Pap Smear Exam
A Pap test is a simple test performed in a doctor's office, used to detect cervical cell abnormalities. It was developed in 1943 by Dr. Papanicolaou, and is still the most frequently used test in screening cervical abnormalities. Some of the abnormalities detected by a Pap test include:
- Infection
- Inflammation
- Abnormal Cells
- Cancerous Cells
How is a Pap test done?
The Pap test is part of a routine gynecological exam, and is relatively quick and painless. It is likely that it will be performed during the routine pelvic exam portion of the visit. During this time cells will be obtained from the cervix, by a small wooden spatula and a tiny soft-bristled brush. The cells are then spread onto a glass slide and sent to a laboratory, where special technicians can exam them for any deviations.
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Who should have a Pap test?
All women, who are or have been sexually active or on oral contraceptives, should have routine Pap tests and examinations performed regularly. It is important that a Pap smear be a part of a woman's routine health exam, due to its abilities to detect abnormalities that can lead to invasive cancer. Most cervical cancers are treatable when detected early. If an abnormal test result is reported it does NOT necessarily mean you have cancer. Pap tests are also good in detecting other changes to the cervix and vagina, including dysplasia(abnormal cells), or pre-cancerous cells, and inflammations. Inflammations may be caused by:
- Bacteria
- Viruses
- Yeast Infections
- Trichomonas Infections
- Pregnancy
- Miscarriage (or abortion)
- Medications or other chemicals
When is a Pap test contraindicated?
For most women an annual or biannual Pap test is recommended; however, a Pap test cannot be done if you are menstruating, have a vaginal infection, or are being treated with medications for a prior infection. Also having sexual intercourse, using spermicidal jelly, douches, and tampons 24 hours prior to your Pap test can interfere with the accuracy of the results.
How are the results of a Pap test reported by University Health Services?
Your Pap test results will be mailed to you a few weeks following your examination. Any follow up examinations will be indicated if appropriate. A Pap test is reported as normal (negative) when all the cells are determined to be of healthy size and shape. An abnormal (positive) test is reported if any cells of a different size or shape are noted. AN ABNORMAL PAP TEST DOES NOT ALWAYS MEAN YOU HAVE CANCER. Categories are used to describe any abnormal cells now, to ensure consistent descriptions of the cells. Basic categories include:
- Inflammation
- ASCUS (Atypical Squamous Cell of Undetermined Significance)
- Low grade SIL (squamous intraepithelial lesion)
- High grad SIL (squamous intraepithelial lesion)
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What can cause an abnormal result?
Abnormal Pap test results can occur when the presence of an infection, such as yeast, Trichomonas, Chlamydia, or gonorrhea cause the cervical cells to be inflamed. Human Papilloma Virus (HPV), is also a common source for abnormal results to be reported on Pap tests. There are many types of HPV, not all are associated with external genital warts. Some forms of HPV have been proven to increase a woman's risk for cervical cancer; therefore, women diagnosed as HPV positive are encouraged to follow the treatment plan suggested by their health care provider.
How are results followed up?
Follow up depends on if there are any cell changes that are determined by the Pap test. Normal (negative) cell changes are usually followed up one year later at your next gynecological exam. Abnormal (positive) tests are followed up differently, depending on the degree of cell changes. Pap tests diagnosed as abnormal due to inflammation are repeated within a few months. If appropriate, medication may be prescribed. A procedure known as a colposcopy is performed if there are any high grade SIL cells discovered or if there are persistent low grade changes. Patients diagnosed with abnormal test results are advised to use condoms, or abstain from intercourse completely until the follow up is completed.
What is a colposcopy?
A colposcope is a microscope that allows your gynecologist to examine the external genital area, vagina, and cervix with great magnification. You should not have intercourse, use spermicidal jelly, vaginal medication, douches, or tampons for 24 hours prior to the colposcopy. The colposcope used during the procedure is useful in determining and identifying areas of abnormality, without ever actually touching you. The position during a colposcopy is similar to that during a Pap test, where a speculum is inserted. Occasionally a solution is applied to the observed area, to make abnormal cells easier to see, known as a Schiller test. If abnormal cells are found during this examination, your physician may opt to perform a biopsy. A biopsy is simply the removal of a small sample of tissue from the abnormal area. Occasionally a woman may complain of a sharp pinch or some cramping in that area; however, most women claim to not feel anything at all. This tissue sample is then sent to a laboratory, where a pathologist examines it. Slight bleeding or spotting may follow for several days after the biopsy. Women are advised to use pads instead of tampons, to reduce the risk of infection until the bleeding stops.
What treatment might be done next if the biopsy shows something wrong?
Treatment following a colposcopy and biopsy are based on the pathology report. Several alternatives are usually available, including more frequent pap tests, repeat colposcopy, cryosurgery or the freezing of abnormal cells, LEEP or the burning off of abnormal cells, laser or conization (cone biopsy). All these procedures and others should be further discussed with your health care provider.
More information regarding treatment