By Anoushka Kuswaha ’24
Graphic by Gabby Gagnon ‘24
Science & Environmental Editor
Content warning: This article mentions transphobia, suicidality and mental illness.
The school year is coming to an end, and for many, this represents both the end and the beginning of new phases of life. These transitional moments are marked by traditions, some that date back to the early days of the College and some that are brand new. Dr. Emily DeMartino, a family nurse practitioner at Mount Holyoke College Health Services, has urged graduating students to form a new tradition themselves by visiting Health Services for a pap smear before leaving campus.
DeMartino acknowledged that some may be resistant to the idea of receiving a pap smear as a graduation present to oneself, as the procedure doesn’t have a reputation as being particularly comfortable. “Pap smears are intimate, they’re uncomfortable, they can be triggering for a lot of people,” DeMartino stated in an interview with Mount Holyoke News. However, they still expressed that they recommend the procedure, stating, “If you have been sexually active, have a cervix and are over 21, I’m going to recommend a pap smear.”
DeMartino reached out to Mount Holyoke News because they were “compelled by the commitment to affirming and empowering healthcare that supports students with tools for health.” They observed this commitment amongst their colleagues at Health Services as well. They wanted to reach out to the broader community upon reflection on their own experiences as a college student, when they “experienced health care that was affirming, that saw [them] as a human being [and] was completely paradigm-changing.”
“It’s completely life changing to have health care where you are listened to, where you are respected, where you are viewed as a valued contributor and consultant on your care,” DeMartino said.
What is a pap smear?
“A pap smear is a test which looks for cellular changes in the cervix or early signs of cervical cancer,” DeMartino explained.
According to the American Academy of Family Physicians, the cervix is “the opening between the vagina and the uterus.” The American College of Obstetricians and Gynecologists define a cervical cancer screening — which can either be a pap smear/test or an HPV test; both tests use cells taken from the cervix — as an exam where patients lie on an exam table, and an instrument called a speculum is used to hold open the walls of a patient’s vagina. The speculum gives the practitioner a clear view of the cervix and the patient’s upper vagina.
DeMartino then explained the next steps of the procedure. “A small brush, which is similar to a mascara brush, is used to collect a swish of cells from the cervix. Just a little swoosh, and then those cells are sent to the lab for evaluation [in] a small vial of liquid preservative, and a week or two later, the lab will report results,” the said.
According to DeMartino, pap smears can help prevent cancer. “Over 95 percent of cervical cancers are caused by HPV. Three in four people who are sexually active … will have HPV at some point in their lives,” DeMartino explained.
According to the CDC, HPV is the most common STI in the United States. In the majority of cases, HPV can go away on its own without causing health issues. DeMartino confirmed this, saying that “many people’s immune systems will clear or eradicate the infection [HPV], but in some people, chronic HPV infection … can cause cellular damage and may cause precancerous or cancerous changes.”
Certain types of HPV, such as HPV 16 or 18, are known to have a higher risk of causing these cellular changes, which, over prolonged periods of time, can lead to cervical cancer, according to DeMartino. They reassured, however, that these types of HPV are prevented from infecting the body through the HPV vaccine, thus emphasizing the critical importance of vaccination against HPV for all people.
Gender-inclusive health care
DeMartino expressed that there is further urgency for people who are transmasculine to receive pap smears in a safe, high-quality health care environment.
“Transmasculine people with cervixes have an over 8 percent higher prevalence of unsatisfactory pap smears, and lower odds of receiving cervical pap tests than cisgender women. People who take testosterone have a higher chance of inadequate pap smears, because of the way testosterone can change internal genital tissue,” DeMartino explained. They reassured that pap smears are still very much viable for people who take testosterone and have cervixes, but that they will potentially “[recommend the] use [of] an estrogen cream for a week or so before a pap smear appointment to improve sample results.”
There are also additional options for HPV testing that allows for cervical cancer screening besides pap smears that are showing promising results, such as self-swabbing for HPV, DeMartino added.
As to why DeMartino emphasizes the above statistic, they explained, “Healthcare providers often understand queer and trans people from a deficits-based model, which is very disappointing. Being transgender is just a normal part of human variation, but a lot of health care for us focuses on disease burden, particularly trauma, suicidality and mental illness.” DeMartino continued, “While I understand this from a prevention perspective, centering our wellness gaps is very limiting. As a patient, it can feel harmful and hurtful to be othered and understood as atypical, when structural transphobia and the resultant inequity are drivers of these gaps.”
As students enter the adult world, especially visible amongst those staying in the United States, there remain issues of health equity that they will need to work hard to address in order to lead healthy lives. “People have inconsistent health insurance. It’s hard to get in with healthcare providers … people should access care when they have it, so [students] should come and get their testing,” DeMartino said. They also emphasized that they and their colleagues at Health Services will speak with students on a case-by-case basis to find out the testing that works best for them, and that they “would invite you to celebrate your graduation with cervical cancer screening.
“Screening and early detection of cervical cancer is critical because it is slow-growing and because it is extremely treatable. … If you can get a pap smear now while you have access to high-quality healthcare, please do it.” DeMartino continued.
DeMartino values informed, collaborative healthcare between a patient and their provider, but noted that an imbalance remains between providers and patients. Providers do appreciate, and often need, a nudge indicating whether they should provide extra support and address specific needs that patients may have. DeMartino emphasized that patients “must trust [themselves] and know that no one is entitled to [their] body, not even healthcare providers.”
Regarding making pap smears more comfortable, DeMartino offered the following tips to Mount Holyoke students. These options can include inserting the speculum yourself during a pap smear, bringing a friend or a support person to any and all appointments or bringing headphones and music to your appointment. There is also flexibility in scheduling appointments and procedures, wherein patients “can talk about a test on one day, and we can plan to do it in a second appointment or a third appointment,” DeMartino stated. “There’s lots of techniques we can use, and your healthcare providers should always be happy to work with you on it … But let us know where you’re at, give us a clue, and I am confident that we will show up for you.”