Pap Smears

Making Choices
Throughout our lives, we have many choices to make. These choices affect our family, friends, employers, and last but not least, ourselves. The choices we make today affect the choices we'll have to make in the future. Health care living choices such as diet, exercise, health habits and physical exams may be among our most important decisions. Our health is one of our most valuable assets; yet, too often we neglect our physical needs or develop habits that may do us harm.

Yearly Checkup
A smart choice that we can make to ensure good health is to have a yearly Pap smear. A Pap smear is a simple test that does not involve much time or discomfort. The Pap smear will detect potential problems of the cervix (opening of the uterus) or vagina (birth canal) early so they can be diagnosed and treated. Another good reason to have a yearly Pap is because your doctor will also do a breast exam, blood pressure check, pelvic exam and listen to your heart and lungs. Other tests may be done based on your needs and health history.

It's a good feeling knowing you're healthy and that you are doing your part to stay that way.

Who should have a Pap smear?
Pap smears of the cervix are recommended every year as soon as a woman is sexually active; otherwise, every year starting from ages 18-21. If a woman has had her uterus removed, Pap smears of the vagina should be done regularly as recommended by her doctor. A common myth is that women should not have a Pap smear until after they have had intercourse. The exam does not in any way harm or alter the female organs.

What does a Pap smear tell us?
A Pap smear give us information about the cells of the cervix or vagina. An abnormal Pap smear means that changes in the cells have been found. These changes can be referred to as "warning cells" (cells that can later become cancer cells). This is why it is important to have regular Pap smears and to treat any abnormalities at an early stage.

How is a Pap smear done?
Some women find the Pap smear and pelvic exam embarrassing, but it should be seen strictly as a necessary medical procedure and not as a procedure to embarrass you. It is the only way to examine you internally and take a Pap smear.

For the exam, you will be asked to lie on your back on the exam table, bend your knees and put your feet on the foot rests. The doctor will want you to let your legs rest out to the sides. The important word at this point is RELAX. Concentrate on letting your muscles go soft and take slow, easy breaths in through your nose and out through your mouth. The more relaxed you are the more comfortable the exam will be. A speculum is gently inserted into the vagina, then opened to allow the examiner to see your cervix. When the cervix is in good view a sampling of cells is taken from the cervix or vaginal wall by gently scraping a wooden spatula and soft brush on your cervix. You may feel a pressure feeling and maybe a small cramp. The cells are placed onto a glass slide and sent to the laboratory to be examined.

Which women are at greater risk for abnormal Paps?
Those who have had sexual contact before age 18. Those with a history of many sexual partners. Women whose mothers took DES (Di-Ethyl-Stilbestrol) - a medication which used to be taken for certain pregnancy complications from the 1940's to the 1960's. Those with frequent infections which may be spread by sexual contact. Those who smoke. Those who become pregnant before age 18.

Planning for your Pap smear.
You can help your doctor do the very best exam by having the following information available: Date of your last period. Current medications such as birth control pills or other hormone pills or creams (the name and dose). Any bleeding at times other than your period and when it occurred. Any discharge (white, thick or watery liquid). Any history of abnormal Pap smears or surgery such as a hysterectomy (having the uterus removed).

These facts help the doctor and the specialist looking at your cells to decide if your Pap smear is normal or not.

If you are having your period at the time of the exam, it is best not to have a Pap done that day. You should also avoid douching or using vaginal cream for at least 24 hours before having a Pap smear.

Some abnormal Pap smears are due to infections of the cervix or vagina. Many abnormal Pap smears caused by infection will return to normal once the infection is treated.

It is not possible to remove every cell of the cervix with a Pap smear. Therefore, cells that are taken for the Pap smear can be normal and the cells remaining on the cervix may be abnormal. This does not happen often, but it is possible. This is another reason to have Pap smears regularly.

What will happen if your Pap smear is not normal?
The doctor will notify you in one to two weeks by telephone or letter if your Pap smear is abnormal and to discuss recommendations for follow-up and treatment.

Further testing may be needed. Colposcopy, an office procedure, may be used to help the doctor view the cervix with a microscope to look for infection or any abnormal cells on the cervix or vaginal wall. This would help him/her to see signs of infection or any abnormal cells. If an area on the cervix does not look normal, the doctor may want to take a biopsy (sample cells) for further testing.

What are the warning signs of cancer?
Bleeding between your periods. Any unusual vaginal discharge or pain. Bleeding after intercourse. Bleeding after menopause.
Remember that these are just warning signs which may or may not indicate cancer. If you notice any of the symptoms listed above, it is important for you to see your doctor, find the cause, and receive treatment.

It is also important to realize that there are often no warning signs, therefore, it is important to have regular Pap smears.

Most women with abnormal Pap results can look forward to a normal Pap smear in the future with appropriate treatment and follow-up.

In summary, there are many good reasons to make the choice to have a Pap smear. It is a simple procedure. A Pap costs little. It is a source of valuable information. It can help prevent further health problems. You are doing something for yourself. You can also get a general physical at the same time. It can be a time to ask questions about other health topics. It can leave you with the positive feeling of knowing you made a "smart choice and a good investment for your health".

THINK OF YOUR YEARLY PHYSICAL AS AN IMPORTANT WAY OF TAKING CARE OF YOURSELF. YOU ARE WORTH IT!

Peer Review Status: Internally
Peer Review Date: 2004

Pre-cancer of the cervix is an abnormal growth of cells on the cervix (the opening of the womb). If not treated, some of these cell growths may become cancer. Because of improved screening tests, cancer of the cervix is becoming less common in the United States.

There are no signs or symptoms related to early cervical cancer, so a pelvic exam of the female sex organs is needed to test your cervix. During this exam, cells are gently scraped from the cervix and later examined under a microscope. This is the basic Pap smear. Although not perfect, it is a good screening tool for cancer and precancer of the cervix. A Pap smear is suggested for all sexually active women or by age 18. It should be repeated every one to three years based upon individual risk.

Women at greater risk for pre-cancers include those who:
• had sex before the age of 18
• have more than two sex partners
• smoke cigarettes
• do not use barrier birth control (such as condoms or a diaphragm)
• have a history of herpes, genital warts or HIV or
• have had limited access to healthcare

Some low grade pre-cancer may disappear without treatment. Some will remain and slowly grow into cancer over several years. If you have an abnormal Pap smear, you may be scheduled for a repeat Pap smear or colposcopy in a few months. A colposcopy is a close exam of your cervix using a special microscope. Samples will be taken of the areas that look abnormal. Examination of the samples will determine if more treatment is needed.

Treating pre-cancer tissue after sampling may include:
• waiting and watching with no treatment and more frequent Pap smears
• getting rid of the pre-cancer cells by laser or freezing
• removing the pre-cancer cells with surgery

Cervical cancer can be prevented, if you follow through with regular Pap smear examinations.