Pap Tests / Colposcopy
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 infections (STls). Abnormal cells can be a precursor to cervical cancer but are completely treatable if caught early. Guidelines advise no one should be screened until age 25, regardless of sexual activity. They also advise that as long as you have normal Pap smears, you should be screened every three years. lmmunocompromised and HIV positive patients should have annual screening. If you have an abnormal Pap result, your healthcare provider will advise you of necessary follow up. The best way to get a good sample is to come approximately one week after your period is over, and not to have had anything in your vagina for the previous 48 hours.
Who should get a Pap test?
Anyone who is sexually active, 25 years of age or older, and has a cervix should get Pap tests. This includes women who have sex with women as well as trans men. Screening can be discontinued at age 70, as long as there have been 3 normal paps in the previous ten years.
How is a Pap test done?
Your healthcare 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 plastic broom. These cells are put in a liquid medium and are sent to a lab. This is different than an STI 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 STI check is routinely done when you have your 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 need treatment. One common diagnosis is ASCUS which stands for “Atypical Squamous Cells of Undetermined Significance.” Another common diagnosis is “Low Grade Squamous intraepithelial Lesion” (LGSIL). If you get either of these results on your Pap for the first time, you will typically be told to repeat the Pap sooner than three years. You will be advised based on current follow up guidelines. Most of these changes revert to normal on their own without any treatment.
You should not repeat the Pap sooner than six months, as it may take that long for the changes to reverse. If your Pap test shows a repeat ASCUS or LGSIL, or a first-time high-grade intraepithelial lesion” it does not mean that you have cancer. It means you need further testing and be referred for a colposcopy.
What causes lesions on the cervix?
Most often, changes to the cells on the cervix are caused by some strains of a sexually transmitted virus called the Human Papillomavirus (HPV). This is the same family of viruses that cause genital warts. The strains of HPV that cause genital warts are not the same strains that can cause changes to cervical cells. It is possible, however, to have more than one strain.
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 into your vagina to see your cervix and place a microscope-like instrument called a colposcope near the opening of your vagina. The doctor may take samples of the cells of your cervix (a biopsy) and send them to a lab for testing. Treatment may be recommended depending on the results.
How are lesions treated?
Lesions can be treated using cryotherapy or laser therapy. Cryotherapy uses a gas whereas laser therapy uses a beam of light to destroy the abnormal cells. Both of these treatments usually take about ten minutes. Freezing should be applied first to lessen the discomfort. The freezing may be applied with a spray or more effectively using a small needle that will feel like a series of pinches. Talk to your doctor about the freezing first. Even with freezing, you may still have some cramping, which is usually temporary, but this varies from person to person.
What follow-up is needed?
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 appointments your healthcare provider(s) 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.
The HPV vaccine (“Gardasil”) was approved for use in Canada in 2006. It offers protection against nine different types of HPV: the two most commonly implicated in causing genital warts and the two that are most likely to cause cervical cancer and abnormal paps. The vaccine comes in 3 doses and the cost (in 2022) at Hassle Free Clinic is $170 per dose. Some insurance companies cover the cost of the vaccine and it is available to some populations free of charge. Ask your healthcare provider about eligibility.