Pap smear: Screening test for cervical cancer
Pap smear: Screening test for cervical cancer
Learn how a Pap smear is done and what abnormal Pap smear results mean.
A Pap smear, also called a Pap test, is a procedure to test for cervical cancer in women. A Pap smear involves collecting cells from your cervix — the lower, narrow end of your uterus.
Detecting cervical cancer early with a Pap smear gives you a greater chance at a cure, should cervical cancer be detected. A Pap smear can also detect changes in your cervical cells that suggest cancer may develop in the future. Detecting these cells early with a Pap smear is your first step in halting the possible development of cervical cancer.
Why it's done
A Pap smear is typically done in conjunction with a pelvic examination — a procedure that allows your doctor to examine your external genitals, vagina, uterus, ovaries and rectum. Although pelvic examinations can screen for reproductive problems or abnormalities, only a Pap smear will detect early cervical cancer or precancers.
Who should have a Pap smear?
After age 21, the groups' guidelines differ slightly because each takes different factors into consideration. Here's a look at Pap smear guidelines from the American Cancer Society (ACS), the American College of Obstetricians and Gynecologists (ACOG) and the U.S. Preventive Services Task Force (USPSTF):
If you have certain risk factors you should undergo a Pap smear annually, regardless of your age. These risk factors include:
Who can consider stopping Pap smears?
A Pap smear is a safe way to screen for cervical cancer. However, a Pap smear isn't foolproof. It's possible to receive false-negative results — meaning that the test indicates no abnormality, even though you do have abnormal cells.
Estimates for the occurrence of false-negative results with a conventional Pap smear vary widely but are at least 5 percent — or one in every 20 women. The liquid-based Pap test, in which the sample of cells is preserved in liquid rather than smeared on a microscope slide, provides fewer false-negative results. With either test, false-positive results — when the test indicates an abnormality when there really isn't one — are extremely rare.
A false-negative result doesn't mean that a mistake was made. Many factors can cause a false-negative result, including:
Although it's possible for abnormal cells to go undetected, time is on your side. Cervical cancer takes several years to develop. And if one test doesn't detect the abnormal cells, the next test most likely will.
How you prepare
To ensure that your Pap smear is most effective, follow these tips prior to your test:
What you can expect
During the Pap smear
You'll lie down on your back on an exam table with your knees bent. Your heels rest in supports called stirrups.
Your doctor will gently insert an instrument called a speculum into your vagina. The speculum holds the walls of the vagina apart so that your doctor can easily see your cervix. Inserting the speculum may cause sensation of pressure in your pelvic area. Sometimes the speculum feels cold when it's first inserted.
Then your doctor will take samples of your cervical cells using a soft brush and a flat scraping device called a spatula. This doesn't hurt and you may not even feel the sample being taken.
After the Pap smear
Depending on the type of Pap test you're undergoing, your doctor transfers the cell sample collected from your cervix onto a glass slide or into a container holding a special liquid to preserve the sample (liquid-based Pap test).
The samples are transferred to a laboratory where a cytotechnologist — a person trained to detect abnormal cells — will examine the sample. These technicians work in cooperation with a pathologist — a doctor who specializes in cellular abnormalities. The pathologist is responsible for the final diagnosis.
Ask your doctor about when you can expect the results of your Pap smear. In some cases, your doctor will only contact you if something of concern is found or if it's determined that you need further testing.
Female reproductive system
The narrow neck of the uterus is called the cervix. This is where cervical cancer may develop.
During a pelvic exam, your doctor uses a speculum to hold your vaginal walls apart. If your pelvic exam also includes a Pap test, your doctor collects a sample of cells from your cervix, using a small cone-shaped brush and a small plastic spatula (1 and 2). Your doctor then transfers the cells onto a glass slide (3) for examination under a microscope. Or your doctor may rinse the brush in a liquid-filled vial (4) and send the vial to a laboratory for testing.
Normal and abnormal cervical cells
The slide on the left shows normal cervical cells magnified by a microscope. Normal cells are uniform in size and shape. By comparison, the slide on the right shows irregular, disfigured cervical cells — typical of cervical cancer.
The Pap smear can alert your doctor of suspicious cells that need further testing.
Here are some terms your doctor might use and what your next course of action might be:
If your Pap smear is abnormal, your doctor may perform a procedure called colposcopy using a special magnifying instrument (colposcope) to examine the tissues of the cervix, vagina and vulva. He or she may take a tissue sample (biopsy) from any areas that appear abnormal. The tissue sample is then sent to a laboratory for analysis and a definitive diagnosis.
Depression, heart disease and erectile dysfunction
There's mounting evidence that depression is associated with an increased chance of having heart problems — and erectile dysfunction. Work with your doctor to make sure you're getting the right treatment if you're feeling down. Treatment can help alleviate erectile dysfunction and may prevent heart problems.
Depression is treated with counseling and medications. Although treating depression can help with erectile dysfunction, some antidepressants have sexual side effects. If you do have bothersome sexual side effects, you may need to try another antidepressant. Your doctor can also decrease the dose or add another medication to offset the effects of the antidepressant on erectile dysfunction.
Atherosclerosis: Where erectile dysfunction and heart disease meet
Atherosclerosis, a buildup of plaques in arteries, can prevent enough blood flow from reaching your heart, legs and brain — and your penis. If atherosclerosis has made your arteries in one part of your body narrow and stiff, arteries elsewhere in your body are probably also affected. When atherosclerosis affects blood flow to your penis, the blood can't sufficiently fill the penis to allow a suitable erection.
The same factors that raise your risk of atherosclerosis in the arteries in your penis also increase your chances of heart disease. Because the arteries supplying your penis are smaller than the ones to your heart, symptoms may first show up as erectile dysfunction. If you haven't been diagnosed with heart problems, consider erectile dysfunction a wake-up call. It could be a warning sign that the blood vessels feeding your heart might also be in trouble.
Medications and erectile dysfunction
Some medications that treat heart disease can make you more likely to develop erectile dysfunction. These include:
Although you can't stop taking your medications, there may be other drug options that are less likely to cause erectile dysfunction. Discuss your symptoms and potential options with your doctor.
Anxiety: The worry of heart disease and sex
Men who've had a heart attack or surgery to treat their heart disease are often anxious about resuming an active sex life. However, intercourse seldom causes heart attacks. Sexual activity with your usual partner in a familiar setting doesn't lead to a particularly high blood pressure level or heart rate. Even if you're at high risk of having a heart attack, weekly sexual activity only slightly raises the risk. Talk to your doctor about when you can resume sexual activity after you've had heart problems or surgery.
Is your erectile dysfunction linked to heart disease?
Seeing your doctor for erectile dysfunction may have a silver lining. It could be a tip-off that you have underlying health problems linked to heart disease that need to be checked out and treated. If your doctor thinks you may be at risk for heart disease, making simple lifestyle changes may be enough to help keep your heart healthy — and improve your ability to have an erection. If you have more serious signs and symptoms of heart disease, you may further tests or treatments.
Last Updated: 04/17/2008
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