Pap Smear

The Pap smear is a simple procedure that is used primarily to detect precancerous cells being shed from the cervix. It is also helpful in the detection of abnormal cells from other causes.

The American College of Obstetricians and Gynecologists (ACOG) recommend that the first cervical cancer screening of a woman using a Pap Smear should be about three years after first sexual intercourse or by age 21, whichever comes first. For all women under 30, annual pap smears are necessary. For women over 30, there are three options:

Women who have had three negative results on annual Pap tests can be rescreened with cytology alone every two to three years.
Annual cervical cytology testing.
Cytology with the addition of an HPV-DNA test. If both the cervical cytology and the DNA test are negative, rescreening should occur no sooner than three years.

Please note that these recommendations are different than those for an annual pelvic examination. ACOG recommends that all women age 18 or older need annual gynecologic examinations, including a pelvic examination, as do sexually active adolescents younger than age 18. The well-woman visit is a key part of preventive care; it includes a discussion of the patient's health history and reproductive health care needs, a physical examination, including a weight and blood pressure check, a clinical breast examination, and various tests depending on a woman's age and risk factors for disease.

The Pap Smear Examination

Having a Pap smear is a relatively simple procedure. The cervix is visually examined by your physician, using an instrument called a speculum. The surface of the cervix is gently skimmed with a spatula and a tiny brush. The cells are then either smeared on a glass slide or rinsed into a vial of liquid and sent to a laboratory for analysis.

It is important not to use douches, vaginal creams or medication, or have vaginal penetration with a penis, finger, or dildo within 48 hours prior to your pelvic exam. These can distort the appearance of the cells to be studied in the pap.

Test Results

Most Pap smears are normal. This means that all the cells appear healthy.

An abnormal Pap smear means that the cells appear different, but are not necessarily harmful. An abnormal Pap may result from infection by bacteria, viruses, or from unknown causes. Sometimes abnormal Pap smears are associated with STIs (sexually transmitted infections).

If your Pap smear was not normal, it could indicate a premalignant condition. Further investigation would be needed to determine the appropriate course of action. This could require a repeat pap smear or the use of a colposcope.

A colposcope is merely a binocular microscope designed to assist in locating abnormal cells on the cervix.

If an abnormal area is discovered, a pinch of tissue must be taken and examined. This is called a "pinch biopsy." The result of the pinch biopsy will help your clinician determine whether treatment is necessary.

Treating Abnormal Pap Smears

The usual treatment for an abnormal Pap smear is called "cryotherapy," which simply means to freeze.

The area from which the unhealthy cells were found is frozen. The frozen tissue is sloughed off by the body and new, healthy tissue will then grow in its place. During this process, a heavy, watery discharge may occur for approximately two weeks.

Your clinician will probably recommend increasing your intake of water and potassium-rich foods during this time. Have a follow-up pap smear 4-6 months after cryotherapy.