Case study: Sue

Sue, nurse Pap test providerI work at the Well Women's Clinic at the Royal Women's Hospital in Parkville. I first started taking Pap tests in 1971 when working at the then-new Dysplasia Clinic at the Royal Women's.

It was only the second such clinic in Australia, and as I was the only permanent staff member working with Dr Bill Chanen, he taught me how to take Pap tests, stain the cervix and take any photos needed. He would then come and take biopsies. He was an excellent teacher, and very respectful of female patients. I have been taking Pap tests ever since.

I trained to be a Pap test provider because I understood women wanted a female practitioner, and wanted to be part of 'Well Women', not the illness model. Being able to take Pap tests myself meant I could offer a more complete service for women. Doctors are also seen as very busy, and women sometimes only book in to see a doctor if they are unwell.

Being able to offer Pap tests as part of general health discussions can make it less of an awkward situation for many women. Because most nurses have more time to sit and speak with women before taking a Pap test, we can build up a bit of rapport before such an intimate examination.

Taking Pap tests during a Well Women's Clinic that uses the social model of health enables us to address many aspects of the woman's wellbeing. Often all sorts of health issues arise, simply because no one has ever asked women these questions before.

When working with women with mental illness, I have been able to combine my experience as a Psych Nurse with women's health, and hopefully provide a more comfortable experience than mainstream health can offer.

I enjoy the role of mentor, sharing my skills with my experienced colleagues and with those new to the profession.

Top tips for good Pap tests

  1. Establish rapport and do not rush the woman. Explain that she is ‘in charge' and can ask to stop the examination at any time.

  2. If you don't take the Pap this visit, let the woman know that's OK, and make another appointment. For some women it may take several visits before she is comfortable enough to actually conduct the examination.

  3. Have adequate drapes and privacy for the women whilst she is undressing, and ensure she is well covered before starting your examination.

  4. Always get the woman to try and relax her legs before even turning back the covering sheet.

  5. Have a variety of spaeculae size, and start with a smaller one. It is less uncomfortable for the woman than starting with a bigger one and needing to change to a smaller one.

  6. Always put a small pillow under the woman's buttocks before starting. Again, it can be distressing if you have trouble finding the cervix, and THEN need to put the pillow there. Women hate being asked to put their fists under their buttocks - very disempowering.

  7. Learn how to pass a speculum with the woman on her side - good for retroverted cervixes and also sometimes for women with lax vaginal walls.

  8. For some women, offer the option of her passing the speculum if she wishes. This is especially useful for women with previous traumatic experiences, including sexual assault or difficulty with Pap tests in the past.
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