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What Exactly is a Pap Smear Checking For?

As gynecologists, we help our patients through some very personal experiences: the dreaded pelvic exam, birth control, miscarriage, pregnancy, menopause, sexually transmitted infections, and so on. Discussing your cholesterol with a stranger just isn’t the same as discussing a first pregnancy or starting birth control. It is a very special part of our job. The pap is something I talk about everyday. Most women understand that they need to “get a pap to get checked down there.” But what exactly is a pap checking for? And why do you have to keep getting them?

The pap is a screening test for cervical cancer. The cervix is at the top of your vagina, and it is part of the outer uterus. We use a small brush (imagine a small toothbrush) to collect some cells from your cervix. It goes to a lab, and a specialist looks at your cells under a microscope. If the cells look abnormal, we do more tests because we are trying to prevent or detect the worse case scenario – cancer. But most times the result is simply normal or abnormal cells, which isn’t as serious but still very important. These abnormal cells can persist and ultimately develop into cancer. We can surgically remove these abnormal cells to help prevent cervical cancer. This is the gist of the pap test, and this part is fairly clear to most women.

Explaining the role of HPV testing casts a fog on all of the above, and this is usually the turning point in the discussion. Recent research has linked the human papilloma virus (HPV) to cervical cancer. We now know that certain types of this virus is what causes the abnormal cells found on paps. More importantly, the HPV virus also causes most types of cervical cancer. This is very important for two reasons: the HPV test effects the way paps are managed by health care providers and it also stresses the importance of the HPV vaccine.

But before I can even answer why it is so important for the patient’s future, I am often confronted with a question regarding the patient’s past. How did I get this virus? The virus is passed from one person to another during sexual contact, i.e. genital skin-to-skin contact. This type of contact can include vaginal, anal and oral sex. This virus is so prevalent that if you have ever had sex, the chances of having this virus is over 80% for your lifetime. In contrast, less than 10% of American women have chlamydia per year. HPV is the most common sexually transmitted infection. It’s like “the common cold” of sexual activity. Almost everyone you know has had the common cold right? The kicker about HPV is that it is a completely asymptomatic infection; there are no sniffles or sore throat, no discharge or pain. This means you will never know who gave it to you (because almost everyone has had it!). That part is not important, so it is not worth interrogating your partner over it.

It can overstay its welcome, and hang around for years. You may have gotten it on prom night five years ago, or you may have picked it up from your fiancé. And unfortunately there is no treatment for it. No pills, no shot. We just have to wait for the body to naturally clear the infection, which it usually does in about 90% of young people within two years of acquiring the infection.

But all of this, while important, is a bit irrelevant to what we are going to do about your abnormal pap smear. That’s our job, to figure out what to do next. Your job? With regards to HPV and your pap smears, here are the take home points:

  • Don’t stress about a positive HPV test. There is no treatment for it, and unlike an acute gonorrhea infection, it doesn’t mean that you or your current partner have been unfaithful.
  • Most women who have or have had HPV do not actually develop cervical cancer. But most women who have cervical cancer have the HPV virus.
  • Stop smoking. Smoking is like a power bar for the HPV virus, it helps it grow, which is not what we want.
  • Use condoms, but remember that a condom does not cover the entire genital area, and HPV can still be transmitted through contact of the exposed skin.
  • Keep your follow-up appointments with us. Even if your abnormal cells are not severe enough to warrant a surgical procedure to remove them today, the cells may become more abnormal in 6 months, or they may be completely normal next year. And wouldn’t that be a relief?
  • If you are under the age of 26, get the Gardasil vaccine. It’s a vaccine that can prevent a cancer. How fascinating and amazing is that!