What is a Pap smear and why is it important? A Pap smear, or a Pap test, is a procedure recommended to people with cervixes between the ages of 21 and 69 to test for cervical cancer [1, 2]. The procedure involves collecting cells from the cervix to test for early cell changes that could lead to cancer [3]. These changes are known as dysplasia, where abnormal cells can transform into cancer by spreading into the surrounding tissue [7]. A cause of cervical cancer is the human papilloma virus (HPV) [1]. The infection creates abnormal cells and can happen before you feel any symptoms [1]! Therefore, a Pap smear is extremely important in order to discover cell changes early and start treatment as soon as possible or prevent cancer from developing.
When and how often should you get a Pap smear? Most doctors recommend people with cervixes to start Pap testing at age 21 [2]. You should get a Pap smear even if you are not sexually active [6]. If you are sexually active before age 21, you may want to start testing sooner [6]. You should get another Pap test every three years [2]. After age 30, you can consider testing every five years and also test for HPV, or just test for HPV instead [2].
A doctor can recommend you get Pap smears more frequently if you’ve had a diagnosis of cervical cancer or had precancerous cells before, been exposed to diethylstilbestrol (DES, a no-longer common non-steroidal estrogen medication) as a fetus, if you have HIV, a weak immune system, or a history of smoking [2].
You can usually stop Pap testing after a total hysterectomy or past the age of 65 if you’ve had consistent negative tests.
How to prepare for a Pap smear? Some precautions you can take prior to getting a Pap test that can help manage potential discomfort or ensure the effectiveness of your test are:
Avoiding intercourse or penetration; tampons; lubricants; douching; vaginal medicines or spermicidal foams, creams or jellies two days prior to the test
Do not test during your menstrual cycle [2]
Ask if you can take ibuprofen ahead of time
Have someone you trust come to the appointment
Pee before the exam
Ask your doctor to describe what’s happening during the test
Ask to wear headphones and listen to music
Practice relaxing your pelvic muscles [6]
Unlike an IUD insertion procedure, a numbing agent can skew your test results and is unable to be used for a Pap smear [6].
If you have a condition like vaginismus, vaginal dryness, vulvodynia, or endometriosis, or have experienced sexual trauma, it can be very difficult to get a Pap test [5, 6]. Some people with cervixes report negative and even traumatic experiences having pelvic exams in general [5]. A pelvic exam or Pap smear can be invasive and uncomfortable, so communicating your concerns before your visit/test with your doctor can help.
You may be able to find a trauma-informed provider or doctor who has experience with trauma that can help accommodate your visit [6]. Or, if you feel comfortable, you can inform your doctor of your past experiences [6]. You and your doctor can discuss pain medications asides from over-the-counter options or about speculum varieties. Speculums come in many different sizes and materials, including the Pederson speculum, Graves speculum, and pediatric speculums, so a smaller size can prevent potential pain, or a plastic speculum can prevent coldness [4].
Any medical procedure should be a safe and painless visit. Pain during a Pap smear is not normal; you have every right to stop the test and speak up [6].
How is the procedure actually done? The test begins by privately undressing from the waist-down and changing into a gown [2, 6]. Then, you will lay down on an examination table with your feet in the stirrups on either side of the table and your knees bent [2, 6]. Your doctor will need to be able to access your pelvic area and cervix [6].
The Pap test is conducted by your doctor carefully inserting a speculum into your vagina [2, 6]. A speculum is a metal or plastic device that holds the internal walls of your vaginal canal apart so your doctor can view your cervix [2, 4, 6]. The speculum insertion can cause pressure or discomfort, but it should not hurt [4]. Communicate with your doctor to stop the test and evaluate your other options if you are in pain.
Once the speculum is inserted, your doctor will use a brush and a spatula, which is a flat scraping device, to collect cell samples from your cervix [2]. This may feel uncomfortable, like a pinch, but should not be painful [6]. Your doctor will then transfer the sample into a container holding a special liquid to preserve it (liquid-based Pap test), or onto a glass slide (conventional Pap smear) [2]. Once the brush and speculum are removed, you can privately get dressed [6].
The whole test should take about a minute [6].
The sample will be sent to a lab and examined under a microscope to look for abnormal cells that indicate cancer or a precancerous condition [2].
What about after the test? Once your test is over, you should be able to continue about your day as normal [2]. A Pap smear is not an impairing procedure and should not cause difficulty after your visit.
However, you may experience mild cramps or bleeding from a small scratch [2, 6]. Use a pad or pantyliner for bleeding, and ibuprofen or a hot water bottle can help with cramps [6].
If you were given pain medication, follow your doctor’s instructions on proper usage and any impairments you might have.
If you experience heavy bleeding or sever cramping, contact your doctor to figure out if something during your test went wrong. If you had a negative experience with your doctor, like them not acknowledging your pain levels, you should consider switching providers or requesting a new doctor at the clinic.
When do I get my results and what do they mean? Results usually take about a week, but your results can depend on the lab [6]. It’s best to ask your doctor to guide your expectations.
Pap smear results that say “negative” or “normal” mean you do not have cancerous cells [2, 6].
A “positive” or “abnormal” result indicates that abnormal, cancerous, or precancerous cells were found, and your doctor should contact you for a follow-up to start a method of treatment or discuss your options as soon as possible [6].
Inconclusive results likely mean you will have to do the test again [6].
Links to References:
https://www.mayoclinic.org/tests-procedures/pap-smear/about/pac-20394841
https://www.cancercareontario.ca/en/get-checked-cancer/letters-to-public/ocsp-invitation-letter
https://gyneco-blogic.com/2017/05/08/speculum-sizes-one-size-does-not-fit-all/
https://www.healthline.com/health/do-pap-smears-hurt#Does-it-hurt?
Comments