Pap Smear Test & Colposcopy

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Also known as a Pap test, a Pap smear test is performed in women to check for cervical cancer. In a routine Pap smear test procedure, cells from the cervix are scraped gently and examined for the presence of any cancerous or precancerous cells. It might be a bit uncomfortable, but it doesn’t cause any long term pain.

It is recommended that women should get regular Pap smears every three years, starting from the age of 21. If a female is HIV-positive or has a low immune system due to chemotherapy or an organ transplant, then she might require Pap smear tests for cervical cancer screening more often.

Women who are above the age of 30 and haven’t had abnormal Pap tests can get one every 5 years after consulting their doctor, provided that the test is combined with HPV (human Papillomavirus) screening.

Who needs to have a Pap test?

A Pap test is required for women with a cervix. Women whose cervix has been removed during a hysterectomy and who have no history of cervical cancer don’t require Pap tests.

How often should one get a Pap smear?

It depends on various factors including risk and age, how often you should get a Pap smear.

  • Below 21 years of age – If you are below the age of 21, you don’t need to get a Pap smear.
  • Between 21 to 29 years of age – If you are between the age of 21 and 29, you should get a Pap test every 3 years.
  • Between 30 to 65 years of age – If you are between the age of 30 and 65, you should either get a Pap smear every 3 years, an HPV test every 5 years, or a combined HPV and Pap test every 5 years.
  • Above 65 years of age – If you are above the age of 65, you might no longer need Pap smear tests. You should consult your doctor about the same. 

How to prepare for a Pap smear?

Generally, there isn’t much preparation required before a Pap smear test. For a smooth Pap smear test, stay calm, take deep breaths and keep your body relaxed. You should keep in mind a few things, including –

  • You should reschedule your Pap test if you’ll be menstruating on the day of your appointment, as the results of the test could be less accurate due to this.
  • Sexual intercourse, spermicidal products and douching can interfere with your test results hence try to avoid it.
  • If you are pregnant, you can safely get a Pap smear within the first 24 weeks of your pregnancy because the test might be uncomfortable and more painful after 24 weeks.
  • If you have recently given birth, you should wait for at least 12 weeks before getting a Pap smear test to increase the accuracy of your results. 

Pap test Procedure

During a Pap smear, you will have to lie on your back on the examination table. The doctor will ask you to spread your legs and put them in supports called stirrups. After this, they will insert the speculum into your vagina. The speculum is used to keep the vaginal walls open and provide access to your cervix.

Then, a small sample of cells from the cervix is scraped off by a spatula, sometimes used with a brush. You might feel a bit uncomfortable due to the slight push and irritation, but the test is a quick procedure. After the procedure, you might even experience some vaginal bleeding. If you feel discomfort or bleeding after the day of the test, you should consult your doctor.

The sample cells are then sent to the laboratory to test for the presence of abnormal or cancerous cells.

Results of Pap smear

Results of a Pap smear test can be normal or abnormal. A normal result indicates that no abnormal cells were present in the cervix. It can also be called a negative result. If the test result is abnormal, it doesn’t necessarily mean that you have cancer. It could also indicate the presence of precancerous cells. Depending on your results, your doctor might recommend getting Pap smears more often. A colposcopy procedure might also be recommended wherein magnification and light would be used to closely examine your cervical and vaginal tissues. A biopsy might be performed wherein a sample of the cervical tissue would be taken for examination.

What is cervical cancer?

Cervical cancer is cancer that develops in the cells of the cervix, the lower of the uterus. The cervix is divided into two parts – endocervix and ectocervix.

  • Endocervix – The innermost part of the cervix is called the endocervix. Cells in the endocervix are tall, column-like and these are responsible for the secretion of mucus.
  • Ectocervix – The outer portion of the cervix is called the ectocervix. This portion protrudes into the vagina and consists of squamous cells. 

Cervical cancer cells and precancerous cells typically form where the endocervix and ectocervix meet. There are generally no signs or symptoms of early-stage cervical cancer whereas symptoms of advanced cervical cancer include vaginal discharge that is watery, bloody, and has a foul odour, vaginal bleeding after menopause, intercourse or between periods, pelvic pain, and pain during intercourse.

Cervical cancer treatment can be of various types depending upon the stage of cancer and other health problems. For early-stage cervical cancer, surgery is typically the best option. Other options include chemotherapy, radiation, immunotherapy, and palliative care. Since most cervical cancers are caused by HPV, women should take the cervical cancer vaccine or the HPV vaccine. The vaccine prevents HPV types that cause most cervical cancers as well as other cancers of the vagina, anus, vulva, oropharynx. The cervical cancer vaccine also prevents HPV types that cause most genital warts. The best time to take the HPV vaccine is between 11 and 12 years of age. It can also be taken by girls between the age of 13 and 26 if they haven’t been vaccinated yet. It is recommended to get regular Pap tests even after being vaccinated.