This may include:

• Embarrassment - acknowledge this discomfort. Explore if any past experience is relevant or if the woman has any suggestions to improve the situation. Check aspects of privacy. If embarrassment cannot be overcome, suggest referral to another service provider.
• Being afraid that something (wrong) may be found - probe whether there is any specific reason for this anxiety (eg: family history of cancer). Explain that the lifetime risk of developing cervical cancer is about 1:112. Reinforce that the majority of Pap tests are normal, and that abnormalities are usually pre-cancerous changes that can be treated before the development of cancer. Check that arrangements about results are clear and acceptable.
• Being afraid that it may hurt - enquire about earlier examinations and check whether the technique requires further explanation. Negotiate the examination - let the woman know that you can stop the examination at any stage; ask the woman to let you know if it starts to hurt; ask the woman which position is most comfortable for her. Warm the speculum and coach the woman in relaxation techniques and tilting of the pelvis.
• Wondering whether the test is reliable - discuss the degree of reliability of tests, reasons for false negative rate and importance of regular two yearly screenings to minimise risks associated with a false negative result.
• Time - the pressures of a busy life may impinge on the time a woman has to make available for a Pap test. Remind her about the importance of regular Pap tests, and if possible, arrange a mutually suitable time in the near future.

• accept that women have the right to say no;
• give as much information as possible
• assure the woman that if they really don't want one that its ok, but that you are available if she changes her mind
• provide written information for her to take away
• make a note in her file
• make sure you listen to what the woman has to say, ask open questions to find out how she feels and reassure her. For example: "Can you tell me something about why you feel this way?".

• In the initial discussion - explain why Pap tests are necessary. Explain the preventative nature of screening for cervical cancer
• negotiate a "stop signal" with her
• explain every step of the procedure
• offer an opportunity to have a support person present during the examination

• warm the speculum
• use an appropriate sized speculum
• be careful not to pinch
• negotiate a "stop signal"

• negotiate a "stop signal"
• offer an alternative person to do it
• offer an opportunity to have someone else in with her
• address any worries she may have (see information from first question)

• this is about re-examining the language you use. You may not know if the woman in front of you is a lesbian or not. Talk in language that acknowledges all sexualities, talk about "partners" not girlfriends or boyfriends
• offer to have a woman present during the examination
• offer to refer her to a female service provider if she is uncomfortable with a male practitioner taking the test
• don't assume that all women are heterosexual - whether or not a woman is comfortable with penetrative sex can impact on whether or not she is comfortable with the process of taking a Pap test
• reassure her that it is still important to have a Pap test
• negotiate a 'stop signal'
• address any worries she may have (see information from first question)

• make sure that she has understood what you have told her
• provide any written material that is available
• if a negative result, reinforce the need for continuing two-yearly Pap tests

• Link to Cervical Screening Essentials.

How can I overcome any concerns she may have?

What do I do if a woman says no to a Pap test?

How do I give control to the woman?

How could I avoid the pain and stop it hurting?

How do I reduce the anxiety of a woman who has experienced sexual abuse?

How do I discuss Pap tests with a woman who has identified as being a lesbian?

How should I inform a woman of her results?

How do I manage the results of an abnormal Pap test?