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Pap Tests and Women With Disabilities

The Pap test, or cervical screening, is our best protection against cervical cancer. The Pap test is a quick and simple test used to check for changes to the cells of the cervix that may lead to cervical cancer. All women between the ages of 18 to 69 years who have ever had sex are advised to have a Pap test every two years. Yet, Australian and overseas studies suggest that women with sensory, physical, intellectual or psychiatric disabilities are less likely to have regular two yearly Pap tests than other women in the community.

Barriers to Pap testing

Women with disabilities may experience a number of barriers in accessing cervical screening services. Some of these barriers include:

Lack of information or access to information.
Difficulties with transport and access to buildings.
Lack of money, particularly when living in areas with few or no bulkbilling services.
Pain when undergoing the Pap test. For example, some women with cerebral palsy experience severe pain caused by muscular spasms.
Difficulties finding a suitable doctor. For example, a hearing impaired woman may not be able to find a doctor who can communicate via sign language.
Demands of coping with the disability, which may mean that little time or thought can be devoted to other health matters, such as Pap tests.
Previous experience - if a woman has had bad experiences with medical staff in the past, she may be reluctant to have a Pap test.
Reliance on a carer or attendant.
Lack of emotional support from partner, family and friends.

Attitudes of health care professionals

Some women with disabilities also find the attitudes of some health professionals a barrier. These may include:

Ill-informed medical staff, who assume that women with disabilities are not sexually active and don’t need Pap tests.
Pap tests are generally provided by health professionals who have more experience working with non-disabled women. Some of these professionals have difficulty in meeting the needs of women with disabilities.
Women who need to spend time in institutions may not receive information on general health matters (such as regular Pap tests) by professional staff.
Health care professionals may focus on treating the disability, and neglect to discuss other health care matters.

Suggestions for overcoming barriers

Suggestions include:

Ring around the various medical and community health services to find one that is appropriate for you.
Tell the receptionist about the nature of your disability, so that you can discuss your support needs in advance of your appointment. For example, you may need to book a longer consultation time.
Ask if there is an outreach or home visit service.
Visit www.papscreen.org.au to search online for an appropriate service provider. You can search for a provider based on disability access including ramped entry and disabled parking.
Take a family member or friend to your appointment.
Discuss your concerns with your doctor, and tell them how they can provide a better service for you.
Pap tests are usually done with the woman lying on her back. You may need to tell your doctor that lying on your side is more comfortable and practical.
Ask the service for appointment reminders.
Sign interpreters are available from VicDeaf on (03) 9657 8111, but need to be booked well in advance.

Breast screening

Evidence suggests that women with physical, intellectual or psychiatric disabilities are also less likely to receive breast screening. One American study found that disability was a key factor for lack of breast screening and Pap tests among Medicare patients.

Where to get help

Your doctor
Your women’s health nurse
Your gynaecologist
Family Planning Victoria, Phone: (03) 9257 0100
The Cancer Council Victoria's, Cancer Helpline, Phone: 131 120
PapScreen Victoria. Online advice available at www.papscreen.org.au.
Women with Disabilities Australia, Phone: (03) 6244 8288

Things to remember

Australian and overseas studies suggest that women with sensory, physical, intellectual or psychiatric disabilities are less likely to have regular two yearly Pap tests.
Some of the barriers experienced by women with disabilities in accessing cervical screening services include lack of information, transport and access difficulties, and negative experiences with insensitive health care professionals.

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