Why you should never skip your Pap

The proverb “an ounce of prevention is worth a pound of cure” could easily have been written about Pap smears. While it may not be the most comfortable of procedures, the Pap smear is definitely worth it: cases of cervical cancer fell by 70 percent in the US in the decades after it was introduced. Here’s everything you need to know about the dreaded and celebrated Pap smear.

What is a Pap smear and what does it test for?

If you are over 21, chances are your doctor has booked you for your first Pap test. A Pap smear is part of a vaginal exam that screens for abnormalities in your cervical cells. It’s not a diagnostic test, though. While it can indicate whether cells are normal or abnormal, a Pap smear can’t detect HPV or cancer. If the results come back abnormal, doctors will order further testing to narrow down the cause of the abnormality.  In Canada, the cost of Pap smear tests are covered under your provincial health insurance coverage.

How is a Pap smear done?

The Pap smear procedure has ‘two steps: a visual check and a cervical swab using a speculum. To begin, your doctor will have you remove your clothes and put on an oh-so-flattering backless medical gown. They’ll get you to lie on your back on the examination table, spread your legs and stick your feet into the stirrups at the bottom of the table.

The doctor will begin with a visual examination of your vulva and the outer part of your vagina. They will then insert a speculum (a duckbill shaped instrument) into your vagina and use it to dilate (open) your vagina to see your cervix. Then, your doctor will insert a swab to remove some cervical cells to send for testing. Your doctor may also do a manual examination, to feel for any abnormalities in your reproductive organs.

Although some women experience spotting or light bleeding after a Pap, the procedure shouldn’t be painful. If you have pain, heavy bleeding, or spotting that lasts for more than a few days, it’s a good idea to contact your doctor as it might be indicative of another problem. An unfortunate exception to this is after menopause when painful Pap smears become more common. This is due to a decline in estrogen levels which can cause dryness and extreme sensitivity in the vagina and cervix.

How often should you get a Pap smear?

Most provincial guidelines in Canada stipulate that if you’re sexually active, you should get your first Pap smear at age 21, and continue to receive them every three years until age 70. These guidelines change, however, if you have had cervical cancer or an abnormal Pap. In these cases, you’ll need more frequent screening until you have a few clear tests under your belt. 

While Pap smears screen for cancer, abnormal cellular changes, and HPV, your doctor’s visual inspection can sometimes spot other STIs such as herpes — but only if you have a visible outbreak. Many STDs, however, aren’t readily diagnosable with a pap. And since STD checks aren’t done routinely, if you think you may have an STD or may have been exposed, you should speak to your doctor about being tested.

When to have a Pap smear

While you can get a Pap smear during your period, blood, tissue, and other foreign substances can obscure your doctor’s view so you may want to reschedule if you have a particularly heavy flow. It’s also best to abstain from both sex and douching (which is bad for vaginal health anyway), for 24 hours before your examination.  If you have a vaginal infection (like a yeast infection), wait until you’ve finished treatment before booking your Pap.

Pap smears during pregnancy

You can get both a Pap smear and a colposcopy (a form of closer examination – more on this later) while pregnant — both are completely safe and will not affect the health of your baby. And a Pap smear when pregnant won’t hurt more. You are also able to undergo a biopsy if your doctor deems it necessary, although this can increase your risk for bleeding.

What can cause an abnormal Pap smear besides HPV?

While it’s entirely normal to freak out when your Pap smear test results come back “abnormal,” keep in mind that this could mean a variety of things. An abnormal pap smear can mean HPV or (less likely) cervical cancer, but it could also be the result of a different infection. Chlamydia, gonorrhea, and even yeast infections can cause a slightly abnormal pap smear. Your doctor will recommend the best course of action based on the results of your test. This can range from scheduling another Pap in three to six months, to getting a colposcopy. But unless your doctor explicitly tells you they are concerned, please don’t panic and think this means you have cervical cancer. Abnormal pap smears are quite common — about eight percent of tests come back abnormal. Even normal physiological changes, such as menopause, can cause test results to return abnormal.

What’s a colposcopy?

Your doctor will sometimes refer you for a colposcopy when your Pap smear returns abnormal. Similar to a Pap, a colposcopy involves a close examination of the cervix using a magnifying glass-type device called a colposcope. It allows your doctor to more thoroughly inspect your cervix and may involve a biopsy. 

It’s completely normal to feel anxious before a Pap smear. Especially if you haven’t had one before or if you have a history of trauma. But Pap smears are an integral part of preventative medicine. And better screening means earlier intervention, which increases your chances of surviving something like cervical cancer. So while it can be tempting to avoid, don’t put off getting your Pap test. It could literally save your life.