Pap smears to screen for cervical cancer or precancerous changes to cells
Cervical cell testing is done using (most commonly) the Papanicolaou (Pap) test. It is usually done by a doctor, who will collect cells from the cervix using a scraping tool and a tiny brush, with the cells later examined under a microscope for changes. This scraping can cause a small amount of bleeding. There are two sorts of tests – the conventional test and the liquid-based test.
Who gets tested and why
Tests should be done after a woman becomes sexually active, since HPV – the virus that causes cervical cancer – can be spread via body fluids and skin contact – eight out of ten people have HPV and don’t even know it, and there is no test for guys, who can spread it around, but never know. This means most of us will have HPV at some point in our lives. What’s important is making sure it doesn’t cause cancer.
Ways to spread HPV include fingers, toys, and body parts, even non-sexual closeness. Condoms can help prevent the spread, but often they don’t stop it, which is why it’s important that anyone sexually active is tested. This means you can have HPV even if you have not had sex with a guy or a girl where genitals actually touched.
HPV is a virus, and is therefore quite keen to spread itself around. HPV is also eradicated by your immune system, but it takes many years to do so, so you won’t have HPV forever, and just having HPV does not mean you will get cervical cancer. HPV has many varieties, and not all cause cancer, but some forms do cause genital warts.
What happens during a Pap test
It’s best if the testing is done when you don’t have your period and haven’t used any douches or vaginal creams for at least 24 hours prior to your test.
You will visit the doctor’s office (or wherever your testing happens to be) and be taken to a private area.
You will be asked to remove your lower layers of clothing – shoes, underwear, trousers/skirt – and climb up on the table that should be covered with a fresh hygienic towel, paper, or other disposable/clean material (for hygiene).
The doctor usually covers your view with a piece of material or paper so you actually can’t see yourself or what they are doing. This is mostly just to keep you separate from what’s going on, since it’s not the most fun thing you’ll ever do. You don’t have to have it there if you don’t want it.
The doctor will lube up a speculum, which is a tool that holds the walls of your vagina apart, since their natural inclination is to close. The test doesn’t really hurt, but it can feel uncomfortable, since the cells are being scraped off. The cervix isn’t that dense with nerve endings, so it’s not like other areas being scraped. In fact, sometimes it just feels like pressure.
The key is to really try to relax – your vaginal muscles can be really tight when you are tense, so just make a concerted effort to relax at least your vaginal muscles to make it less uncomfortable.
A spatula (sort of like a tongue depressor) is used to remove cells from the surface and opening of the cervix, then a small-bristled brush (like a mini bottlebrush) is inserted through the cervical entrance to get the cells from inside the neck of the cervix.
Later in the lab, abnormal cells are hunted down via the microscope, with most often none being found. Abnormal cells have a rating system – CIN I, II, III or IV, with IV being cancerous, and the rest being on the spectrum from slightly abnormal to very much precancerous.
CIN = cervical intraepithelial neoplasia
How often you should be tested
Between ages 21 – 30, testing is most often done every three years, however if you have had an abnormal result at any point, that could be shifted up to every six months or every year. The reason for this is that the virus does spontaneously disappear, and it may clear up on its own.
After age 30, testing is done every three years, or every five years if both a Pap test and a human papillomavirus (HPV) test are done.
After age 65, testing is no longer required if test results have been normal for at least three years in a row, and there was no abnormal result in the past 10 years, but there are exceptions: if you get a new sexual partner(s), you should keep getting tested, because you can catch HPV at any age.
Male testing, and testing on those without a cervix
Soon it is hoped that men will be able to be tested for HPV via blood tests, since currently men are not screened, yet they can still have it. Anal, penile and vulvar/vaginal cancers are thought to also be caused by HPV, so this will be an excellent adjunct to current testing.
Women or intersex/DSD people without a cervix can still get cancers caused by HPV (anal, genital), so it might be worth asking your doctor how you can get tested.
If you do not have a uterus (have had a total hysterectomy) and have not had any abnormal Pap tests, then conventional wisdom suggests you do not need to be tested.
Early sexual activity and sexual abuse
If you became sexually active in your younger teenage years, you should be tested earlier – age is not an indicator of when HPV can strike, but when you get infected with the virus. If you were sexually abused as a child or teenager, keep this in mind – it technically counts as ‘sexual activity’ and can have passed on the virus.
Women who need more frequent tests
Smoking is known to be a factor that makes HPV infection do bad things faster. If you smoke and have HPV, the chances of you developing abnormal cells increases significantly. This isn’t to scare you, but if you do smoke and are sexually active, it’s really important that you get regular checks, maybe even more often than other women.
HIV, immunosuppressant drugs, weakened immune system
If you have HIV, are on drugs that suppress your immune system, or have a weak immune system, you will probably need to be tested more frequently.
The Gardasil vaccine – yes or no?
Pap tests are an effective way to test for and prevent cervical cancer, however there is a vaccine now being made mandatory in many countries. This is in hot debate, so do your research and find out for yourself if the vaccine is worth the risks. Gardasil is one of the riskiest vaccines ever made in terms of adverse vaccine outcomes, so you need to remain informed regarding whether it’s worth it for you or those in your care. Pap tests are great, and with regular testing, the risk of developing cervical cancer is very low.
What to do if you are freaked out by Pap tests
There are some things to know about getting regular Pap tests.
- You don’t have to do anything you don’t want to, and nobody is going to make you. It is 100 per cent your choice to get a Pap test or not.
- There are benefits to being screened for ‘silent’ cancers of your reproductive organs, including not dying of a completely preventable cancer.
- Cancer of your reproductive organs doesn’t really hurt, because they don’t have that many nerve endings, so you can’t tell if something is wrong until it’s too late. You will feel fine.
- You can be spreading HPV to other people and not know. This could result in someone else catching HPV, if they too do not get regularly tested.
- There is a chance that you don’t have HPV, but estimates sit at about eight out of ten people having HPV at some point in their lives.
- People who have HPV don’t necessarily have abnormal cells or develop cancer.
- Don’t be scared of knowing. Not knowing can cause you more anxiety.
- You probably don’t have cervical cancer or abnormal changes!
- Early detection means effective treatments – abnormal cell changes are treated by simply scraping the top cells off your cervix, and does not include cancer treatments at all. It’s half a day in hospital at most. If you catch this early, you can avoid the terrible toll of cancer. Having your cervix and part of your vagina removed will screw up your life in ways you didn’t even know were possible, including possibly ruining your sex life for good.
- It is our strong recommendation that you get tested however often is appropriate for your circumstance, and encourage the women close to you to do the same. Go as a gang. Talk about it. Don’t let fear get the better of you.