Gyn & PAP Smear

What is a Pap smear?

A Pap smear is a screening test for precancerous changes of the uterine cervix. The preceding sentence contains two key concepts that are frequently misunderstood by laypersons and in quite a few instances physicians. I will start by addressing those concepts. A Pap smear is looking for precancerous changes of the uterine cervix. It is not designed to find cancer and it is not designed to find abnormalities of any other organs. (E.g. the ovaries or lungs) The cervix develops cancer in a slow prolonged manner; usually 10-20 years from the first changes until cancer develops. At any place along the way, something may happen to reverse the process and make things normal again. These changes are called dysplasia or sometimes Cervical Intraepithelial Neoplasia or even Squamous Intraepithelial Lesion (different names for the same process).

Why is it done?

Regular Pap tests remain the best way to prevent cervical cancer. Many experts believe that cervical cancer deaths in the US, which currently stand at about 5,000 a year, could be completely wiped out if every woman received adequate Pap test screening. Standard Pap tests are very inexpensive and are widely available free for low-income women.

What happens if my Pap smear is abnormal?

Pap tests sometimes come back with the diagnosis of ASCUS, which means "atypical squamous or glandular cells of undetermined significance." If your Pap test indicates early changes in your cells, you will have another Pap smear. Then if the results are still abnormal, you may have a colposcopy, which examines the surface of the vagina and cervix.

How often do I need to get a Pap test?

It depends on your age and health history. Talk with your doctor about what is best for you. Most women can follow these guidelines:

  • If you are younger than 30 years old, you should get a Pap test every year.
  • If you are age 30 or older and have had 3 normal Pap tests for 3 years in a row, talk to your doctor about spacing out Pap tests to every 2 or 3 years.
  • If you are ages 65 to 70 and have had at least 3 normal Pap tests and no abnormal Pap tests in the last 10 years, ask your doctor if you can stop having Pap tests.
You should have a Pap test every year no matter how old you are if:
  • You have a weakened immune system because of organ transplant, chemotherapy, or steroid use.
  • Your mother was exposed to diethylstilbestrol (DES) while pregnant.
  • You are HIV-positive.
  • Women who are living with HIV, the virus that causes AIDS, are at a higher risk of cervical cancer and other cervical diseases. The U.S. Centers for Disease Control and Prevention recommends that all HIV-positive women get an initial Pap test, and get re-tested 6 months later. If both Pap tests are normal, then these women can get yearly Pap tests in the future.

Before the Pap Smear Test

  • Tell your doctor if you are taking any medications, including oral contraceptives
  • If your doctor is unaware of an abnormal Pap smear result in your past, alert him/her to it.
  • Tell your doctor if you think you might be pregnant.
  • Do not douche, use tampons or take a bath (showers are OK) a day before your test.
  • Avoid having sex 24 hours before your Pap.
  • Be sure to inform your doctor of any medications that you regularly take, including oral contraceptive.
  • You will be asked to disrobe from the waist down and to put on a drape or hospital gown.
  • You will be instructed to empty your bladder before the test.
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