Tag Archives: pap smear

How to Make Your Pelvic Exam Less Scary – Part II

Posted on October 15, 2012 by Genevieve

Last month, I posted “How to Make Your Pelvic Exam Less Scary – Part I,” talking about tips for scheduling your first pelvic appointment. Now I’ll give you some information about what to expect the day of your appointment.

When You Arrive - As with all medical appointments, paperwork comes first. Expect questions about the medications you are taking, allergies, your menstrual cycle and your last menstrual period (LMP), sexual activity, family medical history questions, and any current medical problems. Medical assistants will check your weight and blood pressure. If you have had any sexual trauma or if it is your first exam, please let them know when you schedule the appointment and write something on the form indicating that you need them to be extra gentle, slow, and explain everything they are doing or about to do during the exam. If you like, the medical assistant will hold your hand or you can bring a support person (but they can’t come into the exam room with you).

The Exam – If you are having a complete well-woman exam (pelvic/pap/breast check), you will be asked to remove everything but your socks. You will be instructed to put on a paper gown (opening in front for breast exam) and drape a paper sheet over the lower half of your body. You will then lie down on the exam table. The medical provider (MP) will knock on the door and ask if they can enter the room. You will be asked to move down to the end of the table and put your feet in stirrups. Your MP will then look at the vulva (clitoris, urethra, labia, vaginal opening) and the rectum to make sure they don’t see anything that looks abnormal. They will then insert a speculum made of plastic or metal into the vagina. After it is inserted they will open it wide enough to see your cervix. If you have never seen your vulva or cervix up close and personal, you can ask for the MP to show you with a mirror. If your MP notices any abnormal vaginal discharge or unusual smell they will take a sample of the discharge. If you are having a pap smear the MP will wipe your cervix with a thin Q-tip-like brush to test for cervical cancer.

During the pelvic exam portion of the exam the MP will insert one or two gloved fingers into the vagina and place their hand on your lower abdomen to feel your reproductive organs and make sure they are the right size, not painful, etc. Please let the MP know if you experience any pain during this part of the exam. Some MPs will also perform a rectal exam by placing a gloved finger into the anus to check for anything abnormal. After the exam they will ask if you have any questions and then you will be done!

It sounds like a lot, but the exam is over before you know it. If you have any additional questions, please contact your MP or local Planned Parenthood.

My Pap Came Back Abnormal … Now What?

Posted on August 22, 2012 by E.G. Hanna

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So you got your annual screening and a few weeks later you get a phone call stating your pap test came back “abnormal.” Don’t freak out! This can mean a couple different things. To be clear, infections like chlamydia or yeast do not count as an abnormal pap! An abnormal pap means atypical cells on your cervix, that is, that the cells have begun to change in such a way that may be or become cancerous. This is called dysplasia.

After a pap smear comes back abnormal, what happens next depends upon a couple of factors, including your age and the severity of the dysplasia.

You may only need to repeat your pap smear in a few months, as often a health immune system can fight off the changes itself. Or you and your provider may opt for a colposcopy, which is a better way of looking at the cervix. A speculum is inserted into the vagina, solution is applied to the cervix with a cotton swab to highlight abnormal areas of tissue, and then a special microscope is used to look at the cervix. This allows the provider to see the dysplasia and, if deemed necessary, take one or more small tissue samples. This biopsy may feel like a small pinch and, while slightly uncomfortable for most women, it is usually tolerated very well. This biopsy allows the pathologist (the person who examines the tissue sample at the lab) to get a more detailed and accurate reading of the cervical cellular changes.

Depending on the colposcopy results, you may need to go back to pap smears every 3-6 months or, if the dysplasia is severe, you may need further treatment to fully remove the abnormal tissue. This treatment may consist of cryotherapy or a LEEP (Loop Electricosurgical Excision Procedure). Cryotherapy uses a freezing chemical to remove abnormal cells, allowing healthy cells to grow back in their place. A LEEP cuts away abnormal cells with a thin wire carrying an electrical current. Though both procedures may sound intimidating, in truth they are not very painful (many patients tell me their LEEP was more comfortable than their colposcopy, because of the numbing solution applied).

Cervical dysplasia is most often caused by HPV, a very common virus transmitted through sexual contact. Here are a few tips on how to avoid HPV and cervical changes:

Don’t smoke! Smoking is not good for your immune system, and you need a healthy immune system to fight the virus.

Consider the Gardasil vaccine, which protects you from 4 strands of HPV, 2 of which cause 75% of cervical cancers.

Use condoms. Though they may not fully protect you from HPV, as HPV is passed through skin to skin contact, because condoms cover parts of sexual anatomy they reduce the chance of transmission. Try female condoms too, which cover more skin.

Practicing abstinence or limiting sexual partners is also helpful, but isn’t foolproof. The CDC sums it up really well: “People can also lower their chances of getting HPV by being in a faithful relationship with one partner; limiting their number of sex partners; and choosing a partner who has had no or few prior sex partners. But even people with only one lifetime sex partner can get HPV. And it may not be possible to determine if a partner who has been sexually active in the past is currently infected. That’s why the only sure way to prevent HPV is to avoid all sexual activity.”

Most of all, if you have a pap come back abnormal, keep these two things in mind: 1) Don’t panic. 2) Don’t ignore it. Cervical dysplasia is treatable and it does not necessarily mean you have or will get cancer. The keyword there is “treatable,” meaning you must see your provider for treatment to avoid detrimental effects to your health!

What is a Pap Smear, Anyway?

Posted on July 24, 2012 by E.G. Hanna

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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.

Trans* Health: Trans Men Need Paps Too

Posted on June 7, 2012 by Guest Post

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Today’s guest post is from “Erin” who is a graduating student of Women’s and Gender Studies at a local university. She specializes in sexuality as it relates to gender and her main focus is reproductive rights history.

Here at Planned Parenthood we are concerned with the health of men and women. But say you do not identify as either one of the binary genders, or you do not identify with the gender assigned to you at birth. If that is the case, you may identify as Trans*.

Trans* is a general word for someone not living as the gender that was assigned to them at birth. This could include transgender or transsexual individuals. For the purpose of being all on the same page, I will define trans man as a female-to-male transgender person, and a trans woman as a male-to-female transgender person. It can be easy to get confused, especially if you are not familiar with people of non-gender conforming persuasions. The best thing you can do is respect how each person identifies.

As far as sexual health is concerned, trans men need to remember to get pap smears too. For whatever gender you identify as, if you have a cervix you can be at risk for cervical cancer and need to get screened. Check out this article from earlier this year that details “four ways we can prevent cervical cancer among trans men and genderqueer/gender nonconforming people.” Some barriers for trans men include: health insurance coverage that denies routine preventative care, like pap smear screenings, to trans folks; health care providers being culturally insensitive to the trans community, or just plain discriminating; and maybe not being aware of how to properly take care of cervical health.

For optimal cervical health:

• Get vaccinated for HPV, one of the main contributors to cervical cancer. More about HPV here. More about the HPV vaccine here.

• Go annually for routine pap smears after the age of 21 or 3 years after being sexually active (this goes even if you have been vaccinated for HPV). More about pap smears here.

• Use protection! Wear condoms, female condoms, gloves, and/or dental dams to help protect against STI’s that may cause cervical cancer. More about safer sex here.

As a reproductive rights scholar, I have taken a special interest in Trans* rights. This is for many reasons, but above all, when we talk about what people can and cannot do with their genitals, I believe this is encompassed within reproductive rights. The article Trans Rights Are Reproductive Rights is fantastic.

Another very cool resource for trans health is the Trans Youth Sexual Health Booklet. This is a fairly detailed pamphlet made by and for trans youth about sexuality and sexual health.

Cervical Cancer is Preventable

Posted on January 20, 2012 by Guest Post

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We’ll be back with our regular Fun Friday this afternoon, but this morning, we’re featuring an op-ed from Dr. Sujatha Prabhakaran, MD, MPH, FACOG, our Senior Vice President of Medical Affairs/Medical Director, to mark Cervical Cancer Awareness Month.

January is Cervical Cancer Awareness Month, and it’s important to know that cervical cancer is preventable.

It is one of the few cancers that has two proven strategies to prevent – not just treat – the disease. In 2011, more than 12,000 women were diagnosed with cervical cancer and over 4,000 women died from it.

Almost all of these cases could have been prevented if these women had had access to either cervical cancer screening via Pap smears or to the HPV vaccination – or both.

One thing may not know is that Pap smears don’t usually detect cervical cancer. What they detect are precancerous cells, cells that aren’t cancer yet but show changes that suggest they could become cancerous. Once we detect precancerous cells, we are able to provide treatments to either destroy or remove these cells and prevent them from ever becoming a cancer.

Women who have regular Pap smears (every 2-3 years is now recommended for most women) have a much lower risk of developing cervical cancer because, if they have an abnormality, it is often detected in the precancerous stage.

Another way to prevent cervical cancer or prevent precancerous cells from ever developing is the HPV vaccination. Most cervical cancers are caused by the HPV virus. Seventy percent of cervical cancer cases are caused by two particular types, 16 and 18, which are included in the vaccine. By getting the HPV vaccine before they are exposed to those viruses, women can significantly reduce the risk of developing cervical cancer.

Access to these types of preventive care is vital for the health of women.

While uninsured or under-insured women do have access to Pap tests and HPV vaccinations at safety net providers like county health departments and Planned Parenthood, this access will improve as women’s preventive health services will now be covered 100 percent under the Affordable Care Act.

I’m certain this will be a welcome change for women all over the country.

The Speculum: No, it is NOT a Duckbill Platypus

Posted on January 3, 2012 by Mary

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As a sex educator, there are certain themes that emerge that you can come to expect. For example, when someone sees a speculum for the first time, their first comment is usually that it looks like a duckbill platypus beak. Or if they aren’t familiar with the platypus family, they say, “Um, that goes where?”

So, the speculum can not be found on the control panel of the Starship Enterprise or in a laser spectronomy laboratory. A speculum, my friends, is that plastic or metal instrument that a gynecologist uses to spread the vaginal walls so the cervix can be seen and reached. They are used during Pap smears and other gynecological procedures like IUD insertion or colposcopy. They come in various sizes and I think it would be cool if they had neat designs on them or lit up in neon colors – it would be my way of saying, sorry to bother you, Ms. Vagina, but look how fun this can be!

When a speculum is inserted, it should not hurt. It might feel uncomfortable, especially if you are tense, but if you feel pain, alert the medical professional right away. I know, I know, how are you supposed to feel comfortable in a paper “gown” (seriously, a gown?!) in a sub-freezing room with your feet in stirrups and your lady parts in a stranger’s face? Well, no one wakes up excited for their “annual,” but it is one of those things that we just do because we know we should. Our vaginal and cervical health is important. So this year, when the doctor or nurse is telling you to “scooch all they way to the end of the table,” just remember that a speculum is NOT a duckbill platypus, and is actually a tool that can help save your life.