Following on from my previous post about Gardasil for guys we’re heading back to the heartland of women’s health: the Pap smear.
I’m sure this is a subject as near and dear to your heart (well, perhaps a little lower) as it is to mine, and after our recent focus on Human Papillomavirus it is definitely worth a deeper look (no pun intended).
So here it is… the Ins and Outs of Pap smears.
What is a pap smear?
A Papanicolaou or ‘Pap’ smear is a sample of cells collected from the cervix with a specially-designed brush and then mounted on a microscope slide to look for abnormalities.
The cervix is located using a duck-billed device called a speculum to open and support the vagina. Within the cervix is an area where the surface cells gradually transition from inside-type (glandular) cells to outside-type (squamous) skin cells, an area known as the ‘transition zone’ for obvious reasons. In this region the cells are more likely to undergo unwanted changes called metaplasia.
Thanks to recent research breakthroughs, we now know that cervical metaplasia is triggered by infection with certain types of Human Papillomvirus (HPV), information which has led to the development of vaccines against many cervical and other cancers.
Why do we need one?
By identifying cervical metaplasia early we can easily treat the effected cells before they turn into a cancer. This is why they are done regularly; every two years if your tests are normal or sometimes sooner if early changes are spotted.
When do I have to start getting them? (And when can I stop?)
Ideally, you should have your first pap about two years after your first penetrative sexual experience (which is not limited to penetration by a penis!) but smears are not usually done on girls under the age of 18.
Current Australian guidelines recommend pap smears every two years until the age of 70.
I’ve had the cervical cancer vaccine… do I still need them?
Sadly, yes. Whilst Gardasil reduces the risk of cervical cancer by a whopping 70% in women vaccinated before their sexual debut this still leaves a 30% residual risk ongoing.
Low risk is not the same as no risk, so until we have a vaccine against all the HPV types responsible for cervical cancer, given to all women, the pap smear will remain an important part of our screening regimen.
Meanwhile… has your daughter had all three shots? (Sorry, had to slip that in!)
I’ve only ever had female partners… do I need paps?
Again, sadly yes. HPV is transmitted between partners by intimate sexual contact, so if you’ve had penetrative sex involving another person (including penetration by fingers, toys or other penis facsimiles) then you’ve potentially been exposed and need to have regular paps.
What happens if my smear is “abnormal”?
Better Health Channel has an excellent fact sheet outlining the different types of pap abnormalities.
We know that the vast majority of minor abnormalities will return to normal as the body’s immune system suppresses and eradicates the HPV. That is why your doctor may simply advise a repeat smear in 6 to 12 months initially to confirm that the abnormality has gone.
For more advanced changes, or changes which persist over several smears, you would normally be referred for a colposcopy. This is a special microscope used by a doctor to identify visual characteristics of more significant cervical abnormalities, and if necessary they can take tissue samples (biopsies) for examination by pathologists in a lab.
[box] Pap tips
Know your pap history and keep details or copies of abnormal results; it’s unlikely that you’ll have all your paps done by the same doctor over your lifetime.
Relax! It sounds impossible, relaxing while someone’s poking about “down there”, but if your pelvic floor is relaxed it will definitely boost the comfort rating.
Avoid clenching your buttocks or lifting your pelvis off the bed. Try focusing on your breath with techniques like this one.
Find a clinician you’re happy with, which may be a nurse, doctor or other trained health professional. The important thing is feeling comfortable and trusting in their expertise.[/box]
[author] [author_image timthumb='on']http://www.hercanberra.com.au/wordpress/wp-content/uploads/2011/11/kelly.jpg[/author_image] [author_info]Dr Kelly Teagle lives in Canberra with her daughter Bella (5) and son Alex (2). She graduated from UQ Med School in 2001, is a Fellow of the Royal Australian College of General Practitioners and holds postgraduate qualifications in Women’s Health. Dr Teagle is the Principal of WellFemme Women’s Health Services; for private consultations phone the Annie Lim Group Family Practice in Deakin on 6162 0463 or Sexual Health and Family Planning ACT (SHPACT) on 6247 3077. You can email Kelly at firstname.lastname@example.org. Watch this space for the WellFemme website and Facebook page coming soon![/author_info] [/author]
Dr Kelly Teagle lives in Canberra with her daughter Bella and son Alex. She graduated from UQ Med School in 2001, is a Fellow of the Royal Australian College of General Practitioners and holds postgraduate qualifications in Women’s Health. For private consultations phone the Annie Lim Group Family Practice in Deakin on 6162 0463 or Sexual Health and Family Planning ACT (SHPACT) on 6247 3077. You can email Kelly at email@example.com.View all Kelly Teagle posts.