What is a Pap test?
A Pap test is a procedure where a sample of cells is collected (usually by a doctor or nurse) from the cervix of the uterus, the vaginal walls, or the vulvar skin outside of the vagina. The cells are then analyzed to determine if they are normal or if they are abnormal. The Pap test is most commonly used to screen for preinvasive or invasive cancers of the uterine cervix. All women should have a Pap test within three years of becoming sexually active or by the age of 21.
The Pap test is quite simple to do. It is relatively inexpensive and it can detect abnormalities before they are visible on clinical examination and most importantly, before a true cancer develops. The Pap test is not perfect and it is possible for a woman to have an abnormality and the Pap test not detect that abnormality. However, cervical and vaginal cancers develop slowly so if a woman has regular screening using the Pap test at the time of a pelvic exam, the abnormalities will, in most cases, be detected prior to the development of a life threatening problem.
What happens if the Pap test results are abnormal?
Your health provider will evaluate the results to determine if you should have a repeat Pap test, a colposcopy (pelvic examination using a microscope) or a laboratory test, often a test for the human papillomavirus or HPV. Sometimes a combination of the above tests will be recommended.
Why might a repeat Pap test be necessary?
A repeat Pap test might be necessary if you had an infection at the time of the Pap test or if there were not enough cells collected during the Pap test. Since decreased levels of estrogen can also influence Pap test results, menopausal women might need to take estrogen before the repeat Pap test.
If the results of the repeat Pap test are still abnormal, your health care provider might recommend that you have a colposcopy to further evaluate the problem.
What is a colposcopy?
Colposcopy is an examination of the lower genital tract that uses a low power microscope. This magnifies the tissues of the cervix, the vagina, and sometimes the vulva in order to aid in detecting the area responsible for the abnormal Pap test. Often times once the abnormal area is identified, it will be biopsied along with some small biopsies from surrounding high risk areas. At the time of performing the colposcopy, the colposcope is used outside of the vagina to look into the vagina. The surface of the cervix and vagina are examined using the standard speculum that is used to open the vagina during a pelvic exam.
When a Pap Test is Abnormal?
As previously mentioned, the Pap test is a screening test. Screening tests are tests designed to tell who might have a disease. If a Pap test comes back abnormal, that abnormality should be evaluated by a specialist with expertise in colposcopy if your doctor feels colposcopy is indicated. That evaluation by a specialist in precancers and cancers of the lower genital tract, is extremely important for several reasons. In the young patient, it may prevent them from having procedures that they do not need. Many mild abnormalities are just non-precancerous HPV infections and with close follow-up and patient observation they will resolve on their own. More serious abnormalities in the young patient as well as the more mature woman, will also require the expertise of a specialist to decide the proper therapy.
Risk factors for precancer and cancer of the cervix
Risk factors are things which may increase your chances of developing a disease; in this case, precancer or cancer of the lower genital tract. It is especially important to have regular Pap testing if you have the following risk factors:
- The single most important is positive HPV infection
- Sexually activity before age 18
- Multiple sexual partners
- Sexual partners with genital warts or other sexually transmitted diseases
- A personal history of an abnormal Pap test
- Precancer or cancer
- Cigarette smoking which decreases your ability to clear HPV infection
- Immune compromising conditions such as HIV or medications you are receiving because you have had an organ transplant