Regular screening helps women prevent cervical cancer.

A regular pap smear is the best way a woman can avoid cervical cancer. The simple screening identifies abnormal cell changes and checks for human papillomavirus (HPV), which is the most common sexually transmitted infection.

“More than 80% of men and women will have HPV in their lifetime,” says Carmen Cueto, MD, an obstetrician and gynecologist who provides services at USC Verdugo Hills Hospital, part of Keck Medicine of USC. “With appropriate screening, we can reduce the risk of HPV progressing into cervical cancer.”

What is a pap smear?

A pap smear test is a minimally invasive procedure that involves collecting a sample of superficial cells from around the cervix.

As Dr. Cueto explains, the provider may begin with a bimanual exam where they’ll insert their fingers into the vagina to feel for any lesions around the cervix.

The next step involves inserting a speculum, which opens like a duckbill, into the vagina. This pap smear tool allows the provider a better look at the cervix. They’ll use a small brush to collect a cell sample. The process takes 30 seconds to a minute.

“It’s a relatively quick procedure, and I reassure my patients that I’ll talk them through the whole thing,” Dr. Cueto says.

Patients can expect to feel pressure in the pelvic area when the speculum goes in. A pap smear may feel uncomfortable, but it shouldn’t be painful.

Can you get a pap smear on your period?

It is possible to perform a pap smear while the patient is on their period, but Dr. Cueto says many providers will delay the procedure. “The results could be less clear, so they may reschedule for after your period is done.”

She also recommends patients track their periods so they know when to expect it. That’s because after a pap smear, light spotting is normal but heavier bleeding is not.

“If you come for your pap smear the day before you’re supposed to start your period, then have heavy bleeding the next day, that is likely your next period starting,” she says.

How often should you get a pap smear?

Dr. Cueto says patients should start getting pap smears by age 21. She adds that some providers will delay a pap smear until age 25 if the patient isn’t sexually active.

The U.S. Preventive Services Task Force and the American Society for Colposcopy and Cervical Pathology (ASCCP) recommend patients 21-29 get a pap smear every three years. Patients ages 30-65 are advised to get one every five years.

“Since most individuals’ immune system will naturally clear the HPV infection within that time frame, and the risk of developing cervical cancer remains low, the ASCCP advises that annual pap smears are not necessary,” Dr. Cueto explains.

However, she stresses that these guidelines only apply to patients who had normal pap smear results.

What does a pap smear test for?

A pathologist analyzes the shape, size and structure of the cells to assess for any potential changes that would indicate cancer risk.

Depending on the patient’s age and medical history, the specialist may also examine the sample for HPV. “They’ll test for multiple strains of HPV to identify if it’s a low-risk versus a high-risk strain,” Dr. Cueto explains.

How long do pap smear results take? Patients may wait days or a few weeks for the provider to receive the lab results.

What is an abnormal pap smear?

The presence of atypical cells can cause “abnormal” pap smear results. “There are different categories within that,” Dr. Cueto notes. “What those results mean is that the cells they looked at in the lab have a different morphology compared to normal cells due to inflammation around the cervix.”

Certain strains of HPV create a higher risk of cervical dysplasia, a precancerous condition in which abnormal cells grow on the cervix.

If a patient tests positive for HPV but has normal cells, the typical recommendation is to repeat the pap smear in a year.

Dr. Cueto says this recommendation is based on the fact that the immune system is more likely to eradicate the virus on its own. Providers will perform another pap smear the following year to ensure the body successfully rid itself of the HPV.

What happens after an abnormal pap smear?

If a patient has both HPV and atypical cells, the usual next step is a colposcopy. This exam is similar to a pap smear in that the provider uses a speculum to better visualize the cervix.

The provider then places a solution of acetic acid on the cervix. “A microscope is used to examine cervix, and if the cells turn white, it signals the presence of abnormal cells. The provider will then take a biopsy of the cervical tissue, and the results will help guide next steps,” Dr. Cueto says.

“Testing positive for HPV and having atypical cells does not mean you have cancer,” she emphasizes. “It just means there is inflammation around your cervix causing these changes, and there are steps we can take to ensure it doesn’t turn into that.”

Author: Erin Laviola