What is a Pap test?

The Pap test is a simple test that checks for abnormal cells on your cervix (the opening of the uterus, located near the back of your vagina.). It is done as part of a pelvic exam, but is different than a check for sexually transmitted diseases (STD). You should have a Pap test done once every year. It can take years for abnormal cells on your cervix to become cervical cancer. Cervical cancer can be prevented if these abnormal cells are caught early enough— therefore it is very important to get regular Paps. The best time to get a good sample is one week after your period is over.

Who should get a Pap test?

All women who are sexually active (including women who have sex with women) should have yearly Pap tests.

How is a Pap test done?

Your health care provider will insert an instrument called a speculum into your vagina to help them see your cervix. You may feel a bit of pressure or discomfort but it should not be painful. Some of the cells from your cervix are gently wiped off with a small brush and a small wooden spatula. These cells are put on a glass slide and are sent to a lab. This is different than an STD check, which involves taking samples of the fluids in the vagina and on the cervix using a long, cotton-tipped swab. You may want to ask if an STD check is routinely done when you have your annual Pap test.

What does an abnormal Pap test mean?

The cells on the cervix, like all the cells in your body, are constantly changing. Some of those changes are normal, other changes can tell you that you have a vaginal infection and your body is healing, or that you may need treatment. When your health care provider receives your Pap result, one common diagnosis is ASCUS which stands for Atypical Squamous Cells of Undetermined Significance. The lab technician may say that it “favours benign cellular changes” which are minor changes and are nothing to worry about. You may be told to repeat the pap in six months, instead of a year, just to be sure.

The lab report may say, “Favours a low, medium or high grade intra-epithelial lesion” (this used to be called dysplasia). If you have such a lesion, it does not mean you have cancer, but does mean you need further testing (such as a colposcopy).

What causes lesions on the cervix?

The most common cause is a sexually transmitted virus called human papilloma virus (HPV). It is the same virus that may cause genital warts, though many people carry HPV and don’t know it. Other contributing factors may be smoking or having unprotected intercourse at a young age, before your cervix matures. If your pap test shows a lesion, you will be referred for a colposcopy.

What is a colposcopy?

A colposcopy is an exam done by a gynecologist that looks at the cells of your cervix more closely than a Pap. The doctor will insert a speculum to see your cervix and place a microscope-like instrument called a colposcope near the opening of your vagina. The doctor may take tiny samples of the cells of your cervix, called a biopsy. This can be uncomfortable; you may feel cramps, like your period. It may also cause some spotting or bleeding for a few days. The biopsy is sent to a lab for testing and, depending on the result, you may need treatment.

How are lesions treated?

Lesions can be treated using cryotherapy or laser therapy. Cryrotherapy freezes the cervix with a gas to destroy abnormal cells. Laser therapy uses a beam of light to destroy the abnormal cells. Both of these usually take about ten minutes. Freezing should be applied first to lessen discomfort. It may be applied with a spray or, more effectively, using a small needle that will feel like a series of pinches. Talk to the doctor about the freezing first. Even with freezing, you may still feel some cramping, which is usually temporary, but this varies from woman to woman.

Follow-up

This depends on the treatment you have had. Make sure to ask what to expect and how to take care of yourself after a colposcopy and treatment. Also make sure you are clear on what follow up they are recommending. They may want to see you again, or tell you to have more frequent Pap tests until you have had several normal results in a row. It is important not to be on your period for a Pap test, colposcopy or treatment.