What is a Pap smear? (Papanicalau test)
A Pap smear is an examination under the microscope of cells scraped from the tip of the cervix. The cervix is the lower part of the uterus that opens at the top of the vagina.
How the test is performed
The Pap smear is done as part of a gynecological exam. You will lie on a table and place your feet in stirrups to position your pelvis for examination. The health care provider will insert an instrument (speculum) into your vagina and open it slightly to see inside the vaginal canal.The health care provider will take a sample of cells from the outside and just inside the opening of the cervix (cervical canal) by gently scraping the outside of the cervix with a wooden or plastic spatula, then inserting a small brush that looks like a pipe cleaner into the canal.
The cells are placed on a glass slide, or put in a bottle containing a preservative, and then sent to the lab for examination.
Pap smears find cervical cancer and precancer in the early stages when it can be treated, and thus may reduce the number of deaths from cervical cancer.
CERVICAL CANCER RISK FACTORS — The most important risk factor for cervical cancer is infection with the human papillomavirus (HPV). There are over 100 different types of HPV, however most types of HPV do not cause cancer. At least 80 percent of women are exposed to the HPV virus during their lifetime. Most of the time, the body's immune system gets rid of the virus before it does harm.
Low risk types — HPV types 6 and 11 can cause genital warts and are low-risk types because they rarely cause cervical cancer
High risk types — HPV types 16 and 18 are considered high-risk types because they may cause cervical cancer in some women.
HPV is spread by direct skin-to-skin contact, including sexual intercourse, oral sex, anal sex, or any other contact involving the genital area (eg, hand to genital contact). It is not possible to become infected with HPV by touching an object, such as a toilet seat. In 2006, a vaccine became available in the United States to help prevent infection with certain types of HPV.
Most people who are infected with HPV have no signs or symptoms. Most HPV infections are temporary and resolve within two years. When the virus persists (in 10 to 20% of cases), there is a chance of developing cervical precancer or cancer. However, it usually takes many years for HPV infection to cause cervical cancer.
CERVICAL CANCER SCREENING TESTS — There are several ways to screen for cervical cancer. The traditional screening test is called a Pap smear.
Pap smear — The Pap smear is a method of examining cells from the cervix. The cervix is located at the lower end of the uterus.
To perform a Pap smear, a doctor or nurse will perform a pelvic exam and use a small brush or spatula to collect cells from the cervix. The cells are added to a preservative fluid (called liquid-based, thin layer testing).
HPV testing — An HPV test can be done along with a Pap smear or as a separate test. Like a Pap smear, the HPV test is done during a pelvic exam, using a small brush to collect a sample from the cervix.
If you are 30 years or older, your doctor or nurse may recommend HPV testing in addition to a Pap smear. If your HPV test and Pap smear are negative, repeat testing is not usually needed for 3 years. HPV testing may also be done if the results of your Pap smear results are unclear.
Women who are under age 30 are not usually tested for HPV because many women in this age group have temporary infections, which will go away without treatment.
Even if you have had a vaccine for human papillomavirus, you will still need cervical cancer screening.
WHO SHOULD HAVE A PAP SMEAR?
Younger women — In the United States, the first Pap smear is recommended at age 21; other countries suggest that screening begin at age 25. Cervical cancer is very rare in younger women.
In the past, experts recommended that every woman have a Pap smear every year. This has changed, and Pap testing is suggested every one to two years for most women less than 30 years old, and every two to three years for most women after age 30. A woman’s other risk factors for cervical cancer may affect these recommendations.
Older women — Most experts feel that women who are 65 years or older can stop having Pap smears if:
· You have had Pap smears on a regular basis in the past
· You have had at least three normal Pap smears in a row and no abnormal Pap smears in the past 10 years,
After hysterectomy — Women who have had a total hysterectomy (your uterus and cervix were removed) do not need a Pap smear, unless:
· The hysterectomy did not remove your cervix (eg, if the hysterectomy was "subtotal")
· Your hysterectomy was done because of cervical cancer or precancer
· You were exposed to diethylstilbestrol (DES) during your mother's pregnancy.
PREPARING FOR YOUR PAP SMEAR — Before your appointment, you should not put anything in the vagina (eg, creams).
A Pap smear can be done at any time during your menstrual cycle, but if you have heavy vaginal bleeding on the day of your appointment, call your doctor or nurse to ask if you should reschedule.
PAP SMEAR RESULTS — The results from your Pap smear will be available a few weeks after your visit. Pap smear results may be reported as:
Negative — Pap smears that have no abnormal, precancerous, or cancerous cells are labeled as "Negative for intraepithelial lesion or malignancy".
Abnormal results — Cervical cells may appear abnormal for a variety of reasons. For example, you may have a cervical infection, or you may have a precancerous area or even cervical cancer.
What is a Colposcopy? Having a regular screening test for cervical cancer (Pap smear and/or human papillomavirus testing) is an important part of staying healthy and avoiding cervical cancer. If the results of your screening test are abnormal, further testing is needed to confirm the result and determine the severity of the abnormality. Colposcopy is the test that is usually recommended in this case. It allows your healthcare provider to look at your cervix using magnification.
Not all women with an abnormal cervical screening test will need treatment. Colposcopy can help to determine if and when treatment of the abnormality is needed.
WHY DO I NEED COLPOSCOPY? — Colposcopy is used to follow up abnormal cervical cancer screening tests (eg, Pap smear, human papilloma virus (HPV) testing) or abnormal areas seen on the cervix, vagina, or vulva. Your Pap smear may be abnormal if you have cervical pre-cancer or cancer, often caused by HPV infection of the cervix.The colposcope magnifies the appearance of the cervix. This allows the clinician to better see where the abnormal cells are located and the size of any abnormal areas. The size and location of abnormal cells helps to determine how severe the abnormality is and also helps to determine what treatment, if any, is needed. When monitored and treated early, pre-cancerous areas usually do not develop into cervical cancer.
PREPARING FOR COLPOSCOPY — Before your colposcopy appointment, you should not put anything in the vagina (eg, creams).
Colposcopy can be done at any time during your menstrual cycle, but if you have heavy vaginal bleeding on the day of your appointment, call your healthcare provider to ask if you should reschedule.
If you take any medication to prevent blood clots (aspirin, warfarin, heparin, clopidogrel), notify your healthcare provider in advance. These medications can increase bleeding if you have a biopsy during the colposcopy.
If you know or think you could be pregnant, let your healthcare provider know. Colposcopy is safe during pregnancy, although healthcare providers usually do not perform biopsies of the cervix when you are pregnant.
DefinitionA colposcopy is a special way of looking at the cervix. It uses a light and a low-powered microscope to make the cervix appear much larger. This helps your health care provider find and then biopsy abnormal areas in your cervix.
How the test is performedYou will lie on a table and place your feet in stirrups to position your pelvis for examination. The health care provider will insert an instrument (speculum) into your vagina to open the vaginal walls and examine the cervix. The cervix and vagina are gently swabbed with dilute vinegar (acetic acid). This removes the mucus that covers the surface and highlights abnormal areas. Sometime an iodine-based solution (Lugol's) similar to solutions used for cleaning skin may also be swabbed on the cervix and vagina.
The health care provider will place the colposcope at the opening of the vagina and examine the area. Photographs may be taken. The colposcope does not touch you. If any areas look abnormal, a small sample of the tissue will be removed (biopsy) using small biopsy forceps. Many samples may be taken, depending on the size and location of the area. Sometimes a tissue sample from inside the cervix is removed. This is called endocervical curettage (ECC).
How to prepare for the testThere is no special preparation. You may be more comfortable if you empty your bladder and bowel before the procedure.
You should not douche, place any products into the vagina, or have sexual intercourse for 24 hours before the exam. You should not be menstruating heavily. However, if you are at the very end or beginning of your regular period or you are having abnormal bleeding, you should still keep your appointment.
You may be able to take ibuprofen or acetaminophen (Tylenol) before the colposcopy. Ask your doctor if this is okay, and when and how much you should take. Tell your doctor before the test if you are pregnant or could be pregnant.
How the test will feel
The placement of the instrument (speculum) to better see the cervix may be more uncomfortable than for a regular Pap smear. Some women feel a slight sting from the vinegar or Lugol's solution.
The biopsy or curettage may feel like a pinch or cramp each time a tissue sample is taken. You may have some cramping or slight bleeding after the biopsy. Heavy bleeding is unusual; if you have bleeding that soaks a pad in an hour, call your doctor. Do not use tampons or put anything in the vagina for several days after a biopsy.
It is typical for women to hold their breath during pelvic procedures because they expect pain. Concentrating on slow, regular breathing will help you relax and relieve pain. Ask your doctor or nurse about bringing a support person with you if that will help
Why the test is performed
Colposcopy is done to detect either cancer of the cervix or changes that may lead to cancer at an early stage.
This procedure is most often done when you have had an abnormal Pap smear. It may also be recommended if you have bleeding after sexual intercourse.
Colposcopy may also be done when your health care provider sees abnormal areas on your cervix during a pelvic exam. These may include:
- Any abnormal growth on the cervix, or elsewhere in the vagina
- Genital warts or HPV
- Irritation or inflammation of the cervix (cervicitis)
The colposcopy may be used to keep track of HPV, and to look for abnormal changes that can come back after treatment.
Your doctor should be able to tell you about anything abnormal that was seen during a colposcopy. A smooth, pink surface of the cervix is normal.
A specialist called a pathologist will examine the tissue sample from the cervical biopsy and will report to your doctor whether the cells appear normal or abnormal. Results of a biopsy most often take 1 - 2 weeks. If the biopsy results are normal, it means that no cancer or precancerous changes were seen in the cells.
What abnormal results meanAbnormal findings that may be seen during the colposcopy include:
- Abnormal patterns in the blood vessels
- Areas that are swollen, worn away, or wasted away (atrophic)
- Cervical polyps
- Genital warts
- Whitish patches on the cervix
Abnormal biopsy results may include:
- Cancer of the cervix
- Cervical intraepithelial neoplasia (precancerous tissue changes that are also called cervical dysplasia)
- Cervical warts (infection with human papilloma virus, or HPV)
Paragraphs What the risks are After the biopsy, you may have some bleeding for up to a week. You may have mild cramping, your vagina may feel sore, and you may have a dark discharge for 1 - 3 days.
A colposcopy and biopsy will not make it more difficult for you to become pregnant, or cause problems during pregnancy.
Call your health care provider if:
- Bleeding is very heavy or lasts for longer than 2 weeks.
- You have pain in your belly or in the pelvic area.
- You notice any signs of infection (fever, foul odor, or discharge
Special considerations
You may have some bleeding after the biopsy for up to 1 week.
You should not douche, place tampons or creams into the vagina, or have sex for up to a week afterward. Ask your doctor or nurse how long you should wait. You can use sanitary pads.
If the colposcopy or biopsy does not show why the Pap smear was abnormal, your health care provider may suggest that you have a more extensive biopsy.
AFTER COLPOSCOPY — If you have a biopsy of your cervix, you may have some vaginal bleeding after the colposcopy. If your provider used the liquid bandage solution, you may have brown or black vaginal discharge that looks like coffee grounds. This should resolve within a few days.
Most women are able to return to work or school immediately after having a colposcopy. Some women have mild pain or cramping, but this usually goes away within one to two hours.
Do not put anything in the vagina (creams, douches, tampons) and do not have sex for one week after having a biopsy. If you have a biopsy, ask your healthcare provider when your results will be available (usually within 14 days). In most cases, further testing and treatment will depend on the results of the biopsy
