Clementine Ford: Your Vagina Is Beautiful And Precious. Here's How I Take Care Of Mine.
I thought I was pretty clued in on what I was supposed to do to maintain my vaginal and reproductive health, but a recent routine cervical screening test taught me otherwise.
I’d had my last Pap smear while I was pregnant which, as it was almost four years ago, meant I was two years overdue for another one.
But I was surprised to learn that some of the policies around the procedure have changed. I thought it might be helpful to pass on some new details for others who, like me, haven’t been properly paying attention.
(I need to state outright that I’m not a medical professional and I cannot give medical advice. I recommend following these points up with your GP or gynaecologist.)
1. IT'S NOT EVEN A PAP SMEAR ANYMORE
In late 2017, the standard Pap was replaced by the Cervical Screening Test. Where the Pap test was used to detect cell changes in the cervix, the CST looks for the human papillomavirus (HPV). This simple change is expected to protect up to 30 percent more people with cervixes, which is huge .
As a bonus, after the initial CST is done (which still needs to occur two years following your last Pap) it only needs to be performed once every five years -- perfect for people like me who are a bit muddle headed when it comes to remembering to book in important reproductive healthcare exams.
Unfortunately, the tests feel pretty much the same which means they are no less awkward and uncomfortable (in a best case scenario) or potentially triggering for survivors of sexual assault. Which leads me to the most important thing I’ve learned this week...
2. THERE ARE OPTIONS FOR PEOPLE WHO CANNOT UNDERTAKE CSTs BECAUSE OF TRAUMA
For survivors of sexual violence, medical procedures like CSTs can be incredibly triggering and traumatic. The reasons why are obvious, and speak to exactly why it’s imperative that the medical profession across the board needs to be well versed in trauma and sensitivity training, and take a best practice feminist approach to healthcare.
There are significant numbers of people who are not accessing CSTs because of the methods used and/or their experiences of insensitive healthcare providers. At my most recent screening, my doctor took care to talk me through every step and continuously ask for my consent for what she was doing. I don’t have a history of sexual trauma, but I greatly appreciated the care she was taking to give me informed consent and control over a situation in which I still felt extremely vulnerable and ill at ease.
But it’s also possible to do what’s called “self-collection”. It’s not as effective as a CST administered by a health professional, but it can detect the presence at least of HPV in the vagina. Those wanting to use self-collection will need to discuss it with their GP, but it’s at least an avenue to explore if you are otherwise determined not to seek out a CST.
3. THE AGE AT WHICH SCREENING NEEDS TO START HAS INCREASED
Australia’s National Cervical Screening Program launched in 1991, and it advised all people with cervixes and vaginas over the age of 18 to begin having routine Pap tests. However, while cervical cancer is not an impossibility for people between the ages of 18 and 25, it is rare. And according to the National Cervical Screening Program website, “it can take more than 10-15 years for a persistent HPV infection to develop into cervical cancer”.
Prior to this, it’s possible for some common cervical abnormalities to disappear by themselves.
It's now recommended to start screening at the age of 25, or two years after your last Pap smear, if you had it done at age 23 or over. Starting routine Cervical Screening Tests later reduces a number of unnecessary procedures and interventions that may be ultimately redundant.
4. EVEN IF YOU'VE HAD YOUR HPV VACCINE, YOU STILL NEED TO HAVE FIVE-YEARLY CERVICAL SCREENING TESTS
HPV is responsible for almost all cervical cancers, but the vaccine only protects from up to 90 percent of cancer causing HPV strains. This doesn’t just mean cervical -- it also means vaginal, vulval, anal, throat and penile. It’s an excellent vaccine and weapon in your arsenal, but all vaccines carry a slight margin for error.
It’s also important to remember that the HPV vaccine is best suited to people who’ve never engaged in sexual activity with a partner. It will still protect against a number of strains, but its effectiveness will be reduced. Don’t make the mistake of thinking that your HPV vaccine means the Cervical Screening Test is irrelevant to you -- unfortunately, we still are all better protected from cervical cancer by having those regular tests.
5. IT'S IMPORTANT THAT YOU TRACK ANY CHANGES TO YOUR VAGINAL HEALTH
In rare cases, HPV isn’t the cause of cervical cancer. When that happens, neither a Cervical Screening Test or a Pap will be able to detect the disease. This is why it’s really important to keep an eye on any changes or abnormal things happening in your vagina. Look out for unusual bleeding or discharge, or pain during penetrative sex. If you have any concerns, check it out with your trusted GP, gynaecologist or local sexual health clinic.
CSTs are no picnic, but neither is cervical cancer. Speak to your local healthcare provider about the best options for you and get your screenings up to date. Your vagina is beautiful and precious and it deserves to be taken care of -- just like you do, too.