Who needs a Pap smear?
All women who have ever had sex or skin-to-skin genital contact are recommended to have Pap smears. Even HPV-vaccinated women need to have regular cervical screenings as the vaccine does not protect against all HPV strains which may cause cancer.
Women aged 18-69 are eligible to take part in the National Cervical Screening Program which provides Pap smears for cervical screening every 2 years. Pap tests are not recommended before the age of 18, and from the age of 70 your health care professional may advise that it is safe for you to stop having Pap tests providing that you have had 2 normal screens within the last 5 years.
From the 1st December 2017 changes are being made to the National Cervical Screening Program. These changes include increasing the age of first screening from 18 to 25 years, increasing the time between tests from 2 years to 5 years and replacing the Pap smear with a more accurate Cervical Screening Test which will also detect HPV infection.
What happens during a Pap smear?
During a Pap smear, the doctor inserts a speculum to open the vaginal canal and view the cervix. A swab is used to collect cells from the transformation zone (where the outer squamous cervical cells meet the inner glandular cervical cells) at the surface of the cervix. These cells are then sent to the laboratory for testing.
I'm scared it will hurt
Pap tests are very quick and are not painful, although there may be a little discomfort. Many women avoid Pap smears due to embarrassment, however they are an essential defence against cervical cancer. It is estimated that regular cervical screening saves over 1200 Australian women from cervical cancer each year, whereas approximately three out of four women who develop cervical cancer have either never had a cervical screening test or else have not had one within the last 5 years.
What do the results mean?
Although the majority of Pap smear results are normal, approximately 10% show changes in the cells of the cervix.
There are 3 main types of abnormalities:
1) Low-grade abnormalities
- Cervical cell changes are present due to minor inflammation caused by an acute infection with HPV.
- Most women with low-grade abnormalities are usually asked to return for a repeat Pap smear in 12 months to ensure that HPV has been cleared by the body, or to be referred for further tests.
2) High-grade abnormalities
- Cervical cells appear abnormal and have undergone greater changes, likely due to a persistent HPV infection. These cells are rarely cancer but need to be investigated further to prevent progression.
- Women with high-grade abnormalities are referred to a specialist for a colposcopy.
3) Glandular abnormalities
- There abnormalities are located in the cells at the top part of the cervix leading to the uterus/womb. These changes are difficult to monitor by Pap smear alone, therefore all women with glandular abnormalities are referred to a specialist for a colposcopy.
- These changes are usually not cancer, however finding these abnormalities allows them to be treated earlier and more easily before the possible progression to cervical cancer.
What happens next?
Following a diagnosis of cervical cell changes, you may require further tests, and be referred to a specialist who will discuss your treatment options with you.
Colposcopy
If you have been diagnosed with high-grade or glandular abnormalities it is likely that you will be referred for a colposcopy. A colposcopy helps identify where abnormal cells are and what they look like. During a colposcopy the doctor will insert a speculum to open the vaginal canal, and then use a colposcope (similar to a pair of binoculars on a stand) to see a magnified picture of your cervix, vagina and vulva. If the colposcope is fitted with a camera you may be able to view the procedure yourself on a screen. The doctor may also coat your vagina and cervix with a fluid to highlight any abnormal areas. A colposcopy is not painful, but you may experience 10-15 minutes of mild discomfort during the procedure.
Biopsy
During a colposcopy it is likely that the doctor will also take a small tissue biopsy (sample) to be examined under a microscope in the laboratory. This may feel like a sharp pinch and you may feel some discomfort or pain similar to menstrual cramping for a short time after the biopsy. It is possible that there will be some bleeding or vaginal discharge for a few hours following the procedure, and the doctor will advise you to avoid sexual intercourse or using tampons for 2-3 days to allow healing and reduce the chance of infection.
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