A pap smear is a non-invasive procedure carried out by a doctor or a specialized nurse to look for any changes in cervical cells. It is also called a pap test or a smear test. The test was named after Dr. Georgios Papanikolaou, who came up with the procedure.
A Pap test is used to detect such diseases as cancer and Human Papillomavirus (HPV), which proliferate by mutating or changing the cell structure. During the procedure, the doctor takes a sample of cells from the cervix through the vagina. The sample is then forwarded for laboratory analysis. In the lab, doctors examine the cells under a microscope to look for any distortions or abnormalities.
The test results after an examination may indicate the presence of either normal or abnormal cells. Normal results, sometimes called a negative result, indicate that the cells in your cervix are healthy. Abnormality, on the other hand, may manifest itself in five forms;
- Severe dysplasia
A positive result of altered cells will often result in an intervention to curb the progression of such ailing cells to cancer. Today, the smear test is used to discover cervical cancer and HPV in a matter of minutes. It is a fairly quick and straightforward procedure that is now widely used to detect the mentioned diseases early. The results of a smear test are so accurate that they have been reported to reduce cervical cancer rates by about 80 percent.
Who Needs a Pap Smear?
Ideally, every woman should get a pap test every three years from the age of 21 up to 65. The American Congress of Obstetricians and Gynecologists suggests that women should wait a few years after their first sexual encounter to take a smear test.
In some countries, pap testing is not recommended for women who are not sexually active. The rationale behind this reasoning is that HPV, which is the leading cause of cervical cancer, is dominantly transmitted through sexual intercourse. It is assumed that by the age of 21, many women have already engaged in sexual intercourse, thus posing a risk of contracting HPV.
The general guidelines of pap smear testing with regard to the age of the patient vary in different countries. While the majority agree that one should take the test after three years, others seem to think that the frequency of testing should reduce with age.
In Britain, for instance, it is recommended that women under the age of 25 do not take the test at all, and those between 25 and 50 to take it after three years. Women over the age of 50 in Britain are advised to take the test in 5-year intervals. In America, the consensus is that all women between 21 and 65 get a pap smear done every three years.
Some women may require more frequent tests than others, especially if they may have abnormal cervical cells. In instances such as these, the test may have to be redone in 6 to 12 months. If the cells require further investigation, patients are referred to undergo a colposcopy for a more detailed examination of the cervix. The frequency of testing may also be different in women with previous encounters with cancer or those that have low immunity.
Preparing For a Pap Smear Test
It is always important to schedule a pap smear. This way, you will be able to plan ahead and avoid partaking in activities that might interfere with your test results. Some of the things you need to know are as follows:
If you are on your period, it is necessary to inform your doctor beforehand so that you can reschedule the appointment. During menstruation, the female body produces additional cells that may obscure the cervical cells. Moreover, the female genital organs are most inflamed during the monthly cycle. Menstruation can, therefore, distort the results and lead to inaccurate inferences. Do not worry if you cannot reschedule the appointment. Other alternatives for conducting this test is by using more appropriate techniques, such as using a liquid test.
Avoid sexual intercourse
Do not engage in sexual intercourse the day before the exam. It might also interfere with your test results.
It is recommended that within the first 24 weeks of pregnancy, the patient takes the pap testing. Any further probing after the 24 weeks might be painful or cause irritation. After delivery, a patient should wait at least 12 weeks before undergoing pap testing. For a smooth procedure, the patient needs to stay calm and relaxed during the examination. It is perfectly okay to feel a bit nervous. Remember to avoid sudden motions or jolts of any kind during the procedure since this may cause bruising of the inner cervical walls.
Avoid Douching and the use of spermicidal products
As a general rule, avoid the use of any chemical products in or around your vagina 24 hours to your examination. Like menstruation above, chemicals will also lead to inaccurate results.
Inform your doctor of any untreated vaginal problems or tissue diseases
Ordinarily, a pap smear should be quick and painless. However, patients who have untreated vaginal problems like vaginismus or tissue disease may experience pain and discomfort during scraping. Also, when the cervical skin comes into contact with a cold object, there can be some discomfort. To avert such a situation, it would then be imperative to inform your healthcare provider of these problems before taking the test so that they can take appropriate measures.
Your grooming situation is of no concern to the health care provider. Do what makes you feel comfortable. However, make sure that you wear clothes that you can easily take off. You will undress from the waist down or all the way (especially if you are taking a breast exam as well).
Pap Smear Test Procedure
On the appointed date, you will head into the doctor’s office to confirm your appointment and wait for attention. If it is your first time, you probably do not know what to expect. The possibility is that all the information can be based on rumors and misconceptions — all that is about to change.
Before The Procedure
The first thing you should know is that a pap smear is a quick procedure. It can get a little uncomfortable, especially with all the probing in your nether region. Find solace in the fact that it will be over in a few minutes, and once done, you possibly won’t have to do it for three years.
Once you enter the doctor’s office or exam room, you will undress. In some facilities, you will get a hospital gown, while in others, doctors will cover you in a modesty sheet. The doctor will ask you to lie on your back on the examination table and place your legs against the extensions known as stirrups. The stirrups offer support and keep your legs steady and apart during the process.
During the Procedure
The doctor or nurse will then prepare a device known as a speculum and slowly insert it into your vagina. The purpose of the speculum is to separate your vaginal walls so that the doctor can have a better look at the cervical walls. It is common for doctors to use lube during insertion of the speculum- it should not hurt.
The device is a little bit larger than a tampon when closed. When open, it inserts a bit of pressure on the sides of your vagina, but it is nothing you cannot handle. With the vagina open, the doctor can take a sample of cells from the cervix. This can be done in one of three ways; using a spatula, and brush, or a cytobrush. The extraction of cells includes scraping the inner cervical walls using the spatula.
The doctor will then move the brush around the opening of the cervix. While it is an odd sensation, it does not hurt one bit except if you have vaginal problems. The cells are then collected into a vial or a glass slide and taken for lab analysis. This marks the end of the procedure.
After the Procedure
On your way out of the examination room, you may ask the doctor when the results will be ready. After the test, you can go about your normal day as nothing happened. It is normal to feel a little discomfort afterward. Other common effects are cramping and light bleeding from the vagina. However, if you experience any pain, you should immediately consult your doctor.
Pap Smear Results and Interpretation
In the laboratory, the cell sample collected from a patient is keenly examined by a cytologist for abnormality. Cytologists prepare a lab report containing the results of the pap smear test to deliver to the patient. The report may contain a negative or a positive finding.
A negative or normal finding means there are no abnormal cells observed from the sample collected from the cervix. Under a microscope, all cervical cells look to be in good health and shape.
A positive or abnormal finding indicates that there are some unusual cells in the patient’s cervix. This does not have to be a cause for concern just yet. Women’s cancers are difficult to detect and the abnormality may range from atypical squamous cells (meaning that although the cells are abnormal, they are not cancerous) to carcinoma in situ (meaning that there are cancerous cells in the cervix).
In the United States, Pap smear results are interpreted using the Bethesda System. Under this system, negative Pap test results report as “negative for intraepithelial lesion or malignancy.” Abnormal cells may fall into different categories as prescribed by the National Cancer Institute. These include;
- Atypical Squamous Cells (ASC)
- Atypical Glandular Cells (AGC)
- Endocervical Adenocarcinoma in situ (AIS)
- Low-Grade Squamous Intraepithelial Lesion (LSIL)
- High-Grade Squamous Intraepithelial Lesion (HSIL)
The first two categories are often considered a mild form of abnormalities and often mean that no cancer is present. AIS results indicate the presence of precancerous cells. LSIL is a strong pointer of infections caused by HPV. Results reported as HSIL point toward cells that are likely to progress to cancer.
In case of a normal or negative result, you can schedule another appointment in 3 years’ time. Positive results require further checkups to eliminate any chances of inaccurate information.
For instance, a patient suffering from an STD may record a false-positive result. After treatment, the test should be conducted again after 2 to 3 months to confirm the presence of abnormal cells.
Commonly Asked Questions about Pap Smear
- Do Pap smear tests have risks?
Pap smear test is quite safe, but they also have some limits. There are possibilities that the Pap smear test may not detect abnormal cells that are there or may report abnormal cells that are not there. In both the scenarios, the important part is to get Pap tests as per the schedule for your medical history and age.
- Can a Pap test result tell about STD or STI?
No, a Pap test cannot find STDs or STIs. It can only find abnormal cells present in the cervix that may lead to cervical cancer. You may check with your doctor to conduct STI tests. For STI tests, the doctor will collect fluid samples from the cervix to identify common issues like gonorrhea and chlamydia. For other STDs and STIs, you will need to get a blood test.
- Who doesn’t need to take Pap Test?
Women above 65 years of age with three negative or normal Pap tests in the last ten years do not need to take the Pap test. Women who have been informed by doctors that they do not require the Pap test, or the ones without a cervix ( hysterectomy) also do not require a Pap test. Always consult a doctor before deciding to stop the scheduled Pap tests.
Cervical cancer is the leading killer-cancer among women. It is for this reason that all women of 21 years or older should take the Pap smear. The tests give all women an opportunity to have their cervix screened for those dangerous cancer-causing cells before they progress and lead to death. So, when you have your first gynecologic visit, ask some important questions about your sexual health including inquiring about a pap smear.
If you have not yet taken a Pap smear test in your life, it may be time to schedule an appointment with your doctor. There is nothing to be afraid of; no needles, no drugs, and no invasive procedures. It is a simple procedure that takes very little time. After that, you will have to wait at least three years before taking it again.
The truth is that you stand a better chance of detecting cancer before it hits. And even if it does, you will catch it in its early stages when it is completely manageable. In any case, positive Pap test results don’t necessarily mean that you have cancer. You can get a Pap smear in a hospital, doctor’s office, health department, community hospital, or women’s health clinics across the country.
What’s more, most medical insurance cards cover Pap smears and should not set you back a fortune. Learn more about the list of insurance companies offering various affordable health care plans to cover tests and other related treatments. Take a bold step today and help eradicate cervical cancer by taking a Pap smear test.