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We encourage our patients to have a Pap smear once a year. The annual Pap smear is also a good time to review general health and preventative issues. The Pap smear is designed to detect any changes to the cells of the cervix. The cells of the cervix are continuously growing and shedding. Sometimes, the cells can become abnormal during this process, and may lead to cancer. Not all abnormal cells will become cancer, but early detection and treatment of pre-cancerous (abnormal) cells in the cervix are essential parts of women's health care.

When to have a Pap smear
Pap smears at Aradia Women's Health Center
Risk Factors
Abnormal Pap smears
What is the Cervix?
Resources
Making an Appointment
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When to Have a Pap Smear

You should begin having Pap smears at age 18 or the onset of sexual activity, whichever comes first. Generally, you should continue having pap smears once a year past menopause, even if you are not having sex with men.

It is best to schedule your Pap smear for a time in your cycle when you are not having your period, or are only menstruating lightly. You should make sure that nothing is in your vagina for 24 hours before your test, including tampons, sperm, douches, jellies, creams, foams and films.

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Pap Smears at Aradia

When you meet with your provider, make sure to let her know if you have noticed any changes in your cycle. This includes length of your bleeding, length of your total cycle, and changes in cramping or heaviness of bleeding, as well as any midcycle spotting. The provider may ask you questions about your family history, your pregnancies, any medications/herbal remedies you are taking (including hormonal birth control), your relationship history and your partner's relationship history, and whether you have ever been diagnosed with genital warts or human papillomavirus (HPV). It's also important to let the provider know if you are a survivor of sexual assault, so that she can make sure that you have everything you need to feel safe during your exam. And finally, make sure that you urinate right before your exam and, if possible, have a bowel movement earlier that day.

The Pap smear can be done by itself, or as a part of an annual physical exam. When the provider is ready to do the Pap smear, she will ask you to lie on your back with your hips at the edge of the exam table and your knees supported on stirrups. She will examine your outer genital area, including the labia, the clitoris, the area between the vagina and anus, and the anus. She will check for skin rashes, lumps, discharge, sores and injuries. She will then insert a speculum (a metal instrument that holds the vagina open so that the cervix can be seen inside) and ask you to keep your hips relaxed. The speculum should feel like pressure but should not pinch or catch hairs. If it does, let the provider know so that she can adjust it. When it is inserted, she will open the speculum to see the cervix, which feels like strong pressure. She will then use a flat wooden stick, much like a small, slender popsicle stick with a shaped end, to gently take cells from the surface of your cervix. This usually feels like more pressure. Then she uses a small brush to take cells from the inner opening of your cervix (the os). This can cause a cramp similar to a menstrual cramp, but should not last long. She spreads the cells on a slide and sprays them with alcohol to preserve them for the laboratory.

After the Pap smear, your provider will do any other special tests you want (such as testing for Sexually Transmitted Infections, or vaginal infections) and will then remove the speculum. She will then place one hand on your abdomen and insert two gloved fingers of her other hand into your vagina. This is done to check the size and shape of your uterus, cervix and ovaries. She will press down with her top hand on your abdomen on each side and in the middle to feel your organs between her two hands. This will feel like pressure or squeezing, but should not be sharply painful; if it is, please let her know.

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Risk Factors

Most cases of cervical cancer are caused by a virus called human papillomavirus (HPV), which is sexually transmitted. Your risk of getting HPV increases if you:

  • Started having intercourse before the age of 18
  • Have had more than one sexual partner
  • Have a partner who began having intercourse before 18 or has had multiple sexual partners
  • Have a partner whose previous partner had cervical cancer
  • Are also infected with the HIV virus
  • Smoke cigarettes
  • If you already have HPV, smoking will increase the chance that the HPV will cause cancerous changes in your cervix. Heavy smoking damages your immune system and reduces its ability to fight cancer.

A rare type of cervical cancer has been found in some of the daughters of women who took a drug called diethylstilbestrol (DES) during pregnancy to prevent miscarriage. The drug was used from about 1940 to 1970. If you were born during that time, it's important to know if your mother was treated with DES during her pregnancy.

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Types of Abnormal Pap Smears

The Pap smear is predominately used to screen for cervical cancer, but it also can pick-up some types of infection or inflammation. In fact, the most common "abnormal" Pap smear shows mild inflammation often due to yeast or Bacterial Vaginosis.

Abnormal Pap results cover a wide range of precancerous and cancerous changes. It's important to know exactly what type of "abnormal" result you had, because the treatment is different in each case.

  • The ASCUS Pap result means that some cells are abnormal but not clearly precancerous. In some cases, the abnormality will go away without treatment. Your provider may ask you to return in four to six months for a repeat Pap smear to check the cells, or may recommend a different test to compare results.
  • Precancerous cells are usually called squamous intraepithelial lesions (SIL) and come in two types: low and high grade. LGSIL(low grade) lesions are more dangerous than ASCUS, but less than HGSIL(high grade). Your provider may ask you to have a follow-up test called a colposcopy (a kind of "microscope" used to look at the cells of the cervix more closely) to learn exactly where the abnormal cells are located on your cervix. HGSIL lesions are also tested with colposcopy, and the abnormal cells are usually removed as well to prevent their developing into cervical cancer.
  • Abnormal glandular cells (AGUS) can also lead to cervical cancer, and this would also be treated with colposcopy and removal.
  • Cancer can be limited to the cervix (in situ), or can include nearby lymph nodes or even other distant parts of the body. If you are diagnosed with cancer, your provider will refer you to a doctor who specializes in treating cancer. It's essential that you follow up immediately.

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What is the Cervix?

The cervix is the lower, narrow part of the uterus or womb that opens into the vagina. When you have sex with a man, your partner's penis goes into your vagina; it may touch the cervix but does not go inside it.

Cells on the surface of the cervix sometimes can appear abnormal but not cancerous. However, this can be the first step in a series of slow changes that can lead to cancer years later.

Diagram from the National Cancer Institute

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Resources

  • National Cancer Institute Cervical Cancer Information: www.cancer.gov/cancer_information/cancer_type/cervical/
  • American Cancer Society: www.cancer.org
  • American Social Health Association: www.ashastd.org/hpvccrc/index.html
  • National Cervical Cancer Coalition: www.nccc-online.org
  • National Women's Health Information Center: www.4women.gov/faq/pap.htm#4
  • Intercultural Cancer Council: iccnetwork.org/cancerfacts/

If you have any questions or would like to make an appointment, please do not hesitate to contact us.

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