What is a pap smear test?
Well, pap is short for Papanicolaou, and Papanicolaou happens to be the last name of the doctor (George Papanicolaou) who introduced the smearing of bodily secretions onto glass slides to be read under a microscope to detect abnormal cells. So, pap smear is basically a cervical smear, where a sample of secretions and superficial cells are taken from one's cervix, uterus, and vagina and smeared onto a slide where your doctor can view such sample under a microscope during your visit to detect bacterial over-growths, under-growths, etc. This is significant because it enables your doctor to prescribe medication on the spot for whichever issue you are having. After the initial microscopic visual, your samples are mailed to a lab that analyzes the specimen sample further for cellular abnormalities. This in depth analysis can take anywhere from 1-3 weeks, at which point your doctor will contact you if your results are concerning.
The process
The process includes:
- Undressing and wearing that gorgeous paper gown ;)
- No matter which doctor I see for paps, I am always asked "have you given birth?", this question is like the prerequisite or cue for the technician to pull out the larger than small speculum
- Your doctor lubricates the speculum, and inserts it into your vagina. The speculum expands, opening your vagina enough to give the doctor a clear view to your cervix.
- A small stick or brush is inserted to collect cells from the outside and inside of your cervix
- These cells are then placed onto a slide, and packaged properly to be mailed off to the lab
- Most doctors will then insert their fingers and palpated (to feel for or touch) your reproductive organs
- During this visit breast exams are also done
Below you will find a few pictures showing the microscopic view of pap smear slides:
A picture of a yeast infection under a microscope
A picture of bacterial vaginosis under a microscope
A picture of cervical cancer
A picture of cervical cancer under a microscope
A picture of cervical trichomonas under a microscope
Normal cervix vs. Abnormal cervix
Normal cells vs. Abnormal cells under a microscope
Why should I get a pap smear test?
Pap smears are one of the most reliable and effective cervical cancer screening tests available. Pap smears are important as they detect precancerous and cancerous cells on our cervix, and with proper detection such cells can be treated prior to becoming cancerous, and in other cases these cells can be treated in order to prevent death. In other words, pap smear tests serve as our yearly cervical cancer screening, as well as the yearly screening of our reproductive organs. However, pap smear tests do not detect ovarian, uterine, vaginal, or vulvar cancers. So, it's important to know your body and report any signs or symptoms outside of your norm to your doctor.
Here are a few pictures of the cervix in different health stages.
Stages of Cervical Cancer
Healthy Cervix
Parts of our reproductive organs
Cervix with Chlamydia
Cervix with Trichomoniasis
Cervix with Yeast
Are there any cases where a woman does not need a pap smear test?
There are a few cases where pap smears may not be needed any longer, and those cases are when your doctor states that you no longer need pap smears, AND
- You are older than 65 years of age and your past several pap smears have been normal or
- If you have had your cervix removed as a part of a total hysterectomy for non-cancerous conditions
What are the best timeframes for getting pap smear tests?
- You should start getting pap smears at the age of 21, and it's recommended up until the age of 65
- If you are 30 years of age or older it is recommended that you also get an HPV(human papillomavirus) test along with your pap smear. HPV is a virus that exists in numerous strands, and can cause cellular changes in/on your cervix
- Depending on your age, and past pap smear results, your doctor may opt to lengthen the number of years in between your pap smear tests. For example, if
- You are between the ages of 21 and 29, your doctor may suggest that you get a pap smear every 3 years or
- You are between the ages of 30 and 64, your doctor may suggest that you get co-testing (pap smear test and HPV test) every 5 years, or a pap smear test alone every 3 years.
- Be certain to follow your doctor's recommendations as it pertains to your pap smear test regimen
- When preparing for your pap smear test, you should not
- Douche, or rinse vagina with water or any other fluid
- Use tampons
- Have sex
- Use any type of birth control foam, cream, or jelly
- Use medication creams in your vagina
What are "false positives, and false negatives"?
Because nothing is perfect, there are cases where your pap smear test results can be erroneous. To be specific, most pap smear test errors fall into one of two categories being false positives or false negatives. So, if you have heard or hear your doctor say that your results presented as a false positive, there is no problem, as the test accidentally showed you having abnormal cells when in fact they were normal. On the flip side, if you have heard or hear your doctor say that your results presented as a false negative, there is a potential problem, as the test accidentally showed your cells as normal when in fact they are abnormal. False negatives tend to prolong the treatment of cervical cancer, but with continuous pap smear tests and being in tune with your body, the cells will be discovered. This speaks to how very important it is for everyone to be in tune with their body. The smallest deviation from your normal feelings, discharge, cramping, moods, bloating, smell, etc. can be your body's way of communicating to you that something is changing and it needs to addressed with your doctor.
What does an "abnormal" pap smear result mean?
Hearing that your pap smear results returned as abnormal can be very nerve wrecking, which is why it is important to remember that an abnormal result does not always mean cancer. In fact, an abnormal pap smear could be due to any small change on/in the cervix, such as your cervix changing due to being pregnant. Throughout my entire life, I have had normal pap smears, except once, when I visited my doctor because I had begun to feel different along with sharp pains, cramping, and I thought I was pregnant. I visited my doctor, a pap smear was done and samples were mailed away. Close to a week later my doctor called me to say that my pap smear had returned as abnormal, and I needed to come to her office so she could take a biopsy. My initial feeling was to see another OB/GYN for a second opinion before I had a biopsy done, and long story short, my abnormal results turned into our 6 year old son ;) So, something as simple as pregnancy, or a yeast infection can cause cell changes on/in your cervix, but it is our job to know our body and to follow our gut feelings as the regimen for handling an abnormal pap smear is being created.
When your results are abnormal, your doctor could decide to retest you immediately, in 6 months, or in 1 year, and order additional tests to go along with the pap smear. Keep in mind that some abnormal cells have the potential to become cancerous, and your treatment regimen moving forward to address the abnormal cells should be discussed with you doctor.
New developments related to pap smears...
In 2012, new pap smear recommendations were introduced, and they stated that yearly pap smear tests are no longer recommended for patients with a low-risk of getting cervical cancer. This recommendation stemmed from the fact that overuse of pap smear tests could cause more harm leading to unnecessary testing and medical procedures for women. Based off of the aforementioned information, the American College of Obstetricians and Gynecologists along with the American Society for Colposcopy and Cervical Pathologists initiated new guidelines for screening women with a low-risk of getting cervical cancer, and these new guidelines are:
- Women below age 21: No Pap or HPV screening.
- Women ages 21 to 29: Pap every three years; no HPV testing.
- Women ages 30 to 65: Pap with HPV every five years (preferred) or Pap alone every three years.
- Women after age 65: Discontinue Pap screening.
Some may regard these recommendations as having economic motives, but over time we will be able to see if in fact these recommendations are truly evidence based practices. I wanted to bring these new guidelines to light, as it would be very concerning to me if all of a sudden my OB/GYN were to tell me that I no longer needed annual pap smears, as annual pap smears have been ingrained in our life-styles and health regimens for such a significant amount of time. I would not take it easily, and I would need data and information to help get me on the same page as the recommendations. I have included a few sites for your viewing:
Also, keep in mind that we are all built differently, and our bodies respond differently. With that being said, your OB/GYN will evaluate your candidacy for following the new pap smear guidelines by taking your past and current health status, your life-style, your pap smear history, your age, etc. into consideration to verify that the new guidelines are for you. It looks like we will have to see how these guidelines play out with respect to efficiently and effectively discovering cervical cancer. What are your thoughts?
