A Pap smear is a screening test for cervical cancer.  It is performed by placing a speculum into the vagina and using a small spatula or brush to collect a sample of cells from the cervix. These cells are sent to a pathologist to be examined under a microscope to determine if they are normal or abnormal. Cells become abnormal if they are infected by the human papilloma virus (HPV). Results typically take a week to obtain. 

Pap smear screening begins at the age of 21 and continues throughout a woman’s life until the age of 65.  Subsequent testing is dependent on the results of the last Pap smear or if you have certain risk factors. Between the ages of 21 and 29, only the cells are evaluated.  Starting at the age of 30, the Pap smear may be combined with a test for HPV.  Regardless of your need for a Pap smear, yearly pelvic examinations are still recommended at your annual wellness visit. 

After a total hysterectomy (surgical removal of the uterus and cervix) Pap smears are no longer needed as long as the reason for the hysterectomy was for benign (non-cancerous) conditions.  If your hysterectomy was for a precancerous or cancerous condition of the cervix, continued Pap smears are recommended.  Women can stop routine Pap smears at age 65 if their previous tests for cervical cancer have been negative.

Human papilloma virus (HPV) is a virus that is transmitted through vaginal, anal, or oral sex.  It is the most common sexually transmitted infection in the world.  More than 80% of women will be exposed to HPV at some point in their lifetime.

There are over 100 strains of HPV.  People can be infected with more than one type of HPV at the same time.  The virus generally causes no visible change and is usually eliminated by the immune system.  

HPV which infects the genital region are grouped into low risk and high risk types. Low risk HPV strains typically cause condyloma (genital warts). Genital warts are not at risk of becoming cancer and these low risk strains are usually cleared by the immune system.  High risk HPV strains are more difficult for the immune system to clear, resulting a longer-lasting infection. While infected, high risk HPV can cause the cells on your cervix to become abnormal and possibly progress into cervical cancer over time.

There is currently no treatment for HPV.  Most HPV infections are cleared naturally by your body’s immune system in 1-2 years.  In some individuals, after the infection has been cleared, HPV lays dormant in the body and returns later in life. After the immune systems clears an HPV infection, a person usually develops immunity to that strain.  Vaccination with the HPV vaccine prior to becoming sexually active provides the best chance of preventing HPV infection. 

If you have an abnormal Pap smear or HPV positive result, your provider will contact you to discuss the next step. Management depends on your age, the type of abnormal cells found on your cervix, and your HPV status.  Most commonly your provider will either recommend a repeat Pap smear in 1 year or recommend proceeding with a colposcopy.

A colposcopy is an in-office procedure in which the cervix is examined with the use of a special microscope called a colposcope.  The goal of a colposcopy is to identify any abnormalities of the cervix, vagina, or vulva. 

The procedure starts by placing a speculum into the vagina to visualize the cervix.  A solution is then sprayed onto the cervix to highlight abnormal cells. Your physician will then use the colposcope to view the cells of the cervix under magnification. If necessary, your physician may take a tissue sample from any area that appears abnormal. Local anesthetic spray can be used to prevent any cramping or discomfort which might otherwise occur. Your physician will then apply silver nitrate or liquid ferric subsulfate to stop/prevent any bleeding from occurring. 

A colposcopy usually lasts about 5 to 10 minutes. The tissue sample is sent to a pathologist for analysis and a definitive diagnosis. Results are typically available in a week.

It is not possible to know when a person acquired an HPV infection.  Women who test positive for HPV could have recently become infected by a new or current partner or could be positive from a persistent infection which was dormant and became reactivated. A positive result can also occur after clearing the HPV virus and can represent exposure to a new strain of HPV which a woman did not have before.  

Possibly.  Most people have HPV at some point and never know that the virus was present in their genital cells.   If a person has genital warts caused by HPV, there is an elevated risk of infecting a partner until the warts are cleared.  

Men do not require screening for cancer prevention because their genital skin cells rarely become cancerous when infected with HPV.  If significant abnormal change does develop, it is visible to the naked eye as an area of white, red, or pigmented change and they should see their primary physician.

While HPV is common, cervical cancer is extremely rare and can be prevented.  Abnormal cells are graded as mild, moderate or severe.  If high risk HPV is found during your screening, you will be followed carefully for as long as the virus remains. In a majority of cases, the virus will eventually be cleared by your immune system. If necessary, persistent or severely abnormal cells can be treated to prevent them from becoming cancer cells.