We women hear it every few years during our annual gynecological exams: “All right, you’re due for your Pap test.” If you’re over 21, the test – and that little internal pinch that accompanies it – is probably nothing new to you.
The Papanicolaou test (also known as a Pap test or Pap smear) is administered when your OB-GYN inserts a speculum into your vagina to see your cervix while collecting cells from the outside of your cervix with a medical stick or brush. (Note: A speculum exam alone is not the same thing as a Pap test.)
“The Pap test is not only important for early detection of cervical cancer, but for precancerous cervical conditions, so that we can detect something before it turns into cancer and treat it or not treat it, and observe it,” said Dr. Michele Polidoro, an obstetrician and gynecologist with Novant Health City Lake OB/GYN - Lexington who’s been practicing for more than 27 years.
Pap tests can also be used to diagnose other infections like trichomoniasis caused by a parasite, bacterial vaginosis, chlamydia and gonorrhea. This screening test is recommended for women ages 21 to 65, especially those who are sexually active. (Read: Not only those who are sexually active.) “Women earlier than 21 can clear the virus on their own and they’re not as at-risk,” Polidoro said.
And even if this experience feels like nothing new, there are certain things – some straightforward, some surprising – you should know about Pap tests. Here are five:
You should actually prepare for a Pap test
“To make sure that we’re actually getting the best sample, no douching, do not have sexual intercourse the night before,” Polidoro said.
Vaginal medication, spermicidal foams, creams and jellies should also be avoided for about two days prior. Lastly, try not to get your test done during the heavy part of your period. All of these precautions help you avoid false-negative test results.
You should get a Pap test at least every three years
This routine screening is critical for catching abnormalities in the cervix that could lead to cervical cancer. This type of cancer has two primary causes: The main cause is HPV (the human papillomavirus is actually the most common sexually transmitted infection), followed by glandular cell mutations (which are unrelated to HPV and can lead to adenocarcinoma).
Annually, about 300,000 American women are diagnosed with cervical precancers that need treatment. The good news: Treating invasive cervical cancer in the early stages before it spreads to other tissues and organs bumps the five-year survival rate from 56 percent to 92 percent.
Luckily, Polidoro said, “This is a slow-growing process.” The Pap test helps catch changes over time.
An HPV/Pap may be recommended
“Every once in a while we get a Pap test where we want to add the HPV testing to it,” Polidoro said, clarifying that it’s a common recommendation for women between the ages of 30 and 60. “Maybe that patient has fallen out of the guidelines.”
Even women who have had the HPV vaccine may receive this recommendation, since there are many strains of HPV, which can cause several forms of cancer, including anal cancer. The plus side: co-testing is actually more adept at detecting abnormal cells or cervical cancer than the standard Pap test.
More frequent testing may be suggested for women who have risk factors
As a precautionary measure, Polidoro said women who have multiple sexual partners, are immuno-compromised, have had an abnormal Pap in the past, or have been treated after an abnormal Pap may be advised to get tested annually.
“Predominantly speaking, we have a cancer that is virally related,” she said, “There’s other factors that also increase that risk.” Smoking is another big one.
An abnormal Pap test doesn’t instantly mean you have cervical cancer
“It is really common for women to have abnormal Paps,” Polidoro said, emphasizing that HPV is a prominent virus.
While there are degrees of abnormality, she said, the most standard situation is the detection of an atypical cell of undetermined significance, or ASC-US. If the Pap also shows that HPV is present, that triggers an automatic decision to do a colposcopy, a procedure that allows for an even closer look at the cervix using an instrument called a colposcope.
“We usually tell patients that means we saw some atypical cells, they may be in the early stages of some HPV changes related to the cells,” Polidoro said. “However, we can’t really tell them at what degree or what the abnormality is until we do the colposcopy. So that’s kind of the mysterious category.”
Ultimately, both Pap tests and additional testing are positive steps. “We’re really trying to catch cervical abnormalities earlier than we used to,” Polidoro said, “and being able to diagnose an early problem that’s very treatable and not necessarily recurrent before it actually becomes cancer.”