婦女感受子宮頸抹片之疼痛指數調查

Survey of Pain Scores Associated with Pap Smears

目的：子宮頸癌是女性十大癌症之一，子宮頸抹片檢查在其早期診斷扮演著重要的角色。國民健康署主導的癌症篩檢如火如荼的展開，仍然有一些婦女因為疼痛、害羞和錯誤觀念誤導，將子宮頸抹片檢查視為畏途，延誤了子宮頸病變的早期診斷。本研究主要目的是探討婦女感受子宮頸抹片之疼痛指數，並試圖導正子宮頸抹片疼痛之迷思。方法：這是一個以醫院為基礎的描述性觀察型研究，針對2012年4月起至2013年3月止，就台中市某教學醫院家醫科門診接受子宮頸抹片檢查病患，方便取樣222人給予問卷調查。分析其人口學特徵、接受抹片檢查後由病患以十公分量表自我評估抹片所合併之疼痛指數並紀錄所使用鴨嘴之尺寸和材質。結果：在這222位家醫科門診執行抹片檢查病患，有140位（63.1％）受檢婦女感覺毫無疼痛，74位（33.3％）受檢婦女感覺輕度疼痛。曾有不良骨盆腔檢查經驗之11位病患，其中10位（90.9％）其疼痛指數介於0和3。執行抹片檢查所使用鴨嘴尺寸和材質以極小號103位（46.4％）和小號100位（45.0％）不銹鋼材質鴨嘴為主。結論：子宮頸抹片檢查是否疼痛，長期以來一直困擾著婦女，也妨礙子宮頸癌篩檢之落實。本研究指出在仔細評估病患之身體狀況，並慎選鴨嘴的尺寸和材質，且於採樣過程當中維持持續溝通，子宮頸抹片檢查之疼痛指數是可被大多數病患所接受的。

Purposes: Cervical cancer is one of the top 10 cancers affecting females. Pap smears play a very important role in the early detection of cervical cancer. Despite a recent cancer campaign promoted by the Health Promotion Administration in Taiwan, some women consider Pap smears embarrassing and are influenced by previous painful experiences. Indeed, some women are reluctant to have Pap smear examinations, and thus affect the early diagnosis and treatment of cervical pathology. The aim of this study was to better understand the pain associated with the performance of Pap smears and attempt to dispel the myth of pain associated with Pap smear sampling. Methods: This hospital-based observational convenience-sampling survey used a questionnaire administered to women after undergoing Pap smears at a family medicine outpatient department in a regional teaching hospital in Taichung between April 2012 and March 2013. Two hundred twenty-two participants were recruited for this study. We analyzed the demographic data, pain reported by patients after a Pap smear using a self-report numeric rating scale, and the size and quality of the speculum used. Results: Of the 222 participants, 140 (63.1%) reported no pain and 74 (33.3%) experienced mild pain. Of the 11 participants with a prior poor pelvic examination experience, 10 (90.9%) reported pain scores between 0 and 3. The size of the stainless steel speculum used were extremely small (103 [46.4%]) and small (100 [45.0%]). Conclusions: The pain associated with Pap smears has impacted women for a long time and impeded fulfillment of cervical cancer screening. Our results suggest that with careful evaluation of the patient’s physical condition, meticulous selection of the size and material of the speculum, and continuous communication during sampling, the pain score associated with the performance of Pap smears is acceptable for most patients.