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Evaluation of Abnormal Pap Smears

What is a Pap Smear and why should I have one?

A Papanicolaou Test (pap smear) is a test of a sample of cells taken from your cervix that are examined under a microscope.  It is a way to find abnormal (pre-cancerous) cells on your cervix before they grow into a cervical cancer.  This is very important for you because pre-cancerous cells can be easily treated to prevent cervical cancer. You won’t know the abnormal cells are there if you don’t get a pap smear, so a pap smear could literally save your life.

When should I get a Pap Smear?

In general most women should have a pap smear done starting at age 21 and then every 3 years after that if it is normal.  Starting at age 30 a pap smear can be done with high risk human papilloma virus (HPV) cotesting every 5 years. The pap smear with HPV cotesting is less likely to miss abnormal cells (lower false negative rate) than the pap smear alone.  HPV cotesting is not recommended before age 30. These schedules are general recommendations and will be fine tuned by your provider to your specific medical history.

What is HPV?

Human papilloma virus is a very common virus that is sexually transmitted. There are many different types of the HPV virus and some of the high risk types can cause health problems such as abnormal (pre-cancerous) cells on the cervix.  Please click HERE for more information on HPV and the HPV vaccine.

How is a Pap Smear collected?

Your provider will collect a pap smear at the time of your yearly gyn visit according to the guidelines above.  They will place a speculum into your vagina to look at your cervix and then use a brush gently to swab cells off the cervix. These cells are then placed into a vial with liquid and sent off to the lab for evaluation.

What if my Pap Smear result is abnormal?

If your pap smear result is abnormal your provider may ask you to come back into the office for further evaluation with a procedure called a colposcopy.  A colposcopy means looking at your cervix with a microscope. During a colposcopy your doctor will look at your cervix and swab different solutions on your cervix (dilute acetic acid/vinegar and/or a dark brown iodine solution called lugols).  If any abnormal areas are seen on your cervix then a small piece of tissue (biopsy) is taken from the cervix. This can feel like a strong pinch.  A sample of tissue from inside the cervix (endocervical curettage ) may also be collected by performing a gentle scraping inside the cervix.  This can cause mild menstrual type cramping. Most women do very well during a colposcopy exam and have only mild discomfort during the actual procedure.  Sometimes we will have you take ibuprofen or Tylenol before your colposcopy.

What if my biopsy results are abnormal?

If you have a biopsy or endocervical sample taken from your cervix during colposcopy you should receive the results in about 7 days.  If the result is abnormal (pre-cancer cells present) then your provider may recommend more frequent follow up pap smear testing or further treatment.  Depending on how abnormal the cells are you may be recommended to have further treatment with a Loop Electrosurgical Excision Procedure (LEEP). A LEEP is a treatment for abnormal cells on the cervix that removes the abnormal tissue by using a wire loop heated by electricity to cut the tissue away.   This procedure is usually done right in our office using local anesthetic injected into the cervix.  Most women have minimal discomfort with the LEEP and do well.  The tissue that is removed during a LEEP is sent to the pathology lab for examination. Your provider will call you with the results and a follow up plan.