I remember last year, there was a hot search topic about whether the “duck-billed speculum used in gynecological examinations could be more female-friendly,” which sparked widespread discussion. The topic alone garnered over a hundred million views on a social media platform, with many women recalling unpleasant experiences and sharing their feelings on social media, resonating with many other women. “Cold, scary” are the words I’ve seen the most.
Internet screenshot
In my outpatient clinic, I also have this feeling that most of the patients who come for a consultation subconsciously avoid cervical cancer screening.
Cervical cancer screening includes: high-risk HPV testing, cervical cytology examination, or “co-testing” that includes both.
Where does the fear come from?
It’s not just the body that feels cold
HPV testing checks whether cervical cells are infected by high-risk HPV viruses(such as types 16 and 18). Long-term infection with high-risk HPV is a major cause of cervical cancer.
Cervical cytology(LCT/TCT) determines the presence of precancerous lesions or cancer by observing the morphology of cervical cells.
Since cervical cancer screening is so important, why do so many women avoid it?
Physical discomfort caused by the examination itself Since the cervix is inside the vagina, a speculum is used by doctors to retract the vaginal walls, exposing the cervix, a process that can cause a sensation of vaginal fullness.
Then a cell sampling brush is used to collect cells from the cervix. The brushing process, which touches the cervix, can cause dysmenorrhea(feeling of pelvic heaviness).
Some women with higher BMI, longer vagina, significantly anteverted or retroverted uterus, or history of cesarean section may find it more difficult to expose the cervix, and the discomfort during the procedure may be more pronounced. The actual level of pain varies from person to person.
At the same time, some people may experience slight vaginal bleeding after the examination, lasting about 3 days. However, this does not necessarily mean that the results will be abnormal, so there is no need to worry excessively.
Psychological discomfort from exposure of private parts During the examination, we have to expose our private parts to the doctor, which inevitably leads to tension, shame, and embarrassment.
“Invisible violence” due to lack of humanistic care As mentioned earlier, the privacy exposure during the examination can make people feel psychologically embarrassed and nervous, and the examination may also bring physical discomfort and pain.
At this time, what female patients need most is gentle manipulation and verbal reassurance, which can help patients reduce the discomfort during the examination as much as possible. Unfortunately, many women have not felt such humanistic care in their past examination experiences, but instead have been treated roughly for reasons such as “having given birth”.
For various reasons, many women “talk about cervical cancer screening and change color,” so they take a chance and always put off cervical cancer screening.
The “gynecological torture device” duck-billed speculum, why has it not been improved for a long time? We have explained in our past popular science articles. If you are interested, you can read it here: 「Gynecological torture device duck-billed speculum」, why can’t it be more female-friendly?
Apart from the examination equipment itself, improving the humanistic environment is not something that can be changed overnight. While we look forward to progress, health is a matter closely related to ourselves, which should not be underestimated or delayed. Therefore, from a doctor’s perspective, we still hope that everyone does not avoid cervical cancer screening because of fear, because it is really important.
The horror of cervical cancer lies in the fact that early-stage lesions often have no symptoms. Some patients who hardly have gynecological examinations only seek medical attention when they have obvious symptoms such as abnormal vaginal bleeding or bleeding after intercourse, and the results show that the cancer is not at an early stage(friends who read this, don’t worry, abnormal bleeding does not necessarily mean cervical cancer).
No symptoms do not mean no problems, being older or having less sexual activity does not mean there is no possibility of cervical cancer. So, we must not be complacent, and the significance of screening is to discover lesions in advance and eliminate cancer in its infancy.
Diseases often have no symptoms in the early stage,
don’t wait until symptoms appear to seek medical attention
The optimal age to start cervical cancer screening and the screening methods(such as cytology, HPV) are not clear, and there are differences in recommendations from different expert groups. However, the general suggestions are as follows:
When should screening start? How often should it be done?
Age Starting age: The minimum age to start screening is currently women over 21 years old who are sexually active.
Stopping age: around 65 years old consider stopping screening (no history of CIN2+ cervical lesions in the past 25 years, regular screening, last screening within the last 5 years).
Screening frequency HPV testing or co-testing every 5 years; or cytological testing every 3 years.
It should be noted that high-risk factors (such as multiple sexual partners, early sexual activity, smoking, etc.), the screening interval should be shortened, and specific advice can be sought from a doctor.
Many patients are always anxious about the results after the examination. In fact, HPV infection is quite common, and many women will experience HPV infection, which does not equal cervical cancer.Most HPV infections will clear on their own, and only long-term persistent high-risk HPV infections may increase the risk of cancerization.
If a positive diagnosis is confirmed in women, we generally recommend:
HPV positive ≠ cervical cancer
No need to “panic at the mention of positivity”
In daily life Maintain a healthy lifestyle (such as regular rest, moderate exercise, quitting smoking, etc.), which can enhance immunity and help the body clear the virus faster.
If a biopsy is needed, the doctor will take a small piece of tissue (usually less than half the size of a grain of rice) for pathological analysis, and the wound will heal in a few days, without affecting fertility.
The purpose of the examination is to determine whether there is a lesion and the extent of the lesion, so as to decide on the subsequent treatment plan (such as regular follow-up or surgical treatment).
About 70% of cervical cancers worldwide are caused by high-risk HPV types 16 and 18, and another 20% are caused by HPV types 31, 33, 45, 52, and 58. The domestic HPV nine-valent vaccine not only targets the above 7 HPV types but also includes low-risk HPV types 6 and 11(which can cause about 90% of anal and genital warts).
The vaccine aims to prevent initial HPV infection and subsequent HPV-related lesions. HPV vaccination can effectively prevent cervical diseases, including CIN2 or CIN3 and adenocarcinoma in situ.
Cervical cancer screening is only secondary prevention,
vaccines are primary prevention
Recommended vaccination age 9-45 years old, preferably before becoming sexually active.
Precautions Even after vaccination, regular cervical cancer screening is still needed because the vaccine cannot clear existing HPV infections, nor can it prevent all known subtypes of HPV that cause cervical cancer.
Although cervical cancer screening can cause discomfort, it is an important barrier to protect women’s health. Understanding the significance and process of this examination can help us face it with a more relaxed mindset. Do not ignore this examination because of fear or misunderstanding, regular screening is the greatest responsibility to oneself and family.
I hope every woman can pay attention to cervical health and stay away from the threat of cervical cancer!
References
