Adding a Nonpainful Step at the End of a Pap Smear May Improve Screening Willingness

A study published in Pain found that the addition of nonpainful steps at the end of a Pap smear screening reduced long-term recall of pain and improved willingness to undergo regular Pap tests.

In Taiwan, women underutilize the free yearly Pap test leading to a gap in cervical cancer prevention. A randomized controlled trial was designed to evaluate the hypothesis that adding a nonpainful step at the end of a Pap smear may reduce pain recollection and increase willingness to undergo a subsequent screening.

Women (N=266) aged 30-70 years were recruited at the National Taiwan University Hospital Cancer Screening Center in 2020. Patients were randomly assigned in a 1:1 ratio to undergo a modified (n=133) or traditional (n=133) Pap smear. The modified protocol included a 15-second lag time between rotating the speculum and removing it. The outcomes of interest were pain intensity at 5 minutes on a visual analogue scale (VAS), one-year recalled pain, and willingness to undergo additional Pap smear at one year.

The traditional and modified groups comprised women aged mean 53.6 (SD, 11.6) and 52.2 (SD, 12.4) years, 93.2% and 94.0% had Pap smear experience, 1.12 (SD, 1.01) and 1.21 (SD, 1.04) had undergone Pap smears in the previous 3 years, and they predicted pain levels of 2.56 (SD, 2.10) and 2.83 (SD, 1.99) points, respectively.

The 2 groups had similar average, maximal, and real-time pain scores during the Pap smear overall. However, the proportion of women who were postmenopausal (n=166) reported higher maximal real-time pain (mean, 2.49 vs 2.27 points; P =.006) than women who were not postmenopausal (n=87), respectively.

At 5 minutes, those who received the modified test reported lower levels of pain on a 5-point numeric scale (P <.001) and 10-point VAS scale (P <.001) compared with the traditional group. This difference remained significant after adjusting for covariates (adjusted b, -0.62; P <.001).

The effect of the modified protocol on 5-minute pain recall was more pronounced among the postmenopausal women (odds ratio [OR], 3.19; 95% CI, 1.76-5.77, P <.001).

At one year, the modified Pap smear was associated with lower pain recall on a 5-point numeric scale (adjusted b, -1.96; P <.001) and 10-point VAS scale (adjusted b, -0.67 P <.001) compared with traditional Pap smear recipients. The modified group was more willing to undergo additional Pap smears (adjusted b, 2.11; P <.001).

This study may have been biased, as it was conducted during the COVID-19 pandemic, which affected Pap test screening uptake.

This study indicated that adding a nonpainful step at the end of a Pap smear may improve the patient experience. The study authors concluded, “More long-term primary care studies are warranted to investigate the effect of the nonpainful step on long-term cervical cancer screening participation.”