Barriers to the Pap Smear in Women of Fertile Age

The cervical cancer (CC) is one of the main threats against women life; it is estimated that right now in the world, this disease affects over one million women and most of them have neither been diagnosed or have access to a treatment that could save them or extend their life. In 2012, the World Health Organization (WHO) reported that it was diagnosed 528 000 new occurrences, and 266 000 women died of this disease, over 90% of them happened in countries with medium to low income. It is predicted, without immediate attention, the deaths caused by CC could raise by 25% in the next ten years; this same data is reported by the Pan American Health Organization (PAHO) (WHO/PAHO [5] as mortality indexes due to CC.


Introduction
The cervical cancer (CC) is one of the main threats against women life; it is estimated that right now in the world, this disease affects over one million women and most of them have neither been diagnosed or have access to a treatment that could save them or extend their life. In 2012, the World Health Organization (WHO) reported that it was diagnosed 528 000 new occurrences, and 266 000 women died of this disease, over 90% of them happened in countries with medium to low income. It is predicted, without immediate attention, the deaths caused by CC could raise by 25% in the next ten years; this same data is reported by the Pan American Health Organization (PAHO) (WHO/PAHO [5] as mortality indexes due to CC. The CC is closely related with the presence of the Human Papiloma Virus (HPV) mainly those identified as high risk; the two that cause with higher frequency are types 16  This topical has generated multiple controversies by the stretch relationship it has with the different cultures that the human being has; including that, nowadays women have the false believe that if they do not have a background of developing the CaCU disease, they do not have the necessity of performing PAP. Some barriers to not entering a periodical screening is to not know the age in which the test must be performed and with which frequency it should be done, they also mention that they do not come to their control due to fear of being diagnosed with cancer, also as shame to be examined in the genitals, and never had any children. Other beliefs are that they should have an active sexual life, being that CaCU is a serious health problem and it can take them to perform a chemotherapy, a hysterectomy or even death, and because of this, if she has 21 years old, the woman can perform the cytological exam.
The main action that drives women to come and perform an PAP is by the indication of a medical doctor or a nurse, because they heard it on television or radio, and because family members mentioned the topic in relationship with received benefits, being the most important health care Urrutia [8]; however, the majority of women have the belief that they will be hurt in the moment of performing the PAP, or that they will experiment pain during the exploration; this can have a reason in a lack of appropriate information by the medical staff about the realization of the test; they also refer this fear or shame to being male the one who is going to perform the test and that young women who live with their parents have fear of being revealed that they have an active sexual life. Other of the mentioned barriers mentioned by women are that they do not come to perform the test due to the lack of time or the long await to receive the result of the test, or the lack of consent by the couple, which is very common in the Mexican population by the still perceived machismo.

Material and Methods
The design of this study was descriptive, transversal in a population conformed by women in fertile age in the independence health center in the city of H. Matamoros, Tamaulipas

Results and Discussion
The socio-demographic profile presented by the women participating in the study corresponds to an average age of 34.7 years (SD=7.01), in relationship with the level of education, 43.3% reported middle school level and a low percentage (10%) reported being currently studying at a university. The bigger proportion reported a marital status of being married with an 57.3% and the 89.3% of the participants reported having a stable sexual partner, and in the PAP results, the PAP class II (normal) with a 96.0 (Table   1) prevailed. These results coincide with multiple studies where the average age is 35 years old and women are in a stable sexual relationship Urrutia [4], Sagarduy [7].  [12][13][14].

Conclusion
In relationship with the obtained results, it can be concluded that there still exists false beliefs about PAP and CC, where the most relevant ones are that the population does not know in which age it is necessary to take PAP [13] it also does not know the frequency in which it should be taken, they do not take the PAP due to a long time to being attended in the medical center and do not have that time to take the test, fear of knowing to have cancer and shame to be examined in the genitals. It is very important data to consider by the professionals in the preventive health field, where providing brief information is not enough to achieve woman empowerment and adhere to perform the Papanicolau test.