Embarrassment, fear and lack of knowledge are the main reasons that many women don't have pap smears as often as they should. This is unfortunate, because this test is an excellent way to detect abnormalities of the cervix before they turn into cancer.

It's really a simple test. During a pelvic exam, the health care provider uses a small swab or brush to take some cells from the cervix. These cells are put onto a microscope slide. Later, a laboratory technologist will examine the slide under a microscope, looking for abnormal cells.

Many women dread pelvic exams because they have had bad experiences in the past. When I worked in women's health clinics, I heard many stories from women. Stories about doctors doing an entire pelvic exam without explaining what they were doing or why. Stories about being left lying alone in a cold exam room with your feet up in stirrups for long stretches of time. Stories of women being scared because they had some cramping and slight bleeding after a pelvic exam and not knowing that this is normal. Stories about being uncomfortable during the exam but not telling the health care provider because of embarrassment.

I admit, pelvic exams are always a little uncomfortable. No one likes to lie on their back, feet up in the air, knees apart, with their most private body parts exposed. The speculum, which is placed inside the vagina so that the health care provider can see the walls of the vagina and the cervix, is a strange-looking and potentially uncomfortable device.

Most women, though, can deal with these things, if only their doctor or nurse practitioner or physician assistant would take the time to listen to them, hear their questions and fears, and give them all the information they need before the exam. During the exam, being very gentle, explaining what they are doing before they do it, and checking in with the woman to make sure she isn't too uncomfortable makes a big difference. A pelvic exam usually takes just a couple of minutes. It's amazing that two minutes can cause such anxiety.

I always felt a great sense of satisfaction when a woman said to me, "well, that wasn't bad at all!" after a pelvic exam. I just wish that all women could think of pelvic exams and pap smears in a positive light: as a way to take care of their health and a time to learn more about their bodies.

Last year, there were 13,000 cases of advanced cervical cancer in the United States. Many of these cases could have been caught at an earlier, more treatable stage if women had regular pap smears. If detected later, the cancer can spread to other parts of the body. Treatment at this stage is less effective and the disease can be fatal.

Hispanic women have a higher rate of cervical cancer than other ethnic groups. Only 12.5 percent of the population is Hispanic, but of all the cervical cancer cases in the 1990s, 22 percent were in Hispanic women. This rate is higher than expected because Hispanic women don't have pap smears done as regularly as women of other ethnicities.

So, please encourage your mothers, daughters, sisters, cousins and friends to make an appointment for a pap smear if they haven't had one in the last couple of years. If you find a health care provider who was gentle when doing your pelvic exam and was easy to talk to, tell all the women you know about him or her.

Kathryn B. Brown is a family nurse practitioner with a master's degree in nursing from OHSU. Is there a health topic you would like to read about? Send your idea to kbbrown@eastoregonian.com.

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