The Pap Test (Pap smear)

The Pap test finds changes in the cells of the cervix (the mouth of the womb) that are not normal. When a female has a Pap test, she is positioned on an exam table and a device called a speculum is gently inserted to open the vagina. The speculum allows the healthcare provider to view the cervix and upper vagina. Once the provider can see the cervix, a "broom" device or a brush/spatula combination will be used to collect the cells. While the technique is a little different depending on the device chosen, in general, the provider will gently rotate the device in the endocervix (the cervical canal) and the ectocervix (the portion of the cervix extending into the vagina) to collect squamous and glandular cells. The cells are sent to a laboratory where they are prepared and evaluated under a microscope.

When a female gets Pap test, she is being screened for to make sure that there are no abnormal or precancerous changes in the cells on her cervix. If the Pap test results show these cell changes, this is usually called cervical dysplasia. Other common terms the healthcare provider may use include:

- Abnormal cell changes

- Precancerous cells changes

- CIN (cervical intraepithelial neoplasia)

- SIL (squamous intraepithelial lesions)

- "Warts" on the cervix

All of these terms mean similar things - it simply means that abnormalities were found. Most of the time, these cell changes are due to HPV. There are many types of HPV that can cause cervical dysplasia. Most of these types are considered "high-risk" types, which means that they have been linked with cervical cancer.

Just because a female has cervical dysplasia, it does not mean she will get cervical cancer. It means that her healthcare provider will want to closely monitor her cervix every so often - and possibly do treatment - to prevent further cell changes that could become cancerous over time if left unchecked.

How the Test is performed

You will lie on a table and place your feet in stirrups. The doctor or nurse will place an instrument (called a speculum) into the vagina and open it slightly. This allows the doctor or nurse to better see inside the vagina and cervix. Cells are gently scraped from the cervix area, and sent to a lab for examination.

How to prepare for the Test

Make sure your doctor or nurse knows about all the medicines you are taking. Some birth control pills that contain estrogen or progestin may interfere with test results.

Also tell your doctor or nurse if you:

- Have had an abnormal Pap smear

- Might be pregnant

Avoid the following for 24 hours before the test:

- Douching

- Having intercourse

- Taking a bath

- Using tampons

Avoid scheduling your Pap smear while you have your period (are menstruating), because it may affect the accuracy of the Pap smear. Empty your bladder just before the test.

How the test will feel

A Pap smear may cause some discomfort, similar to menstrual cramps. You may also feel some pressure during the exam. You may bleed a little bit after the test.

Why the Test is performed

The Pap smear is a screening test for cervical cancer. Most cervical cancers can be detected early if a woman has routine Pap smears. You may not need to have a Pap smear if you have had a total hysterectomy (uterus and cervix removed) and have not had an abnormal Pap smear, cervical cancer, or other pelvic cancer.

When will you know the results of the Pap Test?

It may take several weeks to get the test results. If you haven't heard from your doctor's office after three weeks, give them a call to see if your results have come back.

What do the results mean?

A normal Pap test means the cells from the cervix look normal. An abnormal Pap test means the cells do not look normal. Sometimes repeat Pap tests are needed. Different tests also may need to be done, such as a colposcopy (the use of a special microscope to examine the cervix and vagina). Pap tests can occasionally show signs of infection but cannot be relied on to screen for sexually transmitted diseases (STDs). Other tests are necessary to determine the presence of an STD.

What happens if the results are abnormal?

An abnormal Pap test does not necessarily mean that cancer cells were found during the examination. There are many causes for abnormal Pap test results, including infection, inflammation related to using a diaphragm or sex, and changes related to your menstrual cycle. Your doctor will evaluate the results to determine if further testing is necessary.

Why would you need to repeat the Pap Test?

A repeat Pap test may be necessary if there were not enough cells collected during the test. Since decreased levels of the female hormone estrogen also can influence Pap test results, menopausal women may need to take estrogen before they repeat the test. This is not an abnormal result but is called unsatisfactory for evaluation.

How often should you have a Pap smear

All women over 18 who have ever had sex are advised to have a Pap smear every two years, even if they no longer have sex.

Your general practitioner may recommend more frequent Pap smears if a previous smear showed significant cell changes or you experience problems, such as bleeding or pain after sex.

Personal note: I am having Pap Tests every year

Menopause - do you still need to have a Pap smear?

Yes, the risk of getting cervical cancer is the same even after menopause so it is important to keep having Pap smears every two years, even after menopause.

Women with hysterectomy. Do you still need to have Pap smears?

Following a hysterectomy, women should discuss their ongoing need for cervical screening with their doctor. Women who have had a hysterectomy usually do not require further Pap smears. However, in some cases, Pap smears may still be needed.

Women who have had a total hysterectomy, that is, the uterus and cervix removed, and have ever had treatment for severe changes on the cervix, are recommended to continue to have smears taken from the upper vagina (known as vault smears). Women who have had a hysterectomy but have never had a Pap smear should also have a vault smear. Women who have had a partial hysterectomy, where the cervix is not removed, should still have a Pap smear every two years.

Many women do not know exactly what type of hysterectomy they had. If you are not sure, it is important to find out. If your doctor has no records of the operation, an internal examination or a cell sample may be needed.

Considerations

The Pap smear test is not 100% accurate. Cervical cancer may be missed in a small number of cases. Most of the time, cervical cancer develops very slowly and follow-up Pap smears should identify worrisome changes in time for treatment.

How is HPV diagnosed?

Each year, a lot of women are diagnosed with cervical cancer and also die because of it.

Yet cervical cancer is one of the most preventable cancers today. In most cases cervical cancer can be prevented through early detection and treatment of abnormal cell changes that occur in the cervix years before cervical cancer develops. We now know that these cell changes are caused by human papillomavirus, commonly known as HPV.

There are no blood tests for HPV, but some tests can help your health care provider diagnose the infection.

Pap test — During this test, the health care provider removes a sample of cells from the cervix. The cells are then examined under a microscope to look for any changes in the cells, even in the absence of genital warts.

Colposcopy — For this test, a health care provider uses an instrument — called a colposcope (like a microscope)— that shines a light and magnifies the view of the cervix. A vinegar solution is placed on the cervix. The solution turns abnormal cells that are infected with HPV white, so they can be more easily seen.

HPV DNA test — This test looks directly for the genetic material (DNA) of the HPV within a sample of cells. The test can detect the type of HPV connected to cervical cancer. The sample used for this test is generally removed at the same time as a Pap test.

Dr. Oz Answers Your HPV Questions

http://on.aol.com/video/dr--oz-talks-hpv-517505296

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HPV Vaccine Information

Two vaccines are available to prevent the human papillomavirus (HPV) types that cause most cervical cancers. These vaccines are bivalent vaccine (Cervarix) and quadrivalent vaccine (Gardasil). One of the HPV vaccines, Gardasil, also prevents HPV types that cause most genital warts. Gardasil also has been shown to prevent some cancers of the anus, vulva (area around the opening of the vagina), and vagina. Both vaccines are given in 3 shots over 6 months.

Why is the HPV vaccine important?

Genital HPV is a common virus that is passed from one person to another through direct skin-to-skin contact during sexual activity. Most sexually active people will get HPV at some time in their lives, though most will never even know it. HPV infection is most common in people in their late teens and early 20s. There are about 40 types of HPV that can infect the genital areas of men and women. Most HPV types cause no symptoms and go away on their own. But some types can cause cervical cancer in women and other less common cancers— like cancers of the anus, penis, vagina, and vulva and oropharynx (back of throat including base of tongue and tonsils). Other types of HPV can cause warts in the genital areas of men and women, called genital warts. Genital warts are not life-threatening. But they can cause emotional stress and their treatment can be very uncomfortable.

Which girls/women should receive HPV vaccination?

HPV vaccination is recommended with either vaccine for 11 and 12 year-old girls. It is also recommended for girls and women age 13 through 26 years of age who have not yet been vaccinated or completed the vaccine series; HPV vaccine can also be given to girls beginning at age 9 years.

Will sexually active females benefit from the vaccine?

Ideally females should get the vaccine before they become sexually active and exposed to HPV. Females who are sexually active may also benefit from vaccination, but they may get less benefit. This is because they may have already been exposed to one or more of the HPV types targeted by the vaccines. However, few sexually active young women are infected with all HPV types prevented by the vaccines, so most young women could still get protection by getting vaccinated.

Can pregnant women get the vaccine?

The vaccines are not recommended for pregnant women. Studies show that HPV vaccines do not cause problems for babies born to women who were vaccinated while pregnant, but more research is still needed. A pregnant woman should not get any doses of either HPV vaccine until her pregnancy is completed.

Getting the HPV vaccine when pregnant is not a reason to consider ending a pregnancy. If a woman realizes that she got one or more shots of an HPV vaccine while pregnant, she should do two things:

-         Wait until after her pregnancy to finish the remaining HPV vaccine doses.

-         Talk to your doctor.

Should girls and women be screened for cervical cancer before getting vaccinated?

Girls and women do not need to get an HPV test or Pap test to find out if they should get the vaccine. However it is important that women continue to be screened for cervical cancer, even after getting all 3 shots of either HPV vaccine. This is because neither vaccine protects against ALL types of cervical cancer.

How effective are the HPV Vaccines?

The vaccines target the HPV types that most commonly cause cervical cancer. One of the vaccines (Gardasil) also protects against the HPV types that cause most genital warts. Both vaccines are highly effective in preventing the targeted HPV types, as well as the most common health problems caused by them.

The vaccines are less effective in preventing HPV-related disease in young women who have already been exposed to one or more HPV types. That is because the vaccines prevent HPV before a person is exposed to it.  HPV vaccines do not treat existing HPV infections or HPV-associated diseases.

How long does vaccine protection last?

Research suggests that vaccine protection is long-lasting. Current studies have followed vaccinated individuals for six years, and show that there is no evidence of weakened protection over time.

What does the vaccine not protect against?

The vaccines do not protect against all HPV types— so they will not prevent all cases of cervical cancer. About 30% of cervical cancers will not be prevented by the vaccines, so it will be important for women to continue getting screened for cervical cancer (regular Pap tests). Also, the vaccines do not prevent other sexually transmitted infections (STIs). So it will still be important for sexually active persons to lower their risk for other STIs.

Will girls and women be protected against HPV and related diseases, even if they don’t get all 3 doses?

It is not yet known how much protection girls and women get from receiving only one or two doses of an HPV vaccine. So it is very important that girls and women get all 3 doses.

How safe are the HPV vaccines?

Both vaccines have been licensed by the Food and Drug Administration (FDA). The CDC has approved these vaccines as safe and effective. Both vaccines were studied in thousands of people around the world, and these studies showed no serious safety concerns. Side effects reported in these studies were mild, including pain where the shot was given, fever, dizziness, and nausea. Vaccine safety continues to be monitored by CDC and the FDA.

Fainting, which can occur after any medical procedure, has also been noted after HPV vaccination. Fainting after any vaccination is more common in adolescents. Because fainting can cause falls and injuries, adolescents and adults should be seated or lying down during HPV vaccination. Sitting or lying down for about 15 minutes after a vaccination can help prevent fainting and injuries.

Why is HPV vaccination only recommended for women through age 26?

HPV vaccination is not currently recommended for women over age 26 years. Clinical trials showed that, overall, HPV vaccination offered women limited or no protection against HPV-related diseases. For women over age 26 years, the best way to prevent cervical cancer is to get routine cervical cancer screening, as recommended.

What about vaccinating boys and men?

Gardasil was found to be safe and effective for males 9 -26 years. The vaccination series can be started beginning at age 9 years. Vaccination is recommended for males aged 13 through 21 years who have not already been vaccinated or who have not received all 3 doses. The vaccine is most effective when given at younger ages; males aged 22 through 26 years may be vaccinated.

Is HPV vaccine covered by insurance plans?

Most health insurance plans cover the cost of vaccines, but you may want to check with your insurance provider before going to the doctor. If you don't have insurance, or if it does not cover vaccines, the Vaccines for Children (VFC) program may be able to help.

What vaccinated girls/women need to know: will girls/women who have been vaccinated still need cervical cancer screening?

Yes, vaccinated women will still need regular cervical cancer screening (Pap tests) because the vaccines protect against most but not all HPV types that cause cervical cancer. Also, women who got the vaccine after becoming sexually active may not get the full benefit of the vaccine if they had already been exposed to HPV.

Are there other ways to prevent cervical cancer?

Regular cervical cancer screening and follow-up can prevent most cases of cervical cancer. The Pap test can detect cell changes in the cervix before they turn into cancer. Pap tests can also detect most, but not all, cervical cancers at an early, treatable stage. Most women diagnosed with cervical cancer in the U.S. have either never had a Pap test, or have not had a Pap test in the last 5 years. There are HPV tests that can tell if a woman has HPV on her cervix, but the HPV tests on the market should only be used to help screen women at certain ages and to help health care providers assess women with certain Pap test findings for cervical cancer. These tests can be used with the Pap test to help determine next steps in cervical cancer screening.

Are there other ways to prevent HPV?

For those who are sexually active, condoms may lower the chances of getting HPV, if used with every sex act, from start to finish. Condoms may also lower the risk of developing HPV-related diseases (genital warts and cervical cancer). But HPV can infect areas that are not covered by a condom—so condoms may not fully protect against HPV.

People can also lower their chances of getting HPV by being in a faithful relationship with one partner; limiting their number of sex partners; and choosing a partner who has had no or few prior sex partners. But even people with only one lifetime sex partner can get HPV. And it may not be possible to determine if a partner who has been sexually active in the past is currently infected. That's why the only sure way to prevent HPV is to avoid all sexual activity.

How can people prevent HPV?

There are several ways that people can lower their chances of getting HPV:

Vaccines can protect males and females against some of the most common types of HPV that can lead to disease and cancer. These vaccines are given in three shots. It is important to get all three doses to get the best protection. The vaccines are most effective when given at 11 or 12 years of age.

Girls and women: Two vaccines (Cervarix and Gardasil) are available to protect females against the types of HPV that cause most cervical cancers. One of these vaccines (Gardasil) also protects against most genital warts. Gardasil has also been shown to protect against anal, vaginal and vulvar cancers. Either vaccine is recommended for 11 and 12 year-old girls, and for females 13 through 26 years of age, who did not get any or all of the shots when they were younger. These vaccines can also be given to girls beginning at 9 years of age. It is recommended to get the same vaccine brand for all three doses, whenever possible.

Boys and men: One available vaccine (Gardasil) protects males against most genital warts and anal cancers. Gardasil is recommended for 11 and 12 year-old boys, and for males 13 through 26 years of age, who did not get any or all of the shots when they were younger.

Reducing the risk of HPV infection

The human Papillomavirus (HPV) is nicknamed "the common cold of STDs" because if you're a sexually active adult, you've probably contracted several of the 100 different types out there—more than 30 of which are sexually transmitted—and you probably had no idea. Therefore, if you are sexually active it may be difficult to avoid becoming infected with HPV.

As most high-risk HPVs don't cause symptoms, it can be impossible to tell whether your partner is infected. Using condoms and other barrier methods of contraception can help reduce the risk of becoming infected. But they don't cover all of the skin and are therefore not completely effective. A person with genital warts should not have sex until the warts are removed. This might help reduce the risk of spreading HPV. The best prevention available, other than abstinence, is believed to be the HPV vaccine.

You're more likely to become infected with HPV if you start having sex at a younger age and if you have a lot of sexual partners, especially if you’re having sex without using a barrier method of contraception. People can also lower their chances of getting HPV by being in a faithful relationship with one partner; limiting their number of sex partners; and choosing a partner who has had no or few prior sex partners. But even people with only one lifetime sex partner can get HPV. And it may not be possible to determine if a partner who has been sexually active in the past is currently infected. That's why the only sure way to prevent HPV is to avoid all sexual activity.

HPV infection may be more likely if there are abrasions or small cuts and tears in the skin or mucosa. Abrasions and tears are more likely to occur during anal sex, or if the vagina is drier than normal (for example following the menopause). In these situations it can help to use a lubricant during sex.

As HPV infection is common (and difficult to prevent), it's important for people to be alert to any changes in the parts of the body where we know HPV may cause cancer. Cancer diagnosed in the very early stages, before it has begun to spread, is much easier to treat and cure. It's important that women have regular cervical smear tests, as these can pick up changes in the cervix at a very early stage. Women should also have regular pelvic exams to look for abnormal changes in the cervix that might be pre-cancer.

There is some evidence to suggest that people who smoke and have HPV are more likely to develop cell changes that can lead to cancer than non-smokers who have HPV. If you know you have HPV, or even if you don’t know, stopping smoking may help to boost your immune system.

How is HPV spread

There are around 40 different types of HPV that can affect the anogenital area (the cervix, vulva, anal area and penis). HPV is spread through skin contact, often during sex. Exactly how a person gets the virus is uncertain, and it's not always possible to find a sexual cause. It's thought there may be other ways of spreading the virus that have not yet been identified.

HPV can affect both men and women and because the virus is very common, most people who are sexually active will have HPV at some time during their life. Many people don’t have any symptoms and are unaware that they have HPV. The virus may be inactive for weeks, months, and - for some people - possibly even years after infection. The body’s immune system is usually able to get rid of an HPV infection, and for most people infections come and go without causing any problems.

Although HPV can increase the risk of developing some types of cancer, most people who have HPV won't develop cancer.

HPV can also be spread through oral sex. The chance of getting HPV rises with certain risk factors:

*    Number of lifetime sexual partners (risk increases with more partners)

*   Young age: Women aged 20 to 24 are most likely to be infected, but they usually clear the HPV infection with no problems.

*   Women who are sexually active with men who have other partners at the same time

Who can get HPV?

Any man or woman who has ever had sex can get HPV. The virus is spread through sex.

Condoms do not completely protect you from HPV, but are very helpful in protecting you from other infections that can be spread through sex.