How Sexual Assault Survivors Handle Anxiety Around Pap Smears

Between the cold speculum, the invasiveness and the painful pressure in a sensitive area, Pap smears aren’t fun. However, they can be especially tough — even downright triggering — for sexual assault survivors.

“The first time I had a Pap smear, I had a panic attack afterward in my car, called my mom crying and I skipped all my classes for the rest of the day,” said Emerson Karsh-Lombardo, a sex and kink educator and content creator in Colorado. “The fact that I could tell my body was rejecting the penetration of an object that continued to enter my body was especially triggering for me as a survivor.”

Ziva Lane, a 24-year-old survivor, said in her country, India, there’s zero awareness about sexual health. “I don’t know any female who’s gotten a Pap smear or cytology done. It’s that rare,” she said. “However, I’m privileged enough to have received a first-class education … and to be financially stable enough to even get this exam done.” Her experience was incredibly triggering, though. “I felt violated. In every sense. I just wanted it to stop,” she said.

Understandably, many survivors often avoid their appointments to dodge the intense anxiety and emotions that come up. While people usually have their first exam done around age 21, you’re not alone if you want to hold off.

However, while OB-GYNs want you to feel ready, they encourage you to come soon. “I would want women to come when they are ready and prepared, yet not wait too long for [a] screening if it’s been beyond three to five years since their last Pap, especially if they have a history of abnormal results,” said Natasha Spencer, an OB-GYN with Orlando Health Physician Associates in Florida.

Gunvor Ekman-Ordeberg, an OB-GYN and professor of obstetrics and gynecology at Karolinska Institutet in Sweden, explained you don’t need to go the day you turn 21, but the sooner after that point the better. “Early detection of pre-stage changes of cervical cells found in Pap smears leads to early treatment, which may inhibit cancer development,” she said.

While survivors may not be able to make their Pap smear pleasant, per se, they can take steps to reduce the harm. Here’s some advice:

Survivors who knew in advance that they should take preemptive measures focused on communicating with their providers.

Alison Turkos, a 33-year-old advocate and activist for sexual assault survivors, prepared by bringing her anti-anxiety medication, ensuring she had nothing to do later and talking with her doctor.

“Upon entering the room with the provider, I had a direct, honest and transparent conversation regarding my history of sexual assault,” she said. “I asked to be fully informed regarding every move she would be making, [like] ‘I’m going to touch your right thigh,’ ‘I’m going to insert the speculum,’ etc.”

Lane felt more comfortable hinting at her trauma. “My OB-GYN had a brief idea about me being a survivor because I had hinted to her indirectly that I’d been in a ‘bad relationship’ in the past, and told her to be as gentle as she possibly could because of the fear of it being a painful procedure,” she said.

You can also prepare by talking with your therapist, asking a loved one to accompany you, writing affirmations and bringing headphones.

If your Pap smear isn’t a one-and-done thing, don’t beat yourself up.

“It may take you a few appointments to get to the end of the procedure,” said Claire Plumbly, a clinical psychologist specializing in trauma, self-esteem and anxiety in women. “You haven’t failed; you are working toward something that is very hard to do.”

You can let the doctor’s office know you might need extra time for breaks. “Let the nurse know in advance that they need a double appointment due to anxiety — [but] you don’t need to disclose more than that if you don’t wish to,” she said.

Finding the right specialist is crucial. “The best thing for managing Pap smears as a survivor was finding a gynecologist who I trusted and who created a safe space for her clients,” Karsh-Lombardo said.

Some OB-GYNs allow a consultation so you can meet them first. “In order for survivors to feel comfortable with a provider or myself, I have offered establishing care visits that can be used as a pre-screening encounter for women to meet me, build rapport or see if they would like to have me perform their Pap smears and exams,” Spencer said.

When meeting these providers, consider factors such as gentleness, empathy, knowledge about sexual assault and whether they ask for consent the entire time. Additionally, you can ask for a smaller speculum.

Some areas have centers for survivors. For example, The Empower Center in New York offers gynecological and psychological care.

“Talk with a few offices and ask questions about how they may help protect and reassure someone in a similar situation,” Ekman-Ordeberg suggested.

Feeling nervous about sharing your past with your provider? That’s totally normal and understandable. If you don’t want to say it outright, you can communicate it in more comfortable ways.

Plumbly recommended writing it down or asking your therapist to. If you bring a support person, they can do the talking.

Additionally, consider words you’re comfortable with. Maybe you can say “trauma” or “tough stuff” but not “sexual assault.” Maybe it’s the opposite. Go with whatever works for you.

As far as getting through the emotional and physical pain, survivors mentioned validating their emotions and breathing through them.

Turkos leaned into her anxiety. “Instead of pushing it away and saying, ‘This will be fine,’ I ground myself in honesty and say, ‘This might be terrible and hard, and that’s OK.’ I refuse to erase or invalidate my own feelings,” she said.

Emily O’Neill, a 27-year-old self-discovery coach from England, encouraged breathing. “Focusing on my breathing throughout the smear test really helped me to calm down as much as possible and try to relax my body more,” she said.

Another option is grounding. “This is a way of staying present, to be used if you are freezing up or dissociating or having a flashback,” Plumbly said. “Use one of your five senses to bring yourself back, ideally something that is very hard to ignore, such as sucking on an extra-strong mint [or] sniffing smelling salts.”

She recommended distractions, too, such as phone games, podcasts and cute videos.

During the Pap smear, remember your OB-GYN doesn’t want to hurt you and can be a support person.

“I want sexual assault survivors to know that we are here for them, and they can report incidents to us without any judgment or feelings of embarrassment,” Spencer said. “We are women’s health advocates, and I take my position as an honor and privilege to care for women of all ages in one of the most intimate settings and evaluations.”

Spencer shared that you can even play an active role. For example, survivors can direct how providers position the speculum, ask them to stop or ask for an explanation of what’s happening.

If your provider doesn’t already do this, ask. “I constantly tell survivors ‘Asking for what you need is not being needy,’ and it couldn’t be more true when it comes to receiving health care,” Turkos said. “I want survivors to know they’re the only person in control in that room; they should never feel rushed by a provider or forced to do something.”

You and your provider can talk what-ifs. “Agree in advance with the nurse what she should do if you have a panic attack or disassociate,” Plumbly said. She mentioned they can help you practice breathing, get a cold glass of water, or wait while you calm down.

While the Pap smear may be the toughest part, you might still feel upset afterward.

“After the Pap smear, I cried, I called my mom and I gave myself the day to give space to the pain and anxiety I experienced,” Karsh-Lombardo said. “I gave myself lots of love and comfort afterward.”

O’Neill did the same. “After the smear, I rested for the remainder of the day, took some time for self-care and confided in my sister,” she said.

Lane’s doctor stepped in to help. “It was afterward that my doctor told me the importance of this procedure and helped me calm down,” Lane said. “She recommended that I research my triggers and write down my feelings, because I refused therapy.”

While Pap smears can be painful and upsetting, they’re quite important. By communicating with your provider, leaning into your support system, practicing self-care and distracting yourself, you can get through it.

Need help? Visit RAINN’s National Sexual Assault Online Hotline or the National Sexual Violence Resource Center’s website.