What is a Pap smear?
The Pap smear (or Pap test) is a test done on your cervix. The cervix is the opening to the uterus or womb. The doctor or nurse uses a swab, a small brush or small wooden stick to get a sample of cells from your cervix. The sample is sent to a lab where it is looked at under a microscope. If some cells look different form normal cells, it is called an "abnormal Pap smear."
Pap smear or pelvic exam?
A Pap smear is not the same as a pelvic exam. During the pelvic exam, the doctor or nurse looks at and feels the other organs around your cervix to make sure their shape and size is normal. A Pap smear is usually part of a pelvic exam. If you're not sure whether your pelvic exam includes a Pap smear, ask your doctor or nurse.
Unless your doctor tells you otherwise, it is important to get a Pap smear once a year. If your result is abnormal, follow your doctor's or nurse's advice for what to do next. This gives you the best chance to stay healthy and prevent serious problems.
When do I need a Pap smear?
You should have a Pap smear once a year as soon as you start having sex. After three or more normal yearly Paps, some doctors may recommend Paps every two or three years, but it is still important to have a pelvic exam every year. Even women who have passed the change of life (menopause), have had their tubes tied or have had a hysterectomy need a Pap smear regularly as recommended by their doctor or nurse.
When preparing for a Pap smear, it is best to:
- Not use vaginal creams, foams, gels, douches or tampons 48 hours (two days) before your Pap smear. These products could cause an abnormal result.
- Not have sex 48 hours (two days) before your Pap smear. Sex can irritate the skin of the cervix or cause discharge (fluids) that can lead to an abnormal result.
What do my Pap Smear results mean?
This is good. You won't need another Pap smear for 1 to 2 years.
The slide cannot be read. Causes include douching, bleeding, infections, or not enough cells on the slide. The Pap smear must be repeated in 2-3 months.
The Pap showed infection, irritation, or normal cell repair. Have another Pap smear.
There are minor changes in the cells. Since we don't know what these changes mean, another Pap smear should be done in 3 to 6 months. If your Pap smears show atypia repeatedly, then colposcopy is usually done.
- LOW GRADE CHANGES
There maybe a wart virus infection (HPV). In one in six women, the Pap smear will get worse. You should have another Pap smear in 3 months to check. If found twice, then colposcopy is done. Some health care providers do colposcopy the first time.
- HIGH GRADE CHANGES
The cells of the cervix may progress toward cancer, but they are not cancer yet. Less than half of the women with tests like this will progress to cancer. Colposcopy should be done within the next few weeks. Waiting up to 1-3 months is okay because it is not an emergency.
What causes an abnormal Pap smear?
- Human papillomavirus (HPV) causes cell changes that are true abnormal Pap smears.
- Mild infection, irritation from yeast or tampons, or trauma from sexual intercourse also cause cell changes, but these changes often go away on their own or can be easily treated.
- The person reading the Pap smear may see some normal cells as abnormal. (This is not a true abnormal Pap smear, but it will require you to have the test again.)
What is HPV?
HPV is a very common virus. It is passed from the skin of one person to another during sex. There are many types of HPV Some types cause genital warts-bumps on the skin around the penis, vagina or anus-that you can see. A few types of HPV can slowly lead to cancer of the cervix if they are not treated. Most commonly these types do not cause warts or bumps on a woman's pubic area or penis that you can feel. This is why getting a Pap smear once a year is so important to your health. Most women who have HPV do not develop cancer, but some do. The good news is that cervical cancer can be prevented if the abnormal cell changes that can lead to cervical cancer are found and treated early.
What happens if I have an abnormal Pap smear?
If your Pap smear shows abnormal cell changes, your doctor or nurse may:
- Repeat a Pap smear every four to six months to recheck your cervix
- Test your cervix for HPV a sexually transmitted disease
- Look at your cervix with a special lens called a colposcope
- Take a sample of tissue, called a biopsy, from the cervix
Whether the plan is for a follow-up Pap smear, an HPV test, a colposcopy or a biopsy, keep your appointment. Make sure you understand the next step and why your doctor or nurse chose it. Don't be afraid to ask questions. You can use the form on the next page to write down your questions and to make a note of your next appointment.
What is colposcopy?
Colposcopy is looking at the cervix with a special microscope. If abnormal cells are seen, the health care provider will take a sample of the cells (biopsy). The cells are sent to a lab for examination.
What did the biopsy show?
- If biopsy shows the cells are normal, another Pap smear and sometimes another colposcopy are done just to make sure.
- If biopsy shows mild changes (warts, HPV, mild dysplasia, CIN I ), most health care providers do not treat. Treatment will not cure wart virus.
- If biopsy shows high grade changes (moderate to severe dysplasia, CIN II or 111), treatment should be done.
- If biopsy shows cancer, a cone or other surgery should be done.
- If colposcopydoes not give a diagnosis and the Pap smear shows high grade changes, a conization may be done.
What is treatment?
Discuss alternative treatments with your health care provider and follow through with treatment chosen:
- Cryocautery - freezing the surface of the cervix. The abnormal cells peel off and new healthy cells grow back. During cryocautery, you may have mild cramps. Afterwards, you will have a messy discharge and spotting. A risk includes abnormal cells remaining even after the cryocautery. This is the lowest cost treatment.
- LEEP / LLETZ - cutting off the surface of the cervix with an electric wire. This requires a local anesthetic. New healthy cells grow back. During LEEP/LLETZ, you may have some pain and smell burning tissue. Afterwards you will have some spotting and discharge. Risks include bleeding, cutting too deep into the cervix, and some abnormal cells remaining afterwards. This is a moderate cost treatment.
- Laser Vaporization - burns off the surface of the cervix with a carbon dioxide laser. This requires a local anesthetic. New healthy cells grow back. During laser vaporization, you may have some pain. Afterwards you will have spotting and discharge. Risks include bleeding, abnormal cells remaining afterwards, scar tissue in the cervix, and spreading wart virus in the smoke. This is a high cost treatment.
- Cone - cutting a cone-shaped area of the cervix to remove abnormal cells inside and on the surface of the cervix. It can be used to treat early cancer. This requires an anesthetic Afterwards, you will have some spotting. Risks include bleeding, scar tissue in the cervix, menstrual cramps, infertility, and future miscarriage. This is a high cost treatment.
- Hysterectomy - Removal of the uterus should be done only for cancer, not for dysplasia. During hysterectomy, you will be hospitalized and have an anesthetic. You will no longer have periods or be able to have children. Risks include death from anesthesia complications, early menopause if ovaries also removed. Osteoporosis and coronary artery disease are also increased. This is highest cost treatment.
What should I do now?
- Do not smoke. Smoking doubles the chance of cancer of the cervix. Smoking also helps warts grow.
- Eat healthy foods including dark green leafy vegetables and red/orange/ yellow fruits and vegetables. Folic acid and beta-carotene in them help the cervix heal.
- You will need Pap smears every 3 to 4 months for a year.
- You will need a Pap smear every year for the rest of your life, even if you have a hysterectomy (because precancerous cells could develop at the top of the vagina).
Stop by or contact us to talk about scheduling a Yearly GYN exam/pap test.