What Is a Pap Smear?
A pap smear is a medical test to see if a woman has developed pre-cancerous or cancerous cells on her cervix. When you are able to detect cervical cancer early from abnormal cells with a pap smear, you have a better chance at curing it. Additionally, a pap smear is able to detect any changes in your cervical cells which show a predisposition to developing cancer.
Besides checking cells for cervical cancer, a pap smear can also check for infections or inflammation. This test is conducted during a pelvic exam and can be combined with tests for certain types of human papillomavirus (HPV). This medical procedure is done at your gynecologist's office and may cause slight discomfort, but there is no long-term pain associated with it.
What Is the Difference Between a Pap Smear and a Well Woman’s Visit?
In a well-woman exam, the provider will review your medical history, surgical history, medications, and allergies. They will also conduct a physical exam which will include a bimanual exam (checking the size of the uterus and ovaries). We perform a pap smear during the physical exam if it is warranted.
When Should a Woman Get Her First Pap Smear?
A woman will start getting pap smears at the age of 21. The age of first sexual intercourse experience does not matter. From ages 21 to 29, the screening should be performed every 3 years if normal. From age 30 to 65, screening is every 5 years with HPV contesting or every 3 years with a Pap smear alone, if normal. This interval may change based on personal history.
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How Is a Pap Test Done?
For the pap test, a gynecologist will insert a lubricated speculum into the vagina and will visualize the cervix. With a broom, we collect cells using a circular motion around the cervical opening. This takes only a few seconds. After we collect the specimen, the speculum is closed and taken out of the vagina. Then, the collected cells are sent to a laboratory to further analyze for any abnormal cells.
Pap Smear Side Effects
Usually, there are no side effects to a pap smear. If any, there may spotting and mild cramping after the pap smear.
How to Prepare for Your Pap Smear
In preparation for the test, patients should relax as much as possible. Usually, patients experience no pain with a pap smear.
Pap Smear Results
Pap smear results may take up to 2 weeks to complete. Once the results are sent to the office, a provider will review the results and they will be reported to the patient.
What does an abnormal Pap test indicate?
If your Pap test results come back abnormal, this simply means we’ve found abnormal or unusual cells on your cervix. It does not mean you have cervical cancer. Most abnormal results denote cell changes caused by the HPV virus. An abnormal Pap test does require follow-up depending on the results and your provider will tailor that follow up based on your personal medical history.
How Serious is an Abnormal Pap Test?
As mentioned above, there can be various reasons for an abnormal Pap test. In fact, less than 1 percent of abnormal results end in a cervical cancer diagnosis. But abnormal results dictate more attention, just to be safe.
How Common is an Abnormal Pap Test?
An abnormal Pap test is not unusual. In the U.S., over 50 million pap tests are performed each year to screen for cervical cancer. About 5 percent of those Pap tests will come back abnormal with atypical cervical cells. The vast majority of abnormal tests don’t indicate cancer. Of the 3 million U.S. women with abnormal Pap tests each year, less than 1 percent (13,240 cases) will be diagnosed with cervical cancer.
Types of Abnormal Pap Test Results
A variety of abnormal pap test results can occur from ASC-H to ASC-US. The most common abnormal results in pap tests are:
- Normal Pap but, HPV Positive: There are no cellular changes on the cervix, but the patient has been exposed to the HPV virus.
- ASC-US: These cells don’t appear completely normal, but doctors are uncertain about what the cell changes mean. The changes may be related to an HPV infection but they can be caused by other factors.
- ASC-H: These cells don’t appear completely normal and these lesions may be at higher risk of having cancer. The meaning of the cellular changes is unknown. At times a biopsy is necessary.
- Low-Grade Squamous Intraepithelial Lesions (LSIL): Mild abnormalities caused by the HPV virus. These are early changes in size and shape of the cells. Typically, we perform a biopsy to look at the cells more closely.
- High-Grade Squamous Intraepithelial Lesions (HSIL): More severe abnormalities caused by the HPV virus that may progress into cancer if untreated. When examined under a microscope, the cells are further classified into CIN-2, CIN-2/3, or CIN-3 based on severity.
Can an abnormal Pap test result from a yeast infection?
No this is not really true. Yeast can show up on your pap smear but it would not cause your cells to become abnormal. Bacterial infections can also cause signs of inflammation on your pap smear. Women who have been through menopause can have cell changes on a Pap test that are simply the result of getting older.
What is the next step after an abnormal Pap test?
An abnormal Pap test usually means we want to do some more testing, after we’ve looked at the type or types of your abnormal cells.
It’s likely we will want to perform these tests:
- Colposcopy - In this test, we look at your vagina and cervix through a lighted magnifying tool. If we found abnormal cells in your Pap test, we will perform a biopsy to determine if the cells are cancerous or precancerous. For your biopsy, we simply remove a small tissue sample from your cervix during your colposcopy.
- Additional Pap test - To see if your abnormal cells are still present, we’ll recommend you have an additional Pap test in 6 to 12 months, depending on the type of abnormal cells we originally found.
Can You Have a Normal Pap Smear with HPV?
Yes, you can have a normal pap smear with HPV. In this case, a patient will receive HPV typing to see which strain they are infected with or repeat pap smear in 12 months depending on age and history.
Does an abnormal Pap mean I have HPV?
Most abnormal cell changes that show up on a Pap test are caused by HPV. That doesn’t mean you have cervical cancer, however. Most of these cell changes caused by HPV resolve on their own, but certain types of HPV have been linked to cervical cancer. A Pap test is not designed to detect HPV, so at Columbus Women’s Health Care we test for HPV in addition to your Pap test depending on your age. This increases our odds of detecting or preventing cervical cancer.