You’ve probably seen the pap smear conversation that took over Nigerian Twitter this month, which was split down predictable lines. One side traded stories about painful, dismissive appointments. The other side wondered why a routine screening test was being treated like an ordeal. Both sides were talking past each other, so we went straight to the source: women, who are the ‘target audience’ of the procedure, and doctors, who champion and perform it.
Science gives the discourse more credit than it might seem to deserve at first glance. A 2024 study in the Proceedings of the National Academy of Sciences looked at over 21,000 emergency room records across two countries and found that women indeed get treated differently than men when it comes to pain, regardless of the treating doctor’s gender. Women were less likely to have their pain scored on arrival, waited longer to be seen, and were less likely to leave with pain medication. Even when nurses judged pain directly, the same complaint from a woman was rated as less severe than from a man. A 2001 report, “The Girl Who Cried Pain,” found the same pattern going back decades: women report more pain than men and are more likely to have it dismissed as emotional rather than physical. So the caution wasn’t coming from nowhere. It was tracking a pattern medicine itself already knows and acknowledges.
*T has never had a pap smear, but she’s followed the conversation closely, and it’s shaped how she feels about the procedure before she’s even booked one. “I do think doctors can be quite dismissive when it comes to gynaecological procedures and women’s concerns generally,” she says. Given the research above, that’s not an overreaction. It’s a reasonable read of a documented pattern.
*L’s experience, a few days before we spoke to her, sat differently. “It wasn’t painful; it was invasive, a little uncomfortable, but nothing painful at all,” she says. “It was generally a good experience because the doctor was careful and explained the process.” She’d seen the same tweets and brought that into the room instead of avoiding it. “I told the doctor I was scared because of the conversations, and she took her time to explain everything, and was more patient and careful with the procedure because of it.” Her good appointment doesn’t disprove the pattern. It’s one data point among several possible ones.
The doctors we spoke to weren’t interested in defending the profession outright. They pushed back instead on the idea that anyone gets to define pain on someone else’s behalf. “Pain is highly subjective, so I don’t even know why that’s a conversation,” says Dr Aisha. “Why do you think it’s okay to define what’s painful or uncomfortable for someone else, whatever their experience? It’s valid. Two truths can coexist: it can be uncomfortable, it can be painful, and it can still be necessary.” Her own smears haven’t been painful, but she’s careful not to generalise from that. “That doesn’t mean someone who says they experienced pain is lying. Pain is subjective, situations are different, and everyone is allowed to feel what they feel.”
Dr Ife has had the procedure too, and calls it uncomfortable rather than painful, in her case. “Having a speculum put up there is not a very pleasant experience,” she says. “The stranger part was feeling the brush go up past my cervix; that was odd, but quick.” She’s clear her own experience isn’t the benchmark. “It can absolutely be painful for other people, and it depends on what’s being looked for too. There’s no one size fits all. And if someone says it’s painful, you have to believe them.” She also offered a few practical fixes: asking for a smaller speculum, taking pain relief beforehand, or requesting gas and air, a mix of oxygen and nitrous oxide sometimes used to ease procedures like this in the UK where she practises.
Dr Adeoluwa went furthest in explaining why the pain shows up so unevenly to begin with. “A pap smear isn’t expected to be painful, even though it’s possible,” he says. “It would be unfair to disregard people’s experiences, because there are situations where it can come with real pain.” Anxiety plays a role, he explained: tensing up without meaning to can make the exam harder, especially for people carrying past trauma. Vaginal dryness, vaginismus, endometriosis, or an undetected infection can also turn a routine exam painful. His advice was direct. “If a woman experiences pain during the procedure, she should speak up.”
Three doctors, asked separately, landed in nearly the same place without coordinating: pain is real, it’s uneven, no one’s tolerance is the standard, and a patient who says it hurt should be believed. That doesn’t mean dismissive care isn’t happening; the research and anecdotal evidence say clearly that it does. But it suggests the online fight wasn’t really doctor versus patient. The doctors we spoke to already agree with what the discourse is asking for. Where the gap exists, it’s less about belief and more about whether that belief consistently makes it into the room.
What a pap smear is actually for
Strip away the discourse, and it’s simple. A doctor uses a speculum to see the cervix and takes a small sample of cells with a soft brush. Those cells are checked for early changes linked to HPV, before they can develop into cervical cancer. It’s not diagnosing cancer; it’s more like catching the slow process that leads there while it’s still easy to treat.
The stakes are specifically high here. Cervical cancer is the second most common cancer among Nigerian women, and the second leading cause of cancer death among Nigerian women aged 15 to 44. Yet, most Nigerian women who’ve ever been screened have had only one pap smear in their lifetime, largely due to access and awareness gaps rather than choice.
International standards recommend screening from age 21, roughly every three years, with HPV testing sometimes added from 30 onward. Treat that as a benchmark, not a fixed rule, and confirm with your own doctor what applies to you. But the core idea holds everywhere: it’s preventive, it isn’t supposed to hurt, and if it does, that’s worth telling your doctor rather than a reason to skip the next one.
None of this settles the X conversation for good, and it probably shouldn’t. What it does is put some shape around it. The doctors aren’t the villains the timeline sometimes makes them out to be, and the women aren’t exaggerating or creating a problem that isn’t there. Both things are true at once: pain is real and worth naming, and a pap smear is still one of the simplest ways to protect yourself against a disease that kills too many Nigerian women too early. The ask, from everyone we spoke to, was never complicated. Go get one. Say something if it hurts. Expect to be believed when you do.
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