A pap test or pap smear is a standard gynecological procedure that examines your cervix for changes or abnormalities. It can detect infections, HPV or cervical cancer. A pap smear is recommended once every year for women over the age of 21 or once they become sexually active. A pap smear takes cells from your cervix and are sent to a lab for examination and evaluation. Regular tests help detect problems quickly and also rule out mistakes made by false positive and false negative results.
Your First Pap Smear
A typical adolescent exam includes obtaining your personal and family medical history, a full medical assessment, and a minimally invasive exam depending on your size. Annual pelvic exams and pap smears are recommended for all women over the age of 18, but younger patients may receive a modified exam. Since a gynecological exam may be overwhelming for a teenager, we carefully explain the exam process and answer any questions you may have. Examination of the vagina is not needed in all patients. When necessary, we do use baby-sized instruments to obtain pap smears for younger patients. Our gentleness performing exams results in happy patients who return for many years.
Abnormal Pap Smears
An abnormal Pap smear doesn’t necessarily indicate a condition like HPV or cervical cancer. Pap smears detect any changes within the cervical cells, not just cervical cancer. Abnormal Pap smear results may indicate other conditions such as inflammation or infection. False positives are also possible from Pap smears, however further testing is recommended to protect your health whenever the Pap smear is abnormal.
Categories of Pap Smear Results
There are three categories of results: normal, unclear and abnormal. A normal, or negative, result occurs when no changes to the cells of the cervix have been detected. Unclear results are not uncommon, and they simply refer to an inconclusive finding that the cervical cells may or may not be abnormal. This may mean that too few cells were collected during the test. It can also indicate a disease or infection as well as changes caused by hormones or inflammation. The results may be influenced by other factors too, such as having had sexual intercourse, using a douche or applying vaginal cream in the two days prior to the Pap smear testing.
Abnormal, or positive, results typically indicate changes to the cervical cells, which may be caused by a number of conditions. They range from mild or minimal changes, which often resolve without treatment, to moderate or severe changes, which are a sign of potentially serious pre-cancerous or cancerous tissues.
Diagnostic Testing for Abnormal Pap Smears
We may recommend that you have a colposcopy test if your Pap smear is abnormal. With colposcopy, we use a microscope to examine the cervix more closely and we take a biopsy of the cervix. The exam itself is similar to a Pap smear in that a speculum is inserted into the vagina so that the cervix is visible. In our office, numbing cream is applied to the cervix before biopsy, so that the test is not painful. After your biopsy returns we recommend any treatment indicated to prevent cervical cancer.
Some patients will need a mini-surgery called loop electrosurgical excision procedure (LEEP) to remove precancerous cells from the cervix. During the procedure, the abnormal cells are removed to prevent the development of cervical cancer. Wire loops attached to an electrosurgical generator cut away the affected tissue, causing the cells to heat and burst. The tissue removed is sent to a lab for further evaluation and to ensure that the abnormal area has been fully removed. An assessment as to the cause of the growth of abnormal tissue will also be done. The LEEP procedure takes 20 to 30 minutes and can be performed in the office or operating room. A local anesthetic is administered to minimize pain.
Other patients require only a simple Pap smear in our office every 3 months for follow-up until the Pap smear returns to normal. This is a standard approach when the changes that were detected in the cervical cells are considered minor, since they will often resolve with no treatment. However, these follow-up appointments are essential to make sure that the initial results were an anomaly. If the successive Pap smears are found to be abnormal as well, further testing will likely be recommended.