What is a Pap smear and how often do I need one?

By Pamela Schwedler, N.P., M.S.N., NP-C, R.N., R.N.C.
Hallmark Health Medical Associates

To perform a Pap smear, care providers use a medical instrument called a speculum. Some woman refer to it as “the duck,” because its appearance resembles duck bills.

Let’s be honest. Few women get excited about a Pap smear or pelvic exam.

There’s fear about whether it will hurt, and what if they find something abnormal?

As a nurse practitioner, I know how important these tests are and why they are necessary. Both tests can allow us to catch cancer and other diseases before they worsen or spread.

Now there’s good news for women who dread these appointments. While it’s still important to have an annual pelvic exam, the latest guidelines may not require you to have a Pap smear every year.

What is a Pap smear?

First of all, a Pap smear is not the same as a pelvic exam. A pelvic exam is a checkup of your reproductive parts, both internally and externally. We perform pelvic exams to look for specific illnesses and check on the health of your female organs.

A Pap smear is a screening test for cervical cancer. We collect cells outside the cervix, and then we have them examined. This test is often done as part of a pelvic exam.

To perform a Pap smear, we use a medical instrument called a speculum. Some people call it the duck, because it looks kind of like duck bills. The speculum, once inserted into the vagina, allows me to see the cervix.

The speculum is more uncomfortable than painful for most women, but if you’re really nervous, your muscles can tighten up, making it even less comfortable. Talk to your provider if you’re apprehensive about the speculum or any of the items we use during your pelvic exam.

Once I can see the cervix, I use a little brush (which looks like a mascara brush) to swab the outside of the cervix and collect cells. This will feel like a little tickle or a gentle scratch – again, more uncomfortable than painful. The process of collecting the cell sample takes just a few minutes.

We’ll put the cell sample into a solution and send it off to a lab where a pathologist will look at it under a microscope. The pathologist looks for changes to the cells which could turn into cervical cancer. Usually we have results from the pathologist back in a few days.

How often do I need a Pap smear?

The most recent cervical cancer screening guidelines changed the recommendation for when women should get their first Pap smear, and how often they’re needed.

• When should I get my first Pap smear? Age 21
• How often do I need a Pap smear?
  • Women between 21 and 29 years old: Every three years after a normal Pap smear.
  • Women between 30 and 65 years old: Every five years after a normal Pap smear and a normal human papillomavirus (HPV).

Pap smears are no longer required for women who are over age 65 or who have had a hysterectomy for benign reasons.

New research prompted changes to the guidelines. Science has shown that it takes a long time for cells to go from healthy and normal to really bad, so it’s not necessary to have a Pap smear every year. If your cells are healthy right now, you’re most likely not going to have cervical cancer in three years. But you may have some atypical cells by that time, and that’s why we’ll want to screen again, just in case.

Most women celebrate when I tell them about the new guidelines. You’re not off the hook completely, though. We still recommend a pelvic exam every year to look for other problems like ovarian cancer, uterine cancer, or sexually transmitted diseases.

The connection between cervical cancer and HPV

We know through research that nearly every case of cervical cancer is caused by HPV infection. There are more than 150 strains of HPV, but researchers have identified two types of HPV that are responsible for 70 percent of all cases of cervical cancer. A vaccine is now available to preteens and teens to help prevent the most dangerous strains of HPV.

Most people have been exposed to HPV at some point in their lives. Your immune system usually helps you get rid of the virus within a couple years, but in some people, the virus remains and damages cells.

Ninety percent of HPV infections affect women when they are between 21 and 24 years old. That’s why we refer to cervical cancer as “a young woman’s cancer.” It’s unique in this respect – with other common cancers like ovarian cancer and breast cancer, your risk increases as you get older.

The cervical cancer screening guidelines reflect this. We test women more often when they are in that prime age group for HPV exposure. Then, when they turn 30, we start screening for HPV. If your HPV test comes back negative and your Pap smear is normal, you don’t need another test for five years.

A Pap smear can save you from cervical cancer

A Pap smear doesn’t test for all diseases, but it has been proven effective to lower your risk of developing cervical cancer. I understand, it’s not fun when I’m “down there,” but it only takes a few minutes, and if the results are normal, you’ll have some extra peace of mind.

One of our biggest issues is when women have babies but then don’t come back in for a Pap test or pelvic exam for 20 years. You feel fine. You’re busy. You’re working – I get it. Still, it’s important to get screened periodically. It could save your life.

If you’re due for Pap smear, or you’d like to learn more about lowering your risk for cervical cancer, schedule an appointment online with one of our OB/GYNs or call 855-446-2362.