Experts recommend that all women of reproductive age, who are over the age of 21, get a Pap smear – also called a Pap test – every two or three years. Pap smears are screening tests for cervical cancer. Getting regular Pap smears are one of the best ways to prevent cervical cancer, and over the past 50 years, these tests have led to a major decrease in the number of cervical cancer deaths.
Cervical cancer is the third most common cancer in women around the world. In the earliest stages, cervical cancer has no symptoms. Advanced stages of cervical cancer are difficult to treat, since the cancer has already spread to other areas of the body, including the woman’s liver, bladder intestines and lungs. Because cervical cancer can take years to develop, getting regular Pap smears can detect it in its precancerous stage (called dysplasia). Dysplasia is 100 percent treatable and will prevent the cancer from progressing.
A majority of women who are diagnosed with cervical cancer today have not had regular Pap smears.
What is a Pap Smear?
A Pap smear is a procedure/medical test done in a doctor’s office that looks for abnormalities in the cells of your cervix (the opening of the womb). During a routine Pap test, your doctor will collect cervical cells, which are sent to a lab for testing. The results of a Pap smear indicate whether or not there are any signs of cervical cancer, or any unhealthy, abnormal cells that could potentially turn into cancer. A Pap smear will also tell you whether or not you have an infection.
Every woman’s Pap smear experience is different. Having a Pap smear can be uncomfortable for some women, and even painful to others. It may feel like menstrual cramps, and you may also feel some pressure. Some women don’t find it uncomfortable or painful at all. You may experience some bleeding after the Pap test, so it’s a good idea to line your underwear with a panty liner.
Pap Smear Guidelines
According to current recommendations made by the American Congress of Obstetricians and Gynecologists (ACOG), Pap smear guidelines are as follows:
- You need to have a Pap smear every two years, after age 21.
- Teenagers and young adults (under age 21) need to have a Pap smear within three years of becoming sexually active. You are more likely to have an abnormal Pap smear if you have multiple sexual partners.
- Women who are over age 30 may only need to get a Pap test every three years. Similarly, if you’ve had three Pap smears with negative results, you may need to get tested less frequently.
- If you have multiple sexual partners, or if your partner has other sexual partners, you need to get tested every two years.
- Experts recommend menopausal women to continue getting Pap smears. After age 65, if a woman has had three negative tests within the past decade, she can stop having Pap smears all together. However, if an older woman gets a new sexual partner, she needs to resume Pap smear screening.
- Women who have had a total hysterectomy (both her uterus and cervix were removed) do not need to have a Pap smear.
Remember that a Pap test is the only way to detect the earliest signs of cancer – even before your cervical cells become cancerous. Because cervical cancer can be deadly and terminal in advanced stages, all women need to have routine Pap tests.
How to Prepare for a Pap Smear
For two days before your scheduled Pap smear, you need to avoid having sexual intercourse, using tampons, douching, using any vaginal creams or suppositories, and using vaginal deodorant sprays or powers. All of these things can hide abnormal cervical cells during a Pap test, and avoiding them can give the most accurate result.
You should schedule a Pap smear for when you are not on your period, since this can skew the results. The best time for a Pap test is 10 to 20 days after the first day of your last menstrual period. (Day 1 of your period is the day that you start bleeding).
Before you have a Pap smear, you should go urinate and empty your bladder.
Pap Smear Procedure – What Happens?
A Pap smear is typically performed during a pelvic exam at your doctor’s office. You will be asked to lie on an exam table, and your physician will use a special instrument called a speculum to widen the opening of your vagina, so that he or she can examine your cervix (which lies at the top of the vagina). Your healthcare provider will then collect a few cells from your cervix, using a brush, swab, or small spatula.
The collected cervical cells are placed on a glass microscope slide and sent to a laboratory to examine. It can take two or three weeks before you get the results of your Pap smear.
During your Pap smear, always tell your healthcare provider about any medications that you’re taking. Certain medicines, such as estrogen and progestins, can affect the result of your Pap test.
Pap Smear Results
If the cells from your cervix look normal (no abnormal cells were found), the Pap smear results will be negative. Most women will get a negative, normal result.
When the lab finds abnormal cells, you will get a positive (abnormal) result. Before you freak out, getting an abnormal Pap smear does not mean that you have cervical cancer or even the pre-cancerous condition dysplasia. You may have an infection, human Papilloma virus, inflammation, a yeast infection, herpes, or another health concern.
In many cases, there may be unhealthy cells that will disappear on their own. Sometimes, these abnormal cells can turn into cancer. Your doctor may want you to take a repeat Pap smear, or he or she may decide to treat these abnormal cells.
If the Pap smear discovers serious changes in your cervical cells, your doctor may recommend:
- Colposcopy – A special tool that allows the doctor to view the cervical cells and vaginal cells in more detail.
- Endocervical Curettage – Your physician uses a spoon-shaped instrument (called a curette) to take cell samples from your endocervical canal.
- Biopsy – Your doctor takes a sample of cervical tissue, which is sent to a lab to be examined.
One out of every ten abnormal Pap smears is not serious. If you happen to get an abnormal Pap smear result, your physician will give you more specific guidance on what’s the best treatment plan for your individual case.
Every year in the United States, 55 million Pap smears are performed. Only 3.5 million of these (roughly 6 percent) come back abnormal.
Pap Smear Accuracy
Pap smears are not always 100 percent accurate. In some cases, cervical cancer may be missed. False negative (you’re told that your cells are normal, but they are actually precancerous or abnormal) and false positives (you are told you have abnormal cervical cells, but your cell are really normal) can occur with a Pap test.
When you have regular Pap smears, it increases the risk of finding any problems. Fortunately, cervical cancer develops very slowly, so if you get a false negative, chances are the next Pap test you have will find the cancerous cells. Regular screening is crucial.
Pap Smears and Pregnancy
All pregnant women will have a routine Pap smear as part of her prenatal care. In fact, a Pap smear is one of the first trimester tests that your healthcare provider will give you. Pap smears are safe in pregnancy, and it will not harm your unborn baby at all. The cervical cells that are gently scraped are nowhere near your developing baby – who is safely growing in your uterus, inside his or her amniotic sac.
If you happen to get an abnormal Pap smear result during pregnancy, your obstetrician or midwife will discuss safe treatment options. If a colposcopy or cervical biopsy is recommended, you may experience some cervical bleeding, but it’s nothing to worry about.
Now, if your doctor recommends an internal biopsy inside the endocervical canal, there is a small risk of it causing a weakened or incompetent cervix, which may lead to preterm labor and delivery.
Your doctor will discuss what’s the best option for you in your individual situation.