Many IC patients dread or avoid routine pelvic exams and Papanicolaou (Pap) smears because the examination can be painful and precipitate flares. But cervical cancer, which the Pap smear detects in its precancerous state, is a serious disease. It’s the leading cause of cancer death in women in developing (Third World) countries. It used to be one of the leaders in the United States, too, but thanks to Pap smear testing, there has been a 70 percent decline in deaths over the last five decades. Pap smear testing has sent it down to 11th on the US list of women’s cancer killers.
How Often Do I Need A Pap Test?
Although Pap tests are important, they may not have to be done as often as you think. Both the American College of Obstetricians and Gynecologists (ACOG) and American Cancer Society (ACS) recommend that women have an annual pelvic exam -- but note that not all women need an annual Pap test.
American Cancer Society guidelines:
- All women should have a Pap test about 3 years after they begin having vaginal intercourse, but no later than when they are 21 years old.
- Have a Pap test every year with the regular Pap test -- but every 2 years using the newer liquid-based Pap test.
- Starting at age 30, women who have had 3 normal Pap test results in a row may get screened every 2 to 3 years. Or, get screened every 3 years (but not more frequently) with either the conventional or liquid-based Pap test, plus the HPV DNA test.
- Women 70 years of age or older who have had 3 or more normal Pap tests in a row and no abnormal Pap test results in the last 10 years may choose to stop having Pap tests.
Of course, be sure to check with your gynecologist to see if these guidelines apply to your particular situation.
Tips to Help IC Patients Avoid Pain
Those increasing recommendations for longer intervals can help IC patients avoid some discomfort, notes Deborah Metzger, PhD, MD, Director of Helena Women’s Health, Helena, MT. But, she said, when you do have a Pap, there are steps you and your gynecologist or nurse practitioner can take to make both the speculum exam for the Pap test and the pelvic exam easier on you.
Dr. Metzger offered these tips to help IC patients avoid pain with the speculum exam:
- Use an over-the-counter anesthetic preparation, like Lanacane, on the vulva about an hour beforehand. But, be careful not to get any of the cream or gel in the vagina, because that can interfere with the Pap test.
- Ask your gynecologist or nurse practitioner to use a small Pederson speculum or a pediatric speculum (it’s likely the Pederson) instead of the usual Grave speculum. Unlike the Grave speculum, the Pederson does not expand at the end, so it’s easier to get into the vagina.
- Ask your gynecologist or nurse practitioner to place the speculum blades laterally -- that is, left and right -- rather than usual anterior and posterior -- that is, front and back. That avoids putting pressure on the bladder.
- Take phenazopyridine (Pyridium) or some type of bladder anesthetic prior to the exam; these medications can help keep your symptoms from getting worse after the exam.
- To numb the area, place an ice pack wrapped in a towel over the vulvar area to help make you more comfortable before the exam or help bring relief after.
- For relief after the exam, you can use an over-the-counter anesthetic or lidocaine gel, which your doctor can give you, in the vulvovaginal area. This can be helpful for IC patients who may also have vulvodynia or vulvar vestibulitis, as many IC patients do but don’t have diagnosed.
The second part of the routine gynecologic exam is the bimanual exam, to check your pelvic organs by feel. That can also be painful for IC patients, but there are ways to make that easier, too, said Dr. Metzger.
- Ask your gynecologist or nurse practitioner to do the exam with only one finger. "Usually, a physician uses two fingers in the vagina, "and when that’s two male fingers," she pointed out, "it’s even harder."
- Your gynecologist or nurse practitioner can help you relax your pelvic floor muscles, which helps reduce pain. "I will put finger in the vagina and feel my patient’s muscles, and if they’re really, really tight, I’ll have her contract around my finger and then do some relax-contract, relax-contract exercise and start talking to her about fun things—shopping for shoes, something that’s just "girl talk." As I do this, she’s relaxing, and that makes a big difference," said Dr. Metzger.
Doing this means your physician or nurse practitioner needs to listen to you and take time. "Talk to your physician or nurse practitioner ahead of time about any of your concerns. If the he or she blows you off, don’t go to that person for an exam. You need to find someone else," she advised. But, Dr. Metzger added, be confident. "Because this is a common condition, there are physicians out there who understand." She also suggested that a nurse practitioner may be the more appropriate health professional to do these exams for you because, typically, they can take more time with patients than physicians can.
The bottom line, Dr. Metzger said, is feeling in control, which is an important part of healing. "IC and all of the pain syndromes that occur in the pelvis can make you feel out of control. But you can feel in control by choosing your healthcare providers -- choosing YOUR team."
Posted January 24, 2009