Pap Tests

"How does the doctor do a Pap test?"
A plastic or metal speculum (which looks like a duck bill) is used to open the vaginal vault and allow the practitioner to see the cervix. The cervix usually looks like a skin colored ring with a small hole in the middle called the 'os'. The practitioner assesses the walls of the vagina, the health of the cervix and the quality of the normal vaginal discharge. The next step is to get a sample of the tissue of the cervix and this is done first with a small plastic paddle called a spatula. The spatula is placed on the cervix and twirled around to gather loose cells. This is then placed in a small cup with a liquid that separates the cells so they can be looked at under a microscope. The next instrument is called a brush and looks like a tiny bottle brush. This is inserted into the cervical os and rotated around briefly to get cells from just inside the opening into the uterus. The brush is then placed into the same cup and this liquid is sent off to the lab.

"Why does the doctor have to put his hand in my vagina during a gynecologic exam?"
The bimanual examination is important to assess the different organs of a woman's anatomy. The uterus is palpated using the hand which is outside the vagina, the ovaries are appreciated on either side with both hands and the cervix is palpated to assess whether or not there may be inflammation involved in this part of the anatomy with the internal hand.

"Why do I need a yearly Pap test if I have never had sex?"
The general rule is that women have a pap test either at the time they first begin to have intercourse (whatever year that is) or at age 18 regardless of whether they have become sexually active. The changes in a woman's cervix are most often associated with exposure to Human Papilloma Virus and the more partners a woman has, the more risk there is to her having been exposed to this. But having a gynecologic exam is important to establish her gynecologic health and to begin a lifelong habit of routine examinations.

"My Pap test came back "abnormal" and the doctor says I have to have another one in 3 months. What does that mean?"
There are different levels of severity of changes in the cervical cells. With any early changes detected on a screening Pap test, the practitioner will always want to repeat the test within a few months for two reasons. First, the changes can resolve without treatment and cervix returned to normal on retesting. Second, if the cervix is unchanged or worse on retesting, this prompts further tests and maintenance follow up to avoid the possible progression to cervical cancer.

"I have only had two male partners and both wore condoms, how can I get changes in my Pap test if abnormal cells are related to HPV and I should have been protected from exposure to that?"
Human Papilloma Virus (HPV) is one of the causes of changes in the cells that line the cervix. The cells can change without the presence of HPV even in women who have never been sexually active. Other risk factors are multiple partners, early age of sexual intercourse and smoking. Do not forget that while condoms protect against many diseases, viral size particles can penetrate through the latex so protection is not 100% assured even with a condom.

"Because I have changes on my pap smear, and had a positive screening test for HPV does this mean that I have genital warts too?"
Positive HPV DNA tests are associated with the risk of cervical cell changes. If HPV is found in the screening test it means that you have been exposed to one or more strains of the virus. Whether or not you develop genital warts is not determined by the pap screening but being positive for these species of virus does increase the odds of exposure to other types which can cause genital warts.

Gorbach, Sherwood. et. al.,Infectious Diseases, Third Edition, pp.1968. Lippincott, Williams & Wilkins, 2004.