PAP Smears – Well Woman Exam

Why should I get a PAP smear?  Better yet, what is a PAP smear?

austin family medicine pap smear well womanPAP Smear is an abbreviation of the physician’s name who discovered the staining techniques which are still used in today’s PAP Smears.  His name was Dr. Papanicolaou.  As you can see in the photo, the cells are stained multiple colors, and this aids the pathologist in determining if cells are cancerous.  The PAP Smear has been performed routinely for women (and some men) for decades.  The PAP Smear is part of your Well Woman Exam, and the goal of this test is to reduce the likelihood of death caused by cervical cancer.  The PAP smear procedure involves brushing cells off of the cervix to be analyzed under a microscope.  Your healthcare provider opens the vaginal canal with a speculum in order to visualize the cervix.  The cervix is the opening of the uterus.  If you think of a 2L coke bottle upside down, the bottle is the uterus, and the cap is the cervix.  The cervix is the part of the uterus that you hear referred to as dilating during childbirth.  It is normally closed with a bellybutton-like appearance when you are not pregnant.  During childbirth, it opens to 10cm which is the size of a bagel (or a newborn’s head).  When your healthcare provider is doing a PAP smear, the cervix is brushed gently in order to collect cells for the pathologist to examine under a microscope.

Why do I need a PAP smear?

PAP smears are used to detect early signs of cervical cancer.  It is a useful test since cervical cancer develops very slowly – it takes years before it becomes malignant.  Plus, it is easily treated.  If your PAP smear is ever abnormal, it is important to follow the recommendations from your healthcare provider.  Your next step will most likely be repeat PAP smear or a Colposcopy.  I will go over more details about Colposcopy in future blogs.

Did you know that the PAP smear guidelines changed recently? How often should I get a PAP smear?

For starters, your first PAP smear is due after you turn 21 regardless of your sexual activity.  The old guidelines based your first PAP smear on your first sexual encounter.  Now, it is much simpler:  All women start PAP smears at age 21.  …preferably after you have recovered from your 21st birthday celebrations.  After your first PAP smear, you need repeat PAP smears every 3 years if your results are normal.  After age 30, we perform Co-Testing which includes a PAP smear and HPV Testing (see below for details).   If both tests are negative, you are considered “double negative,” and you can get PAP smears performed every 5 years.  After age 65, you do not need any additional PAP smears.  However, even this recommendation has been an area of controversy since people are living longer.  In my opinion, you can continue PAP smears every 5 years after age 65 if you choose to do so, but your insurance company may not cover the test, and it may not benefit you.

If I don’t need a PAP smear, then do I still need a well woman exam?

Yes!  We still encourage women to be seen yearly for their Well Woman Exams because it is a good time to discuss other risks in more detail –heart disease risk, colon cancer risk, smoking cessation, etc.  Many women have missed getting their entire body examined because of the focus on the pelvic exam during PAP smears.  There is controversy surrounding whether physicians should continue doing pelvic exams even when not doing a PAP smear.  The reason for doing a pelvic exam without a PAP smear is to assess for other forms of disease, such as uterine fibroids, vaginal infections, and ovarian cancer to list a few.  I leave this choice to my patients.  If they do not want to do a pelvic exam and their risk of cancer is low – then we do not need to perform the exam.

Healthcare is supposed to be personal and patient-centered.  Each person’s exam is tailored to their individual needs, desires, and concerns.