That Dear Little Smear
When that big spunk of a Phys Ed teacher broke my virginity at eighteen, my mother did two things: she put me on the pill and sent me for a pap smear.
I didn’t like the sound of that. (Who gets smeared? What is ‘pap’?)
Next thing, I was on my back, feet in stirrups with a floodlight bearing down on my by-appointment-only parts which prefer the subtlety of dusk, as a man in a white coat and gloves chatted to me about the cricket while inserting a cold metal speculum up there, assuring me (as only he could know) that ‘this won’t hurt at all.’
Since then I’ve always treated pap smears, like dental check-ups and tax returns, an annual nuisance on my to-do list, an inconvenience wrapped in an indignity. Frankly, I wouldn’t know a cervix from a pancreas, having never actually seen mine. All I knew about my cervix is that mine refused to dilate during labour in my first pregnancy, getting to three centimetres and stopping in mid-stride like it suddenly remembered something and lost concentration.
The cervix is a shy little spot of the female anatomy, tucked inside us, like the toe of a sock with a hole in it, if the vagina were a sock, yet is rather important in our anatomy, connecting the uterus to the vagina, allowing menstrual fluids to pass and stretching during childbirth with staggering generosity to the size of a baby’s head.
The covert identity of the cervix is partly what drove women in the 1970’s, in groups, mind you, armed with torches, mirrors and a speculum to lie back and examine their insides. Annie Sprinkle, a porn star in the US invites the audience to come up and have a look at her cervix, ‘because it’s beautiful,’ which is true if mini glazed donuts do it for you.
Recently I got a call from my doctor to ‘come-and-discuss-my-pap-smear-results.’ On my way there, I made a mental note to tell my husband to marry our babysitter if I died, the kids really like her.
The doctor told me I had CIN III.
Was that good? Bad? Fatal?
I learned that on the cervix is a small patch of unstable cells known as the ‘transformation zone’ (TZ), where changes occur frequently but relatively slowly. It is a sample of these cells that is collected in a pap smear revealing normal, abnormal, CIN I, CIN II, and CIN III or cancerous changes. Cervical cancer is most often caused by infection with the sexually acquired Human Papilloma Virus (HPV). Many of us become infected with the virus without knowing it. The virus can sit dormant for a long time before cellular changes show on a Pap smear.
The best news is that unlike many kinds of cancers, cervical cancer is easily preventable because of the Pap smear in which a layer of cells is scraped off the TZ and examined for changes.
The Pap smear is the invention of a Greek doctor, George Papanicolau in the 1940’s who studied the sex differences in the water flea. He and his wife emigrated to the US, with no English and very little money and worked at Gimbels Department store selling rugs before finding a job at Cornell University in a department researching the effects of alcohol on guinea pigs. Borrowing a few spare female guinea pigs to further his study of sex differentiation, Dr Pap figured that to obtain their eggs before ovulation, he needed to extract their vaginal discharge, (I mean, that’s obvious, right?) Using a small nasal speculum, he scraped off guinea pig vaginal cells, smearing them onto a glass slide (hence the name Pap Smear) to examine under a microscope. Because of the expertise he had gained by working with the water flea for many years, he detected patterns in these vaginal cells.
Here’s where it gets interesting. At some point in all this study of the vaginal cells of guinea pigs, a version of the following conversation must have taken place with his wife:
‘My dear, I wonder if I could prevail upon you for a small favour after dinner.’
‘Certainly, George, what is it?’
‘I was wondering if I might scrape some cells off your cervix?’
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Mrs P. agreed. Not once. Not twice. For twenty years, almost daily, she submitted to these examinations, as a result of which Dr Pap observed normal changes in the cells in different parts of the vagina through a menstrual cycle and then from one menstrual cycle to the next. This research was the beginning of a scientific journey into examining the abnormal changes in cells. What began with a water flea has led to the most successful pathology test to prevent cervical cancer, a disease with which approximately 1000 women in Australia are diagnosed annually.
When it comes to taking responsibility for our health, these days we are fortunate to have a range of options. Regular check-ups – mammograms, pap smears and colonoscopies can literally be the difference between us living to see our grandchildren or not.
Using condoms in sex is still the best way to avoid contracting HPV. The yardstick is that if it’s not sterilized, it shouldn’t be going up there in the first place. Most tampons are not sterilized, though a new sterilized tampon (Pureste) has recently come onto the market which is lovely and all, but remember you can’t catch HPV from a tampon.
Secondly, cancer research has yielded some miraculous breakthroughs including the world’s first cancer vaccine against cervical cancer involving three doses over a six month period, recently introduced in Australian schools for girls from the age of 12 as part of the federally funded National Immunization Programme. In November 2006, the government offered those who had already left school (up to the age of 26) a two year ‘catch-up’ period which ends on 30th June 2009 (unless the first vaccine has been administered in which case the remaining boosters will be available until 31 December 2009). This vaccine immunizes young women before they become sexually active against HPV types 16 and 18, the two strains associated with 70% of all cervical cancers. Interestingly, a third of the female school going population has elected not to have the vaccine. Some parents perceive it promotes sexual promiscuity by giving the impression the vaccine makes unprotected sex safe and are anxious about the side-effects of the vaccine.
Because HPV causes cervical cancer, it makes sense for us to know whether or not we are carriers. Recently a new test kit called Tampap (in similar style to home-pregnancy tests) makes it possible for women to test themselves at home for HPV by inserting an ordinary tampon, and sending it off to a lab where it is tested for the presence of the virus.
Despite all these latest developments, the pap smear is still the best and most effective way of detecting cervical cancer (sorry, girls) and we’re all advised to have one every two years, unless we’ve had a bad result before, in which case we should go annually.
Now if ever I wince at the prospect of discussing cricket while pretending I don’t have a salad server in my delicates, I spare a thought for good old Mrs Pap, that great unsung heroine of women’s health who offered up her cervix to science and who, in her generosity, saved my life and the lives of countless other lucky women.
Published in Vogue, Australia, July 2009
Author, writing mentor, retreat leader. I’m an internationally bestselling author of nine books, inspirational speaker and writing mentor. I’ve had books published in just about every genre- fiction, non-fiction, self-help, memoir – by some of the top publishing houses in the world. My books have sold over 650 000 copies and have been translated in a range of languages. Two of my books have been #1 Amazon bestsellers, and at one point the German edition of Secret Mothers’ Business outsold Harry Potter- crazy, right?