Navigating your healthcare with autonomy and empowerment means knowing what your options are and what the purpose is of different procedures. One test that is commonly recommended for people cis-women and people with vaginas is the pap smear.
Pap smears are an essential part of reproductive health care, giving providers vital information about your cervical health. Still, it can be a sensitive and/or uncomfortable test to get, with sometimes confusing results. Let’s explore what exactly a pap smear is and why it’s important for you and your reproductive health.
What Is a Pap Smear?
Before explaining the purpose of a Pap smear, you have to understand the body part that it’s testing – the cervix. The cervix is a doughnut-shaped organ located between the vagina and the uterus.
The cervix acts as a bodyguard, protecting the uterus from bacteria and infection, while also playing a vital role in conception, pregnancy, and birth. Outside of pregnancy, the cervix also creates mucus that protects the uterus and inner organs from bacteria that can lead to infections.
A Pap smear or Pap test examines the cells on the cervix to check for any abnormalities or early signs of cervical cancer. The procedure was named after Dr. George Papanicolaou, the American physician who developed the test.
The frequency of your testing depends on your age, prior Pap results, and other healthcare concerns, but is typically 3-5 years for people ages 21-65.
The Purpose of a Pap Smear
The main purpose of a Pap smear is to detect cervical cancer or precancerous cells on the cervix. While it can detect these cells, the test cannot be used to diagnose cancer. Abnormal results require further testing. Early detection is crucial when it comes to treating cervical cancer, as it can greatly improve the efficacy of treatment.
Pap smears are often confused with HPV tests, but they are not the same thing. HPV, or Human Papillomavirus is a group of more than 100 related viruses and is often transmitted through sexual contact, but not always.
Your provider may also give you an HPV test at the same time (co-test), which is technically a different test than a Pap smear but is typically done at the same time. There are many different types of HPV, but scientists have detected 13 strains that can cause cervical cancer. At least one of these strains can also cause other cancers in the vagina, anus, vulva, head, and neck.
Pap smears can also detect infections and inflammation around the cervix and reproductive organs. It does not detect other STIs like chlamydia or gonorrhea, but your healthcare provider can take a swab for the cervix or perform a blood or urine test for a complete STI screening.
What Happens During a Pap Smear
Pap smears are often part of a normal gynecological appointment. Your provider will probably perform a pelvic exam first where they will start by palpating and examining your reproductive organs like your uterus and ovaries. You may also get an STI test during your appointment.
The Pap test is performed by inserting a speculum into the vagina, during which you might feel slight pressure. This tool is used so that your provider can see your cervix. They then gently scrape cervical cells using a small brush or spatula. Your provider then sends your cervical cells off to a lab to have them examined under a microscope to look for abnormalities and signs of cancer.
The test usually only takes a few minutes and should not be painful, although it may be uncomfortable. Some people experience light spotting after the test.
How To Prepare for a Pap Smear
How do you prepare for your appointment? You should avoid having vaginal sex, using tampons, or vaginal creams or medicines for two days before your exam. Try to schedule your appointment at least five days after the end of your period.
What Your Pap Smear Results Mean
If your results show abnormal cells these changes are typically caused by HPV, not cervical cancer. Abnormal results range from low grade to high grade, but typically minor abnormalities clear up on their own.
HPV results will either be negative or positive for the types of HPV that can lead to cervical cancer. Abnormal results typically require further testing or testing more often, depending on the severity of the abnormalities.
Who Should Get a Pap Smear?
The U.S. CDC recommends people get their first Pap test at age 21, then about every three years after that if the results are normal until the age of 29. People ages 30-65 should get either a Pap test alone every three years, or a Pap/HPV co-test every five years.
People over the age of 65 who have had prior screenings typically don’t require further testing unless they have had abnormal results or are at high risk for cervical cancer. Pap smears are still recommended for people who are no longer sexually active or have never had sex. This is because not all cervical cancers are caused by sex.
Do people who have had the HPV vaccine still need to get Pap smears? Yes, because while the vaccine is highly effective in protecting against most types of HPV that can cause cervical cancer, it doesn’t protect against all of them.
People may require more frequent screenings or tests after the age of 65 if they have HIV, were exposed to DES in utero, or have been treated for cervical cancer.
Pap Smears: What To Remember
Remember that an abnormal Pap smear does not mean that you have cancer or will develop it, but it will probably require closer monitoring in the following months or years. Pap smears allow for early detection of cervical cancer, allowing for potentially life-saving treatment – 95% of cases treated for precancerous cells don’t develop into cervical cancer.
We highly recommend getting regular Pap smears that are appropriate for your age group. Be sure to talk to your healthcare provider to help determine when you should get a Pap smear, and how often you should be getting them. If you’re heading off to your first Pap smear, we have some more tips to help you prepare. Kudos for being proactive about your reproductive health!