Pap Smear

What is a Pap smear?

• The Pap smear, also called a Pap test, checks the cervix for abnormal cells and signs of cancer. The cervix of a female is the narrow opening at the bottom part of the uterus (womb). The cervix is round and cone shaped, and joins the top part of the vagina. Your cervix is made of different kinds of cells and has a small opening in the middle. During a Pap test, your caregiver collects samples of the cells from in and on your cervix. These are then placed in a container with liquid or on a thin piece of glass called a slide. The samples are sent to a lab to be tested and examined. A Pap test can also be used to check for germs and signs of infection in your vagina.
  
  
• The Pap test is a very important test for checking on the health of your cervix. Caregivers will look carefully for any abnormal cells. Having regular Pap tests lets you and your caregiver know if your cervical cells are becoming abnormal. Over time abnormal cervical cells may go on to turn into a cancer. Cells from your cervix usually show abnormal changes long before they become cancer. Knowing early that you have developed abnormal cervical cells lets your caregivers treat you even before you have cancer. Early treatment can help prevent cancer from appearing and causing damage.

What is cancer of the cervix?

When you have cancer of the cervix, tumors (lumps) may grow on your cervix and damage nearby tissues. Cancer cells may spread to other parts of your body and damage other organs. You may have pain and bleeding, and lose weight and become weak. Some females are at an increased risk of having cancer of the cervix. They may need to have Pap tests more often to let caregivers check for abnormal cells.

What may increase my risk of having cancer of the cervix?

Your risk of having cervical cancer may increase if:

• You have had genital warts. These warts are caused by a germ called human papilloma virus (HPV). Ask your caregiver for more information about HPV.
  
  
• You have had sex before you were 20 years old.
  
  
• You or your sexual partners have had sex with three or more other different people.
  
  
• You smoke tobacco.

What should I do before having a Pap smear?

Pap tests should not be done during your monthly menstrual period. The best time of the month is usually the time right after your period. This is 10 to 20 days after the first day of your last period. During the 24 hours before, do not have vaginal sexual intercourse or put anything in your vagina.

What will happen during a Pap smear?

• A Pap smear is usually done as part of a pelvic exam on females. You will be positioned on the exam table so your caregiver can see and access your vagina (birth canal). This position usually requires you to lie on your back with your legs spread open. You will be covered up as much as possible during this exam. Your feet will be put on footrests called stirrups so your legs do not get tired.
  
  
• Your caregiver will gently insert a device called a speculum into your vagina. The speculum is used to spread open the walls of your vagina to let him see your cervix. He will use a thin brush or a cotton swab to collect cells from the opening in the middle of your cervix. He will get samples from the surface of your cervix using a special tool called a spatula. The spatula is a long plastic or wood tool shaped to fit to the outside of the cervix. He may also scrape the upper part of the vagina to get samples. The samples are placed in a container with liquid or on a glass slide. The samples are sent a lab and examined for abnormal cells.

What do caregivers check for in a Pap smear?

Caregivers carefully look at the cells from your cervix. They will compare them with how normal cells from the cervix look. Your Pap test results can be any of the following:

• Normal: All your cells look normal and your results are negative for cervical cell problems.
  
  
• Abnormal: Caregivers find cells that look different from normal ones. When you have abnormal cells, it may mean one of the following:
  
  
  • Abnormal cells: This is also called cervical dysplasia (dis-PLAY-zhah). This is when some of your cervical cells are abnormal but you do not have cancer. Cells in this stage are precancerous, which means that later on they could become a cancer.
    
    
  • Inflammation: This is irritation or swelling in your cervix. This can be caused by an infection in your vagina. Ask your caregiver for more information about cervicitis.
    
    
  • Cancer: You may have cancer that is only in your cervix. If you have more advanced cancer, it may have grown and spread to other areas.

What may happen if I have a positive Pap smear result?

Your caregiver may do another Pap test to check if the result is correct. He may test your cervical cells for HPV if you are over 30 years old. He may also do a colposcopy exam. A colposcopy is a procedure that lets your caregiver get a better look at your cervix. This procedure is done with a special tool called a colposcope. The colposcope has a bright light and a magnifying lens to help your caregiver see your cervix more clearly. During your colposcopy, caregivers may collect samples of abnormal tissues. The samples will be sent to a lab to be tested. Ask your caregiver for more information about HPV testing and about colposcopy.

When should I have Pap smears?

Some experts suggest that you begin having Pap tests three years or less after you have vaginal sexual intercourse for the first time. Other experts say that Pap tests should begin at the age of 21. Ask your caregiver when you should begin to have Pap tests.

How often should I have Pap smears?

At first, you will need to have a Pap test every year or two. Ask your caregiver how often you should have a Pap test. You may need this test less often after age 30. With any of the following, your caregiver may suggest that you have a Pap test more often:

• Age 30, and you have had a positive test result for HPV.
  
  
• Exposure to diethylstilbestrol (DES) medicine when you were still in your mother's womb.
  
  
• You have a weak immune system.
  
  
• You have been treated for cervical intraepithelial neoplasm (CIN), or cervical cancer.
  
  
• You have the human immunodeficiency virus (HIV).

When may I stop having Pap smears?

Caregivers will check your health and your Pap test results to see if you can stop having Pap tests. You may be able to stop having Pap tests when you have the following:

• Age 65 or 70 years, with no abnormal Pap test results in any of the past 10 years, and three or more negative Pap tests in a row.
  
  
• If you did not have cancer or a history of CIN, and you have had surgery to remove your uterus and cervix (total hysterectomy).

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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