The PAP tweet

mobile phoneNot so long ago, one of my young patients ‘tweeted’ that she was having a Pap smear.

During the actual procedure.

Yep, as I was scraping cells out of her endocervical canal, Miss C was busy tapping away on her iPhone. “@docs having pap smr atm, std chk 2, hope im clean … bfn” was posted to the internet for public consumption.

“I have, like, 100 followers,” she said proudly. I presume she meant on Twitter — she seemed unlikely to be the leader of a religious sect. I wondered how many of these had any interest whatsoever in her gynaecological checkup. Perhaps those with whom she had been sexually intimate would be interested, but I doubt they would have made up the entire hundred who’d received her tweet.

While I printed out her pathology form, Miss C updated her Facebook status to ensure everyone with whom she had ever had contact knew about her earth-shattering Pap smear news as well.

It got me thinking. When did getting a cervical smear go from being an embarrassing, secretive affair to one worth broadcasting? When was the mystery taken out of ‘women’s business’?

Quite a few of my under 25-year-old patients bring their friends and/or boyfriends into the consulting room with them when having smear tests. When I’ve politely suggested that Miss X might feel more comfortable if Mr Y waited outside, I’ve not uncommonly got a response along the lines of “It’s no biggie — it’s not as if he hasn’t seen it all before.”

I once had a very curious young man ask me to point out his lover’s anatomical landmarks. He particularly wanted to see her cervix, saying, “To see that would be totally awesome!”

The ‘secret women’s business’ divide is not cleanly split along generational lines. I had a 68-year-old patient request that her 15-year-old granddaughter be permitted to observe her Pap smear for educational purposes. “If she sees one being done, she won’t be as worried about it when it’s her turn to start,” my patient said matter-of-factly.

Later that same day, I had a 19-year-old look at me in horror when I gently explained that she would need to remove her underwear as well as her jeans. “Can’t you just, like, work around them?” she pleaded. “It’s, like, so embarrassing!”

My favourite Pap smear anecdote, however, involves a particularly self-conscious and nervous older lady and a mobile phone. After several attempts I had finally convinced this 52-year-old to have her first smear test in 20 years, and I was trying my best to make the experience as atraumatic as possible. To my horror, just as I was inserting the speculum, my mobile phone went off. The Beethoven ring tone seemed to go on forever but I tried to ignore it and continue seemingly undeterred.

At the end of the procedure the patient said: “Thank you so much for providing the lovely classical music — it was very thoughtful of you. It really helped me to relax. One thing puzzled me though — I couldn’t work out how you managed to start the music at the right time. Did you have a remote control or was there a switch on the speculum? Modern technology is amazing, isn’t it? A singing speculum — what will they think of next?”

Now, that’s the kind of Pap experience that would almost be worth a tweet if one was that way inclined.

Published in Australian Doctor on 22nd February, 2012 The PAP “tweet”–on-pap-smears

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