Do I Really Need a Pap Smear?

I know what you’re thinking…

“Not again… I hated it the first time”

“But my last test was fine, do I really need to go again?”

“My friend told me that it was really painful, now I’m too scared”

“But there’s nothing wrong with me, I feel fine”

There are so many reasons why us women believe that we don’t need to go for a Pap smear. I want to separate the myths and from the facts so that you can make your own informed decision.

But first, what is a Pap smear?

The Pap smear, or Pap test, was developed in the 1940’s by Dr George Papanicolaou. So it’s been around for quite a while. It involves lightly scraping cells from the cervix, more specifically from what is known as the transformation zone. Oh yes, it’s anatomy time!

This is the part of the cervix where most cervical cancers develop so we want to make sure we cover it properly. I’ve highlighted the transformation zone in the image below so you can have an idea of where it is.

Why do we keep being told to go for the test?

Well, the World Health Organisation (WHO) estimates that there have been roughly 570 000 new cases of cervical cancer in 2018 alone. That’s an insane amount, I mean the year isn’t even over yet! They also found that the majority of deaths from cervical cancer occur in low and middle-income countries. This can be due to having less access to healthcare and not enough early screening.

Having a simple Pap smear done can reduce the number of deaths by cervical cancer tremendously1WHO. World Health Organization. [Online]. Available from: http://www.who.int/cancer/prevention/diagnosis-screening/cervical-cancer/en/ [Accessed 11 October 2018].. This is because we are able to pick it up while it’s still early, before it is even considered cancer yet, and cure it!

What does the WHO recommend?

The WHO provides us with a guideline which should be considered a minimum standard. This is because we need to consider the availability of healthcare resources in developing countries.

They recommend that Pap smears be done at least once for every woman in the age group of 30-49  years2WHO. World Health Organization. [Online]. Available from: http://www.who.int/cancer/prevention/diagnosis-screening/cervical-cancer/en/ [Accessed 11 October 2018].

In more developed countries, routine Pap smears begin roughly 3 years after becoming sexually active, or at the age of 21 – whichever comes first. The guidelines can vary from country to country.

The guidelines are a little different for women living with HIV. This is because HIV can cause cervical cancer to develop earlier, progress a lot faster and may lead to an earlier death3WHO. Comprehensive Cervical Cancer Control A guide to essential practice. (2nd ed.). : World Health Organisation; 2014.. (Okay, things got a little morbid pretty fast…)

For women living with HIV:

  • Pap smears should be done in women and girls, regardless of age, who have started engaging in sexual activity as soon as she has tested positive for HIV.
  • If the results show no abnormalities, then they should be screened again within three years time.
  • For those who have been treated for cervical pre-cancer, they should come again after one year for another Pap smear.

How I prepare for a Pap smear?

 

 

  1. Ideally you shouldn’t be menstruating when you go for your Pap smear, but if you are, don’t let it stop you from getting one. It can just make the test a little more difficult to interpret.

  2. Avoid vaginal intercourse, douching, the use of tampons, or any sort of vaginal cream (medical or otherwise) for 24-48 hours before.

  3. If you are having abnormal bleeding or discharge from the vagina before your Pap smear, don’t postpone the test because there is a chance that the symptoms could be due to cervical cancer – and we don’t want to miss an early opportunity to catch it in time!

How does the actual procedure work?

Let me break it down for you into the different steps:

Step 1: You will lie on your back with your legs separated (this is known as the lithotomy position in the medical world) as shown below:

Image result for pap smear position

Image Source via ifthedevilhadmenopause

Step 2: A lubricated speculum is inserted into the vagina to visualise the cervix. This part can be slightly uncomfortable. A speculum is a device that is used to open up and separate the walls of the vagina so that the healthcare provider can see the cervix properly before doing the test. There is one in the image below:

Image result for pap smear

Image Source

Step 3: The healthcare provider will then lightly scrape or brush the transformation zone (discussed above) with a wooden spatula or brush before transferring the cells onto a glass slide or into a liquid solution.

Step 4: The speculum is then removed and you can get dressed again. The procedure is over (you are free!). The cells are then sent to the lab for interpretation.

It is a very short procedure, it shouldn’t take more than five minutes.

What happens next?

Now we wait for the results. How long you will wait depends on the lab and how busy they are at the time. Less busy, private laboratories may take as few as 3 days, but busy state laboratories can take up to 6 weeks.

The results

There is a wide range of possible results, ranging from no abnormalities found to full-on cancer. There are quite a few stages to go through before it is actually considered cancer though. We call them “pre-cancer” or “pre-cancerous lesions”. When your results come back, your doctor will explain the results to you and what the next step will be, depending on what was found.

Now it’s up to you

Do you think it’s worth it? Let me know in the comments. Five minutes of feeling uncomfortable could actually save your life!

We can go deeper into the possible results in another post, so please let me know if you would like to know more! I want to try give you just enough information so that you can make your own informed decision.

Much love,

Dr Megan Martin

Medical Doctor with an Interest in Sexual Health. Aspiring Sexual Health Physician and Sexologist with a Specific Interest in Women’s Sexual Well-being

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