'In a world where women are losing their voice, rights, and choices, healthcare should not be the venue where people remain silent.'
Editor's Note: This article was originally published on June 1, 2022 and it has since been updated.
A 33-year-old midwife went viral on TikTok after sharing several tips to make pap smears as painless and comfortable as possible. In a video that's been viewed more than 469,000 times on the platform, Pamela Boatner—a certified nurse-midwife who also serves as co-founder of Prepared Pregnancy, an online educational prenatal tool for pregnant people and their families—proclaimed to her followers: "Hey sis. This is your midwife talking. It should not hurt to get a Pap smear. Pay attention, because this is what you need to do to make sure that your next annual exam goes smoothly."
"First thing you need to do is ask for a smaller speculum, because 9 times out of 10, they're using that big birther speculum, and unless you've had a 15-pound baby or have a pelvic disorder, you probably don't need that," Boatner explained. Secondly, she recommends asking "for plenty of lubrication on the speculum, because we're not jamming it in there all raw. We don't have time for that today." And when it comes to the type of speculum being used, Boatner said: "If they're using a metal speculum, please have them take the 15 seconds to warm up the speculum for you because coldness down there... don't nobody wanna do that either."
Those going in for pap smears can also "change your position," she suggests in the video. "Sometimes, laying on your back with your feet up in those little stirrup things is not what's most comfortable for you. Ask them if you can change your feet and put them in a different position. This might be better for you." Boatner concludes the video with one last tip that'll save you lots of trouble in future pap smear appointments. "When they find your cervix, tell them to tell you exactly what position it's in—left, right, or back—so you can remember and tell them for your next Pap smear to make it easier," she said.
Thousands responded to Boatner's video, with many admitting that they had no idea pap smears weren't supposed to hurt and that they didn't know they had options when it came to advocating for themselves in these situations. Speaking to BuzzFeed about why she believes so many people are surprised by everything she shares in her video, Boatner said: "Unfortunately, the medical model of care often focuses on the disease or condition and NOT the patient. It is easier for the provider to use a bigger speculum, less lubrication, or keep the patient in one standard position. However, the midwifery model of care centers on the woman/patient and her needs. This factors in comfort, education, and past trauma, to name a few."
"When women are ONLY exposed to the medical model of care, they don't even know there are other options," she continued. "Many people don't have an accurate picture of what a midwife is or may not have access to one, therefore not knowing these options even exist. I strive to educate people for this reason. Many physicians have not been trained with patient-centered care in mind, as their main focus is to diagnose and treat the disease. This leaves the disease or condition managed adequately, but leaves the patient feeling a disconnect. All physicians are not disease-focused, however, and some seek cultural/LGBTQ/low-risk training yearly to make improvements to their personal practice."
Knowing the location of your cervix can prove quite helpful to avoid pain during a pap smear, Boatner explained. "Just like how most people have hair but the color or texture of the hair can be different, birthing bodies have a cervix but its location is not always in the same position," she shared. "For most, it is located directly in the center and posterior of the vagina, and for others, it can be displaced slightly off to the right, left, down, or up. This is a variance of normal and is expected to change from person to person. With this in mind, imagine how frustrating it can be for a provider to extend an already potentially uncomfortable exam because they are looking for the cervix in the wrong position. Knowing exactly where your cervix is not only empowers your body awareness, but helps both you AND the provider... Once the first provider tells you where your cervix is located, take note and remember. It makes the next Pap smear easier."
"In a world where women are losing their voice, rights, and choices, healthcare should not be the venue where people remain silent. It is your body and deserves to be respected," Boatner said. "Learning to self-advocate helps ensure you have pleasant healthcare experiences and ultimately decreases the incidence of healthcare avoidance based on fear or trauma. Better healthcare experiences lead to better outcomes. Education is key. Empowerment and confidence can only start with awareness. For pregnant women and families, take a prenatal education course. We offer these, as well as midwifery consultations, at Prepared Pregnancy. For non-pregnant patients, seek out a provider who spends time educating you, answering your questions, and managing your concerns with YOU as the center of this care. It's easier to advocate to a person you know will listen to you."