A lot of women understand a pap smear as something they have to do to get their birth control, and may not know much about it beyond that. I know that when I decided to get on birth control at 18, I had to go get a full well-woman exam, and all I knew was that it was awkward and the speculum was uncomfortable. It was years before I actually knew what the purpose of the exam was, beyond getting a prescription for birth control. Because a pap involves a pelvic exam, I’ve noticed some women assume that if they had a pelvic exam, a pap was done. Not true! Let’s discuss what actually goes on in a pap smear, and when and why you should do it.
Your well-woman visit consists of your breast exam, a bimanual exam (performed by the doctor with both hands, to check the size, shape, consistency, and location of the cervix and uterus), and a pap smear. The pap smear is the part that involves a speculum.
The practitioner takes a small brush and collects cells from your cervix, and at the lab a cytologist examines the cells to make sure they look normal.
Normal cells mean you don’t have cancer. Abnormal cells require further testing to require if you have precancerous changes (dysplasia), or possibly cancer. Cervical cancer often has no symptoms until it’s advanced, and symptoms may include irregular bleeding, which can be caused by other things and, therefore, be overlooked. Because of this, it’s important to get your pap smear regularly even if you feel fine.
The important thing to remember about a pap smear is that it’s a cancer screening, not an infection screening. Don’t assume that because you had a pelvic exam, you had a pap! Some infection screenings require a sample of vaginal discharge, and usually this means a practitioner will require a speculum exam.
A pap smear won’t tell you if you have a sexually transmitted infection (although abnormal results may indicate the presence of high-risk HPV, a second test must be done at the lab to confirm), or a common vaginal infection such as yeast, bacterial vaginosis, or trichomonis. If you have symptoms of infection, be sure to talk to your healthcare provider.
Here’s some questions you might want to ask yourself and your health care provider:
Do I need a pap smear if:
- I have irregular bleeding or bleeding after sex?
If you are due for one or if all infections have been ruled out, probably. Ask your healthcare provider!
- I have discharge, odor, or pain during sex?
You definitely need an infection screening, which will involve the provider inserting a speculum and taking a sample of discharge for testing. They most likely will not do a pap at this time.
- I want to get tested for STIs?
A pap doesn’t directly test you for HPV or other STIs. You can get screened for most infections through urine and blood tests.
For routine pap screenings, current testing guidelines state:”It depends on your age and health history. Talk with your doctor about what is best for you.”
Most women can follow these guidelines:
- Starting at age 21, have a Pap test every 2 years.
- If you are 30 years old and older and have had 3 normal Pap tests for 3 years in a row, talk to your doctor about spacing out Pap tests to every 3 years.
- If you are over 65 years old, ask your doctor if you can stop having Pap tests.
Ask your doctor about more frequent testing if:
- You have a weakened immune system because of organ transplant, chemotherapy, or steroid use;
- Your mother was exposed to diethylstilbestrol (DES) while pregnant; or
- You are HIV-positive
If you are younger than 21 and require birth control, ask your healthcare provider what you need to do to get a prescription without a pap smear.