Pap test

Before I have a little game that I want to play, fact versus fiction.

But before that, I quickly want to touch on pap smears and How much trauma people can either get triggered over past trauma or how traumatic a pap smear can be.

I once had a gynecologist.

I was living in Madrid and I was trying different ones with my insurance, getting my master's.

Okay.

But here's the big mic drop moment.

there, pap smears are going to be, there is now FDA approved at home collection of pap, which is pretty cool.

And I don't mean you should never go to a doctor again.

So risk factors for uterine cancer is strongly advised when there's factors such as obesity, tamoxifen use, uh, for breas- breast cancer treatment or prevention, uh, type 2 diabetes, a genetic syndrome called Lynch syndrome, which increases colon and uterine cancer, or if follow-up is, uh, uncertain.

And so ideally, if you have a high-risk patient and you're a gynecologist or a women's health specialist, you're examining the patient, you've made sure that they're, you know, not pregnant, you really wanna do an exam, a diagnostic Pap, and an endometrial sampling right there and get the tissue.

If our patients call in and they've had off-schedule bleeding, and it's not within an acceptable timeframe of just starting hormone therapy, we'll-- where we may accept some bleeding or spotting for the first few months.

If the woman's, you know, over 40, and rarely I've even diagnosed uterine cancer in women under age 40, knowing your family history is also very, very important.

And it's important to engage in shared decision-making and discussing the options.

And doing an endometrial sampling for most women is not too much more than a Pap, especially if the cervix is open And women who've had vaginal deliveries, women who don't have severe vaginal thinning, or who, who have not had procedures done to the cervix, there is a medication, misoprostol, that we can prescribe prior to, uh, endometrial sampling.

The, the procedure typically just lasts about 10 minutes, and, you know, most people get right up and go right about their day.

Um, certainly taking a nonsteroidal anti-inflammatory agent, if there's no other contraindications, can sometimes be done, and there can be a little bit of menstrual-like cramps afterwards.

I want to talk about something today that almost nobody says out loud in a doctor's office, even though I think most of you have felt it.

You dread the pap smear.

Not just find it inconvenient, actually dread it enough to push the appointment back a few months, then maybe a few more, and then somehow it's been two years and you haven't had your pap done.

If that's you, I'm not going to tell you that's irrational because it isn't.

The concern is persistent infection with certain high-risk strains which is what screening is actually designed to catch either directly through HPV testing or or indirectly through a PrEP test looking at cervical changes, or looking at your cervical cells for changes.

Now, here's where I want to correct something because I think a lot of you are operating on outdated information about how often you actually need to do this.

The old assumption was a pap smear every single year.

And I think that assumption alone is part of why this feels so heavy.

Et je pense qu'aujourd'hui les médecins sont un peu plus conscientisés quand même là à bien accompagner les jeunes.

Mais c'est clair que ça m'a donné quand même un tu sais, j'ai, j'ai jusqu'à aujourd'hui, j'ai pas encore passé un PAP test complet sans crise de panique, là.

C'est, c'est jamais ré arrivé.

J'ai vraiment eu de la misère.

Là, aujourd'hui, c'est moins pire.

Parce que là, j'ai été voir un psy puis on a fait une sorte d'hypnothérapie pour calmer ça.

Ah, ça a marché tellement là, ça fait tu sais, tu vois, aujourd'hui, j'ai pas encore retourné passer un PAP test, mais aujourd'hui, je le- Con-- Tu sais, je, je m'imagine y aller.

Puis je pense que ce sera peut-être pas genre la plus belle journée de ma vie, mais ce sera pas paniquant.

And let's say they don't have any warts; they're asymptomatic.

How would we know we're HPV positive? Well, if we get a Pap smear, that Pap smear result could come up abnormal.

Long-term effects, biggest one is about 99% of all cervical cancers are directly related to HPV.

There are new cancers coming up with HPV-positive individuals that ha- that are throat, esophageal, anal.

Gardasil 9 is the vaccine.

We wanna encourage it.

Obviously, if somebody already has HPV, then we are going to stress using protection, and we're really gonna stress routine Pap smear screening to catch those, again, dysplasia cells early before this turns into stage III, IV cervical cancer, and then we're in a bad position, and promote barrier condom use.

All right.

I would probably be leaning more towards a no, though, if I was getting a pap smear.

But then I think of the time that I have had students in there, and it's when, like, uh-

Pap smear

... [laughs] yeah, those suck.

God, they really could've came up with a better term for that.

[laughs]

No kidding.

Which, w- Josh, which Naked Gun movie was it where the bad guy's name was Pap Smear?

If you lose the rivalry that week, the following week your opponent gets to rename your team and put a new logo on your team.

So in that moment, you become the, uh, you become the Steve Zabin Pap Smears and with-

[laughs]

... and a logo that is representative-