"A PAP smear, No thanks,” says 26-year-old Mary Kaitesi. It’s the same response when I ask 20-year-old Rose, a university student. 

The rate at which  young girls are shunning the Pap smear test is worrying.  Yet it is a harmless test that could save many from cervical cancer. The Pap smear is a screening test for cervical cancer. Cells scraped from the opening of the cervix are examined under a microscope. The cervix is the lower part of the uterus (womb).

Dr Alphonse Butoyi, a gynaecologist at Kanombe Military Hospital says that he sees three to four women per week coming for consultation on the Pap smear test.  It’s a similar trend across most healthy facilities across the country. 

"Only one woman out of the four I receive every week is willing to take a pap smear,” Dr Butoyi says.

He  advises that  the pap smear test is important for the early detection of cervical cancer which mainly occurs when cells on the cervix grow out of control. If detected early cervical cancer can be treated.  Many theories have been advanced to explain this worrying  trend of women who shun the Pap smear. 

Some say the procedure of carrying out the test encroaches on the women’s  privacy especially because most gynaecologists in the country are men. 

"Women are shying away from something that could save their lives. Is it because most gynaecologists are men?,” asks Joan a mother of two.

Don’t wait when it’s too late

Joy Mukamusoni got the courage to take a pap smear test after her auntie was diagnosed with cervical cancer. 

"My aunt got to know that she was suffering from cervical cancer when it was too late and nothing could be done to save her. I could not stomach the fact that in a few months, as the doctor had said, we would never celebrate another Christmas with her. She was like a mother to me. She raised me after my mother had been killed in the 1994 Genocide against the Tutsi when I was just 10 years old,” Mukamusoni narrates. 

Mukamusoni adds that it was during the time she was taking care of her sick aunt when she made up her mind to do some research about cervical cancer.

"I got to learn that a Pap smear test was crucial if one needed to detect and prevent the possibility of suffering from cervical cancer. But the thought of having to open my legs for a male doctor seemed uncomfortable.  The pain my aunt was going through actually pushed me into taking the test,” Mukamusoni reveals. 

She adds: " I closed my eyes when the doctor was doing the test, I didn’t feel any pain and it was so quick. He explained to me that he was scooping cells from the uterus wall which would be tested.  He showed me the cotton pad that he used and that was it. The test showed that I didn’t have any abnormalities. From that day on, I frequently take a pap smear.”

Dr Butoyi says that cervical cancer is caused by an infection related to a common virus called papillomavirus (HPV).

"Any sexually active woman should undergo a Pap smear test. It’s a simple procedure and it’s not painful like what most women think when they come for the first time. It’s a routine women shy away from maybe because they don’t have complications at the time or other factors are at play,” Dr Butoyi explains. 

Besides helping in the early detection of cervical cancer, a Pap smear test can help to detect other infections such as sexually transmitted diseases. 

Cultural barriers cited 

Cultural barriers and stereo types have also been blamed for the problem of women not embracing pap smear. 

In Rwandan culture, it’s a taboo for a woman to expose her genitals unless of course she has complications like infections. 

"But I think perceptions and cultural beliefs should change especially when it comes to issues related to one’s health,” Dr. Butoyi advises. 

According to the World Health Organisation, Rwanda is ranked among the countries with the highest cervical cancer incidence, estimated at 49.4 per 100,000 while in East Africa the overall incidence is 42.7 per 100,000 women annually.

According to the Ministry of Health 2013 statistics, 68.5% of cancer cases are confirmed microscopically, and cancer related mortality is estimated at around 9.6% in Rwanda. 

Breast and cervical cancers are the most persistent in Rwandan women, affecting 32% of all women diagnosed with cancer.

According to Nathan Mugume, the Head of the Rwanda Health Communication Centre, there are various cervical cancer awareness programmes in Rwanda. 

"We educate women and girls about the early signs of cancer as well as encourage them to go for screening for early detection and a Pap smear test is one of the many ways for early detection. HPV vaccination for girls aged between 12 and 15 is another programme that has been ongoing in regard to the cervical cancer prevention,” Mugume explains.

The human papilloma virus (HPV) vaccine prevents infection with certain species of human papillomavirus associated with the development of cervical cancer. 

When asked if the low numbers of women going to health centres for the Pap smear test has anything to do with the fact that there are only male gynaecologists in Rwanda, Mugume says: "I don’t think that’s an issue. Having a healthy life should come before our perceptions and attitudes.  We always educate the women, to freely talk to the doctor and ask them to explain some procedures that they do not understand. The doctors are ethical and know how to prepare a patient to open up. It’s not about the issue on whether the doctor is female or male. They are the same doctors women go to see when they are pregnant. ” 

Although Mugume says that it does not matter which doctor is going to do a Pap smear and so women should not shy away from the test, Marie Louise Uwizeyimana thinks otherwise. 

" I can’t spread my legs for a young male or female doctor. I would not feel comfortable. Maybe because I have never given birth before, that could be why. The thought of spreading my legs for a doctor already feels awkward. It’s the possibility of bumping into these young doctors somewhere that is even more uncomforting,” Uwizeyimana argues. 

Uwizeyimana, the Vice President of the Rwanda Journalist Association and Editor of Intego Newspaper says she has gone for a Pap smear test once. 

"At some point I contemplated  calling off  the appointment. Luckily the gynaecologist was an old man in his late 60s. He prepared me psychologically that it didn’t feel awkward anymore. If I went for another test which I plan on doing again like next year, it will have to be an older female or male gynaecologist to do the test. Period,” Uwizeyimana emphasises. 

Some people think a pap-smear is painful while others are shy to undertake it. There are some women who are just uncomfortable at the thought of their bodies being examined. Whatever the reason is, every doctor worth their salt will tell you that it is a quick and painless process, insisting that you have absolutely nothing to worry about. So go get that Pap smear, you never know just how much gratitude you will owe it later in life.

 How to prepare for a Pap smear test

You should not schedule your Pap test for a time when you are having your period. If you are going to have a Pap test —

•You should not douche (rinse the vagina with water or another fluid).

•You should not use a tampon.

•You should not have sex.

•You should not use a birth control foam, cream, or jelly.

•You should not use medicine or cream in your vagina.

Women’s views on the pap smear

I have them and it’s always done by my male doctor but with a female nurse present. It’s the law here in the UK. I always worry about him seeing my bits of course! I make sure I go immediately after having a bath when I’m very fresh. I don’t have any preference, male or female; I’m just uncomfortable with my bits being on show. I understand the fear but it could save your life. You can get a doctor to be comfortable with. It’s such a fast procedure anyway so you won’t be on show for long. Wear very clean underwear and be fresh down there. The doctor has seen so many he’ll not be able to remember which belongs to which face.

Trudy Babirye

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I have gone for the test many times. It is recommended by doctors in Canada every year.  I have always dealt with male doctors. I feel more comfortable. My first time wasn’t scary since the doctor passed me through the whole process before she could do it. I was uncomfortable spreading my legs to a stranger especially a white lady. Anyway, time for the qui tip (ear pad like stick) was very uncomfortable. You feel every movement. I felt every movement in that I was nervous throughout. But it’s easy and relaxing is key.

Mary Arinaitwe

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I think it’s painful so I have not tried it. The thought of tissue being plucked from within me freaks me out to death. I know I still need one someday. I have walked away from the test more than four times. I will do it someday though I’m not sure when. I think I prefer a male doctor. They are more gentle and concerned while at work. 

Enid Achiro

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I had my first pap smear after giving birth to my daughter. I’ve had two tests since then I have done one per year. I would not mind either. I’ve had male gynecologists before. I am due again this year. It is a bit uncomfortable but not painful and it’s over in a flash. 

Winnie Gimoro

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It’s a procedure that helps detect if you are at risk of cervical cancer or not. I have never gone for one because I am scared though it is important. I hope to go for one soon. However, I would rather be examined by a woman as we are one and the same. I wouldn’t be comfortable having a man check out my ‘lady business’. 

Irene Babirye