You know the drill: Your feet are in the stirrups, the speculum is in your vagina, and your gyno is all up in there.
So what are they doing in there anyway? BuzzFeed Life talked to some gynecologists to give you more info about Pap smears — like how often you really need one and what an “abnormal result” actually means.
1. First things first: A Pap test is something you get at your gynecologist’s office to screen for cervical cancer.
During a Pap test, your gyno is collecting cells from your cervix using a small scraper or cervical brush. Those cells are then sent off to a lab to be analyzed for any abnormalities that could be associated with HPV or cervical cancer.
Fun fact: The term actually changed from Pap smear to Pap test. That’s because the test used to be done by placing the cells (or smear) on a microscope slide, but now the cells are collected and put in a vial.
2. The Pap test ONLY screens for cervical cancer — not STIs.
Your gyno might also do some STI tests while they’re down there, but that’s not the same as the Pap test. So just know that if you go for a Pap test (or have already had one) that doesn’t necessarily mean you’re getting screened for STIs, too. You’ll need to ask your doctor specifically about what STI tests are recommended for you based on your age and sexual habits. For more info on that, check out our guide to getting tested.
3. If you don’t hear from your doctor after a Pap test, give them a call.
Every doctor’s office has their own way of sending you test results, but don’t automatically assume that no news is good news, Dr. Alyssa Dweck, board-certified OB-GYN and coauthor of V is For Vagina, tells BuzzFeed Life. Even if your doctor says they’ll reach out if they find something, give them a call if you haven’t heard anything and you’re concerned.
4. OK, so your doctor called and said you had an abnormal result. WTF does that mean?
Don’t panic. It basically means that the test picked up some abnormalities that they’ll need to confirm with some follow-up, says Dweck. There are a few different levels of abnormalities, so feel free to ask your doctor what exactly they found so you’re not panicking about the unknown.
The least abnormal result would be atypical cells of undetermined significance. “This means that your cells don’t look 100% right, but they don’t look precancerous,” says Dweck. The next levels of abnormality would be mild, moderate, and severe dysplasia, which means they found precancerous cells that have either a low, moderate, or high risk of developing into cancer unless treated. (FYI: dysplasia refers to abnormal cell changes that may become cancerous.) And very rarely, an abnormal Pap test could find cancer, but this is really unlikely in younger women.
5. An abnormal result may just mean that you need to come back in for another Pap test.
Sometimes the sample just wasn’t ideal for testing, and they have to do another one. Or it’s possible that some other factors interfered with the result, says Dweck, like an infection or irritation (from recently having sex or using lube or being on your period). The tests aren’t perfect, so try not to jump to the worst case scenario.
6. When you have an abnormal Pap result, the next step is usually an HPV test.
Regardless of your age, the lab will usually run an HPV test automatically when the Pap test comes back abnormal, says Dweck. That’s because these abnormal cell changes are often related to HPV, and that’s what can lead to cancer. (Some people will get Pap tests and HPV tests together, but we’ll go over all those guidelines in a bit.)
Here’s the thing: HPV is incredibly common (like, if you’ve had sex ever, you’ve probably been exposed), and in most cases it clears on its own. But if the test shows that you have a high-risk type of HPV that’s more likely to lead to cervical cancer, they’ll want to take a closer look at things.
7. If the test shows you have abnormal cells and HPV, you’ll probably get a colposcopy, which is a microscopic exam of your cervix.
Here’s what that entails: Your doctor will look at your cervix and vagina with a microscopic tool called a colposcope. They may use a vinegar-type solution on the area to help them see any abnormal cells, and if they find any, they’ll take small tissue biopsies for testing. It’s no root canal, but it can be uncomfortable, says Dweck. Try your best to relax, and ask your doctor if you can take a pain reliever before coming in.
8. Depending on those biopsy results, you may need a surgical procedure to treat it.
“HPV and cervical dysplasia are 100% treatable,” Dr. Tara Allmen, board-certified OB-GYN with the Center for Menopause, Hormonal Disorders and Women’s Health, tells BuzzFeed Life. Once you treat it (usually with a LEEP procedure or conization biopsy) and go through the necessary follow-up, you’ll go back to being screened at the recommended intervals.
9. The recommendations for Pap tests changed recently, so people are getting them way less often.
If you’re in your late 20s or older, you’re probably used to getting a Pap test every year for as long as you can remember. But the guidelines have changed. In 2013, the American College of Obstetricians and Gynecologists released new recommendations for cervical cancer screening for anyone with a vagina. Here they are:
• You don’t need a Pap test until age 21. (Yes, even if you’re sexually active.)
• If you’re between the ages of 21-29, you should get a Pap test every 3 years.
• If you’re between the ages of 30-65, you should get a Pap test every 3 years OR a Pap test and HPV test together every 5 years.
• You can stop getting routine Pap tests at age 65 if you don’t have a history of moderate/severe dysplasia or cancer AND you’ve had three negative Pap results in a row or two negative Pap/HPV results in a row, with the most recent test in the last five years.
BUT: If you have an abnormal Pap result, a history of cervical cancer, HIV, or a weakened immune system, you will most likely be screened more often. So check with your doctor about that.
10. Fewer screenings might sound terrifying, but it’s actually a good thing.
For starters, HPV is super common in people under age 21, and in most cases it goes away on it’s own, says Allmen. So instead of identifying every case of HPV and then doing biopsies and surgeries to get rid of something that most times would have cleared up anyway, experts now suggest delaying these screenings until later on. “What we’ve learned over time was that we were doing way more biopsies and way more surgeries to cure mild dysplasia that never would have progressed to cancer,” says Allmen.
It’s also possible that these cervical biopsies and surgeries could weaken the cervix, which could lead to pregnancy complications down the line. For this reason, your doctor may want to just keep a watch on mild dysplasia until after you’ve had kids (if that’s something you’re planning), rather than treat it immediately. “It takes many years from exposure to the HPV virus to cervical infection, and most women wont get there. And of that minority, only a minority of those will proceed to cervical cancer, and the whole journey takes about 10 years,” says Allmen.
11. But even if you don’t need a Pap test every year, you should still have annual gyno appointments.
Your yearly gyno appointment can help you check for STIs, talk about birth control and fertility concerns, and help you stay on top of your sexual and reproductive health. All important things.
And remember: There’s an HPV vaccine that can reduce your risk of cervical cancer. It’s recommended for all girls and boys at age 11 or 12, but you can catch up through age 26 if you haven’t gotten all three shots yet.
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