Table 2.

Participant Responses to the Question: “What Caused Your Abnormal Pap Smear Result?”

Cause	Explanatory Narrative
Gynecologic problems	“I have a fibroid and they can become cancerous.”
Menopause or cysts	“Because one time I had a cyst. When I got the letter, I thought maybe she found the cyst again.”
	“There is too much estrogen feeding into the uterus and these hormones can affect it to grow.”
Sexual activity	“If you’re not protecting yourself. He’s ejaculating in you and it’s different—semen is different from what women have.”
	“The fluid (semen) can carry venereal diseases.”
Misbehavior	“I am a married woman. And I had this thing with this other man. Whatever I have, I have caused, I have brought it unto myself.”
	“Sleeping around—doin’ it at a higher frequency. Bein’ more out there. Gettin’ exposed.”
Medical error	“Possibly the tools they used were not sterilized. Maybe the Petri dish was infected.”
	“Something not sterilized can obviously have bacteria. Then most likely it would go abnormal.”
Miscellaneous	“Some of those, you know, on top of the McDonald’s hamburger ... poppy seeds. It could just show up on the Pap smear.”
	“It could have been something I ate. ... I guess medication could affect it (Pap smear) or maybe it could have been something I had never eaten before ... it could’ve affected my system.”