The Pap smear is a test used to detect abnormal changes in the cervix, the lower end of the uterus, or womb. It is the main test used for early detection of cervical cancer, a treatable cancer when caught early enough. Abnormal test results do not mean that cancer is present, but rather that more tests need to be performed. An abnormal Pap may be the result of problems such as vaginal infections or sexually transmitted disease (STD). Infections may be caused by a simple overgrowth of germs naturally found in the vaginal area or an STD such as genital herpes, warts, chlamydia or gonorrhea. STDs are spread between partners during sexual activity. The Pap test may also show pre-cancerous cells that, if untreated, might lead to cancer and particularly, cervical cancer. Cervical cancer can affect women of all ages, but is most common between ages 40 and 55. There is evidence that suggests a relationship to certain viral infections, including the human papilloma virus (HPV), which causes genital warts. Risk of cervical cancer increases with a family history of cervical cancer, a history of genital warts, recurrent vaginal infections, smoking, early childbearing, early age of first intercourse, and multiple sexual partners.
The Pap test is a simple procedure that, performed routinely, may save your life. During a Pap test, your doctor will view the cervix through the vagina using an instrument called a speculum to hold the vagina open. Then, a few cells are taken from the cervix, smeared on a slide and viewed under a microscope. If all of the cells appear normal, the test is said to be negative, or normal. The Pap results are considered positive if any abnormal cells are seen. Abnormal (positive) results are categorized according to the type of changes seen in the cells and the number of cells affected. There are several methods used for categorizing abnormal changes.
Symptoms may include:
For a vaginal infection:
Vaginal discharge, odor, itching or irritation
There may be no symptoms at all
In cervical cancer:
Often absent in early stages
Vaginal bleeding or discharge
Pain or bleeding during or following sexual intercourse
Late symptoms may include abdominal pain, loss of appetite and weight loss.
What your doctor can do:
Most often, your doctor will recommend repeating the test in approximately 3 months if it shows an abnormality.
Prescribe antibiotics to treat bacterial infections.
Recommend treatment for all sexual partners in the case of an STD.
What you can do:
If an STD is present, practice abstinence or use condoms during sexual intercourse until you and your partner have both been treated and recovered.
What you can expect:
Follow-up may include further diagnostic tests. Most tests can be performed in your doctor's office and take only 15-30 minutes. They are usually painless but you may experience some stinging or cramping. Over-the-counter pain medicines, such as acetaminophen or ibuprofen can be taken for discomfort.
Colposcopy is a procedure that uses a special instrument called a colposcope to magnify the view of the cervix. During the exam, biopsies (samples) of the abnormal cells are collected.
If pre-cancerous or cancerous cells are present, your doctor may recommend surgery. If advanced cancer is present, further tests, surgery, anti-cancer drugs, chemotherapy or radiation may be recommended.
Advanced stages of cancer may require a hysterectomy (removal of all reproductive organs).
Even though most abnormal pap smears have simple causes, they should not be ignored. Early detection and treatment can completely cure many problems, including cervical cancer.
