Pap smears and abnormal pap smears

What is a Pap smear?

A Pap smear is a screening tool used to detect abnormalities in cervical cells. Abnormal cells may indicate changes that can lead to cancers, and therefore regular Pap tests allow for these changes to be caught early and be treated. Pap tests should be started at the age of 21 and continued throughout life as per your doctor’s recommendation.

How often do I need a Pap smear?

It is recommended that women start getting Pap smears every three years from age 21. Women who have an increased risk for cancer, infection, or who have a weakened immune system may be recommended to have more frequent testing.

If you are over 30 and have had three or more normal Pap smears in a row you may be able to reduce the frequency of your testing to every five years to combine it with HPV screening. Women over the age of 65 who have a history of normal Pap smears may be able to stop having them in the future, but should still get check-ups as per their doctor’s recommendations.

Even if you’re in a monogamous relationship you should still have regular Pap smears.

Understanding Pap smear results

After a Pap smear you will either get normal or abnormal results.

Normal results mean that you have no abnormal cells identified, sometimes referred to as negative results. If your results are normal you won’t need another Pap smear for three years.

If your results are abnormal, it does not mean you have cancer, but you simply have abnormal cells in your cervix, which may be on their way to becoming cancerous.

Depending on the results of your test, your doctor may recommend that you increase the frequency of your Pap smears or have a colposcopy.

The results of Pap smears are very accurate, and regular screenings reduce the cervical cancer rates and mortality by 80 per cent. It may be an uncomfortable test, but the brief discomfort can protect your life and reproductive health.

Abnormal cervical cells

There are several levels of abnormal cells:

  • Atypia – cells of undetermined significance
  • Mild – some cells look different from the others
  • Moderate
  • Severe dysplasia – possible precancerous cells
  • Carcinoma in situ – very early stage cancer cells

It is more common for cells to have milder abnormalities than severe abnormalities.

Abnormal Pap smear results can also indicate an infection of abnormal cells called dysplasia, which does not necessarily mean cancer.

Abnormal cells can sometimes resolve themselves, so your doctor will probably ask you to repeat a Pap smear in six to twelve months to monitor the cell changes. If the changes do not resolve themselves after a period of time, or if they have increased, your doctor will likely suggest further investigation such as a colposcopy and treatments that can remove the abnormal cells.

Abnormal Pap smear results may indicate the presence of any of the follow:

  • Herpes
  • Inflammation or infection
  • Trichomoniasis
  • HPV
  • Dysplasia, HPV, cancer

What is a colposcopy?

A colposcopy is a procedure that may be recommended if you have abnormal Pap smear results. It involves using a light and magnification to get a closer look at the vaginal and cervical tissue. Your doctor may also take a sample of cervical tissue for further examination, which is called a biopsy.

Understanding HPV

HPV is an asymptomatic sexually transmitted virus that is very common among sexually active men and women. It is estimated that roughly 80 per cent of sexually active men and women will contract it in their life. It is usually asymptomatic and harmless, but HPV can leave lead to changes in the cervical cells that can cause cancer.

Cervical cellular abnormalities do not tend to present symptoms, which is why screening is important. In some cases, however, there are detectable symptoms that include:

  • Abnormal discharge from the vagina – changes in colour, amount, odour, texture
  • Abnormal sensations in pelvic or genital area during urination or sex – pain, itching, burning
  • Sores, blisters, warts, lumps or rashes on or around the genitals

If you experience any of these symptoms, you should consult your healthcare professional or gynaecologist.

What a Pap smear feels like

Pap smears may be a little bit uncomfortable, but are very quick. During the procedure, you will lay on an examination table with your knees apart and possibly your feet in stirrups, with a covering over your upper thighs so you can’t look at what the doctor is doing. Your doctor or gynaecologist will carefully insert a device called a speculum into your vagina, with lubricant, which provides access to your cervix by keeping your vaginal walls open.

The doctor will then scrape a small sample of cells from your cervix. This can be done in a few ways. They may use a spatula, a brush and spatula, or a cytobrush. Some women may feel a slight push and irritation during the brief scraping.

The cell sample from your cervix will then be preserved and sent to a lab for testing.

After your Pap smear, you may feel some mild discomfort from the scraping or some light cramping. You may also experience some light spotting immediately following the test. If the bleeding or discomfort continues for a few days after the test you should consult your doctor.

Pap smears are life-saving tests that can catch cancerous changes very early and prevent cervical cancer. If you are sexually active and have not been tested yet, make an appointment with your doctor.