For some women, getting a Pap smear is hell.

Since her early 20s, Kevinn Poree has suffered from chronic vaginal pain — pain that led her to scream in agony the first time a gynecologist tried to insert a speculum.

“I completely lost it,” said Poree, 38. After the speculum was removed, she started “crying in the fetal position.”

Ever since, like many women, she has dreaded the cervical cancer screening test, which requires a patient’s legs to be held apart with stirrups and a cold metal device to be inserted vaginally, while a physician scrapes cells from the cervix.

Even when acute pain isn’t an issue, research suggests that, for many, Pap smears are uncomfortable, for a complex set of physical and emotional reasons.

“There are people who experience distress” due to fear or embarrassment or a history of sexual trauma, said Karen Knudsen, CEO of the American Cancer Society.

Now, a few health care companies are preparing to introduce a new model for cervical cancer screening and prevention that would circumvent the speculum: self-collection, in which a woman swabs her vagina in the doctor’s office, using only a narrow swab that looks similar to the one for a COVID-19 test. Once the sample is collected, a lab would test it for the strains of human papillomavirus, or HPV, most likely to cause cervical cancer.

A key change in HPV screening has made the technique possible: Labs are now able to test using samples taken from the vaginal walls, as opposed to from the cervix itself.

In introducing self- collection, the U.S. will follow countries including Australia, Denmark, the Netherlands and Sweden, which have gradually introduced self-sampling for cervical cancer screening in recent years, with great success in its adoption.

Two decades of research suggest this method is as effective at preventing cervical cancer as traditional Pap tests for women 25 and older.

In May, the Food and Drug Administration approved self-collection tools from pharmaceutical companies Roche and BD (Becton, Dickinson and Co.) for use inside health care settings. Patients can test themselves in private and leave a sample with a health care provider, similar to when they provide a urine sample.

But representatives for the firms said the longer-term goal is at-home cervical cancer screening, in which a test is ordered by a health care provider, a woman collects a sample at home and then sends it to a lab for HPV screening. If the sample comes back positive, her provider would advise next steps.

While screening at home is available in other countries, this method is still under FDA review in the United States. It could gain approval by early next year.

For women who want to self-sample sooner, BD’s kits are expected to begin shipping to medical facilities in September, and Roche’s will roll out later this fall, their spokespeople said. Both tests involve inserting a swab about 3 inches into the vagina.

Experts hope the tests — which will be covered by public and private insurance, and free at many federally funded clinics for women who are uninsured — will help reach the 30% of eligible women in the United States who do not get screened regularly, including those who avoid Pap smears due to discomfort. This screening gap results in thousands of preventable deaths from cervical cancer every year.

Self-sampling comes at a time when women are pushing back against culturally embedded beliefs that gynecologic and reproductive pain is something they have to simply endure. Along with advances in alleviating IUD pain and the side effects of menopause, women’s health companies are also designing more comfortable speculums for gynecological exams.

Erin Kobetz, the associate director for community outreach and engagement at the Sylvester Comprehensive Cancer Center in Florida, who has spent two decades studying cervical cancer self-sampling, described the new tests as having been “a long time coming.”

Why the Pap has endured

Despite being disliked by many women, the patient experience of having a Pap smear with a speculum and stirrups has remained largely unchanged since the 1940s, when the test — named for its inventor, Dr. George Papanicolaou — became standard practice in the United States.

This is in part because it works, said Knudsen. The introduction of the Pap smear reduced cervical cancer mortality by more than 70% in the 20th century, so from that perspective, she said, “the Pap smear is unquestionably a win.”

During a Pap smear, the doctor takes a sample of cells from the cervix, smears it onto a slide and sends it away to a cytologist, who looks for precancerous or cancerous cells. If the test comes back positive for abnormal cells, and the disease is still in its early stages, a physician can usually remove the affected area and stop the disease from progressing.

More recently, in many cases, samples taken during Pap smears are also tested for the strains of HPV most likely to cause cervical cancer. If an HPV test comes back positive for one of these strains, physicians will monitor the patient for precancerous cells over the following years. (If abnormal cervical cells are also detected, the patient may receive treatment.)

Pap smears and HPV tests are especially effective at preventing cervical cancer because the disease progresses slowly, relative to many other cancers; it typically takes years to move beyond the precancerous stage.

Preventable cervical cancer deaths persist

Despite the Pap smear’s effectiveness, the drop in cervical cancer deaths has leveled off since 2008. In the U.S., about 11,500 women are diagnosed with cervical cancer each year, and 4,000 will die from it.

Public health officials say many of these deaths are preventable — and due, in part, to the current testing protocol failing to reach millions. “The incidence has really sharply declined” thanks to the Pap smear, Kobetz said, but this decline “has not been experienced equitably.”

Women who live in rural areas without easy access to doctors tend to be under-screened, as do women with lower socioeconomic status and Black and Latina women. Women with insurance were four times as likely to have been screened in the previous year compared with those without insurance.

Experts say that they are cautiously optimistic that broader screening via self-collection — in concert with more robust vaccination against HPV — could help the World Health Organization meet its goal of eradicating cervical cancer in the near future.

“This is the one cancer that we could eliminate in our lifetime,” Kobetz said.