What’s a Pap smear?

Demystifying pelvic exams, self-tests and how to make cervical cancer screening easier

What’s a Pap smear?

If you’ve never had a Pap smear before, Tamara Jacobson, M.D., can break it down for you:

A Pap smear is a screening tool for cervical cancer.

This type of cancer is highly preventable with HPV (human papillomavirus) vaccination and early detection and treatment. But more than half of all people diagnosed with cervical cancer in the United States have never been screened or didn’t get screened regularly, the National Cancer Institute reports.

Get screened: Cervical cancer screening at Sanford Health

Screening for cervical cancer currently requires patients to visit a clinic for a pelvic exam, which is when the Pap smear is collected.

Patients told the cancer institute that lots of reasons can keep them from screening: distance to the clinic, cost, not understanding its importance, personal or religious preferences, physical disability, medical conditions, or history of trauma.

Dr. Jacobson, an OB/GYN at Sanford Health in Fargo, North Dakota, wants to make screening easier for everyone.

How often to get a Pap smear

OB/GYNs recommend women at average risk of cervical cancer start getting routine Pap smears every three years from age 21 to age 30, then every five years from age 30 to 65.

If any of those screenings are abnormal, you may need to be screened more often, Dr. Jacobson said.

What to expect from a Pap smear

A Pap smear includes a pelvic exam. This is the part where the patient lies down on an exam table and puts her feet in stirrups while the health care provider uses a small tool called a speculum to see the cervix.

The speculum gets inserted into the vagina, allowing the provider to see the cervix. They then use a small plastic spatula to gently press against the cervix to collect a sample of cells.

Then those cells get sent to the pathologist to examine under a microscope. That same fluid can be tested for HPV.

“So the Pap smear is just the collection of cells,” Dr. Jacobson said. “The pelvic exam is the speculum exam.”

Will a Pap smear hurt?

A pelvic exam with a Pap smear shouldn’t hurt. If you don’t have pain or discomfort with intercourse, a pelvic exam should not be painful or uncomfortable for you, Dr. Jacobson said.

If it does hurt, she wants to find out why.

“I would rather, as a provider, work up your discomfort and try to fix that before doing the pelvic exam so that it’s not uncomfortable for you,” she said.

Some medical reasons behind painful pelvic exams include:

  • Endometriosis
  • Pelvic floor dysfunction
  • Lesions
  • Moles
  • Herpes outbreaks
  • Yeast infections
  • Bacterial infections

If you know about these conditions, you and your provider can address them as needed.

The most common reason for discomfort is muscle tension, so Dr. Jacobson tries to help patients relax and distract themselves. Take deep breaths, watch a video on your phone, whatever helps you. Just be sure to tell your provider how you’re doing.

“If they are painful, you have to let me know so we can do things differently. Use a different size speculum, or wait – meaning not do the pelvic exam today,” she said.

What to do with Pap smear results

If your results are negative, that means everything looks normal and you can continue screening every three to five years based on your age. If the results are positive, the next steps depend on what was different about your screening.

Minor abnormalities may just require you to get another Pap smear in a year, Dr. Jacobson said.

More significant abnormalities may show you need to come back in the next one or two months for a colposcopy. This procedure gives providers a closer look at the cervical cells with a microscope and allows them to get biopsies if needed.

Most of the time, getting a callback does not mean you have cancer, Dr. Jacobson said. It usually means you have cells that could potentially become cervical cancer if left untreated or unwatched.

“If we watch them closely and treat them, if they’re becoming more abnormal, we can actually prevent a cervical cancer from ever happening,” she said.

In that case, two types of follow-up treatment are available:

  • LEEP, or loop electrosurgical excision procedure. This procedure uses a wire loop heated by electric current to remove a small portion of the end of the cervix where the abnormal cells or HPV are living. A pathologist can examine the removed tissue to give providers a better idea of their next steps.
  • Cryotherapy, or freezing and destroying the affected portion of the cervix. This procedure is less common now because it takes away the chance to examine the abnormal tissue for follow-up.

What about self-testing?

At-home HPV testing isn’t available in the U.S. yet, but the Food and Drug Administration recently approved self-collection in health care settings.

That means if the patient and provider decide against a pelvic exam, it’s now possible for patients to collect their own vaginal swab in a private room in the pharmacy or clinic. Then the provider uses the same testing they would have if they had collected the sample.

Keep in mind that pelvic exams with Pap smears do more than HPV tests alone, Dr. Jacobson said. They can detect cervical cancers not caused by HPV. And sometimes a pelvic exam will reveal other medical issues such as an abnormal uterus or abnormal ovaries.

But self-collecting is better than not getting screened at all.

“Some women will avoid coming in for the pelvic exam, for the Pap smear, because of their past history. It’s creating flashbacks or trauma for them,” Dr. Jacobson said.

For patients with a history of sexual assault, she will ask if the pelvic exam is necessary or if there are other ways she can make them feel more comfortable and in control.

“Make sure you’re letting us know if you’ve had a bad experience in the past because there’s things we can do to hopefully make this a much better experience this time,” she said. “We can talk through it ahead of time.”

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Posted In Cancer, Cancer Screenings, Healthy Living, Women's