympathize, but it’s also important, and I’m worried.

Dear Reader: A Pap smear is a test used to screen for cervical cancer. During the procedure, a small brush is used to collect cells from the surface of the cervix. Those cells are then examined under a microscope for signs of cancer, or the types of changes that may indicate a precancerous condition. It is uncomfortable at best. But, as you point out in your letter, Pap smears are an important part of preventive care. It is recommended that women start getting tested for cervical cancer at age 21 and have a Pap smear every three years.

When it comes to gynecological care, some patients do prefer it when their doctor is a woman. By its very nature, this type of medical care is quite sensitive, and patients can feel more comfortable when being examined by someone of the same sex. Having undergone the various procedures and exams herself, a female doctor may have a better understanding of what her patient is experiencing. This can make it easier for the patient to share concerns, and that can translate into more empathetic care.

Regarding Pap smears, there has been a new development that will make the procedure easier. Last spring, the Food and Drug Administration approved a test that allows a woman to perform this test herself. This involves collecting a sample of cells from the inside of the vagina using a narrow swab. The swab is then sent to a lab, where it is screened for the presence of the human papilloma virus, which is the cause of virtually all cases of cervical cancer. The reason this change is possible is that labs are now able to analyze cells taken from the vagina, and not only the cervix itself.

For now, this test will be done by the patient in a doctor’s office or other health care setting. But in the future, the plan is for an at-home test to become available. This is the first change to cervical cancer screening in the U.S. since the 1940s, which is when the Pap smear was first adopted. Self-collection tests have been available in Europe and elsewhere for several years.

The self-collection test makes cervical cancer screening far less unpleasant. It also removes the barriers that have prevented many women from having this test. This includes living in an area with limited access to health care, a lack of insurance and being unable to take time off work. A self-test will also help women like your daughter, who are avoiding a procedure they dread.

Send your questions to askthedoctors@mednet.ucla.edu.