What is a Pap smear?
Updated: May 9, 2020
Besides awkward and uncomfortable..
A Pap smear screens for cervical cancer, or more accurately, it screens for changes that can lead to cervical cancer over time. When I do a pap, I place a speculum in the vagina so I can see the cervix. I then take a brush and brush some cells off the cervix (awkward, but not painful). Those cells go in a jar off to a lab technician who looks at them under a microscope to make sure everything looks OK.
How often do I need Pap?
You should have your first pap at age 21.
Then every 3 years as long as the pap is normal.
We start screening for HPV at age 30
If paps stay normal and HPV stays negative after age 30, then pap every 3-5 years is OK.
I do screen some people more often (women who are HPV+ or immunosuppressed, so review with your OBGYN what's best for you)
All reputable gynecologists follow ASCCP guidelines, so we're not just making this stuff up. (ASCCP = American Society for Colposcopy and Cervical Pathology)
Why is it OK to wait 3 years to repeat a pap?
Cervical cancer is usually a slow-growing process. We typically see a few years of abnormal paps and precancerous cells leading up to cervical cancer. If you have an abnormal pap we will monitor you closely, and if you get to a pre-cancerous stage, we will recommend treatment to prevent cancer of course.
But when you have a normal pap, then we know you would be years away from developing cancer, so that's why it's OK to screen less often. Also the technology behind pap smears is better than ever, and since we have data from the last 100 years of getting paps every year, we now understand the natural progression of cervical cancer.
The pap is just a screening test, so anytime it comes back abnormal, we will recommend follow-up. Depending on your age and what the pap showed, we will either want to repeat the pap (with an HPV test) in one year, or see you back in the office for a colposcopy.
What is a colposcopy?
A "colpo" is a quick procedure where we take a good look at your cervix.
I place a speculum in the vagina so I can see the whole cervix. I wash the cervix off with some vinegar, which helps to highlight any abnormal cells that might be there. I then take a good look at the cervix with a magnifying glass (the colpo). Then I'll take a biopsy of whatever part of your cervix looks most exciting.
That biopsy will go off to the pathologist who looks at everything under a microscope and determines whether it's:
CIN 1 or LGSIL - this means "mild dysplasia," which means nothing precancerous
CIN 2, CIN 3 or HGSIL - this means pre-cancerous cells are present
Cancer (It's rare we find cancer if you've had a pap in past few years, but that's what we want to be sure not to miss)
We now know that the HPV virus causes most cases of cervical cancer, and specifically which strains of the virus are most problematic.
Usually if you are young and healthy, your own immune system will clear the virus and your cervix will go back to normal on its own. We'll just follow you closely to be sure you do.
However, if there are precancerous cells present, we often want to remove them so we won't worry about progression to cervical cancer. This is so easy to do.
What is a LEEP?
So if we find some precancerous cells in your cervix, we'll recommend we get rid of them and set you back to a normal cervix. This is a quick and easy procedure that usually can be done right in the office. We essentially numb up your cervix with lidocaine and use a wire loop to remove the abnormal potion of your cervix. This only takes a few minutes and it is relatively painless (just awkward and uncomfortable like everything else we do). There's no real downtime for recovery - I'll usually recommend you take it easy and not have sex for 2 weeks while your cervix heals.
Cervical cancer is a horrible disease that affects relatively young women. I'll never forget the patients I've seen suffer from cervical cancer - heartbreaking. The thing that gets to you is that it's so preventable.
It is a very common cancer among women worldwide, but less common in countries that have access to healthcare and HPV vaccines.
Just go see your OBGYN or women's healthcare provider and get a pap every few years.
I rarely see cervical cancer anymore - just in the few patients who are afraid to get a pap and wait 10 years to see a gynecologist - it breaks my heart.
Nobody enjoys getting a Pap smear, but it is so important that you do. I always promise my patients to make it as quick and easy as possible.