PAP TEST

• Having a pap test is often said to be the worst experience, associated with a whole lot of discomfort, a bunch of strange, threatening instruments and you lying in a vulnerable position feeling terribly embarrassed.
  
• Somewhere in the mix there is a wonderful woman, with a cervix connected to her mind and soul, and there is a doctor and a nurse.
  
• At Meridia Gynecology, we promise you that you will never have a bad experience due to lack of caring or rushed time.
  
• We know how important this examination is to you and we aim to make it as easy and comfortable as possible. Your gynaecological examination (see the info about Gyne exams) will be informative and interactive with you always in control.

The Pap test

A pap test is a sample of cells rubbed off your cervix and tested for abnormal changes that can be treated before they become cancerous in the future.

How often do I need to have a pap test?

• At Meridia Gynecology, we recommend a pap test from the time you become sexually active or from 21 years old, whichever is first.
  
• After that, a pap test every year for 3 years.
  
• If these first 3 pap tests are normal, then you need a pap test every second year.
  
• If you ever have an abnormal pap test, once treated, you need a pap test once a year until you are 70.
  
• There are exceptions and sometimes we need to do pap tests more often.
  
• There are many guidelines (see:
  http://www.cancercare.on.ca/pdf/pebc_cervical_screen.pdf and
  http://www.acog.org/from_home/publications/press_releases/nr07-31-03-1.cfm )
  

• This is an image of the uterus, or the womb.
  
• The cervix is the bottom of the uterus.
  
• It is small and round with an opening in the middle. The cervix is located at the top of the vagina.
  
• If you insert your middle finger into your vagina and feel the very top of your vagina, you will feel your cervix. It feels like the tip of your nose – smooth, firm, round and mobile.

Why is the cervix so fragile?

• This is not entirely known either, but we think that it is because the cervix is where a clash of two different cells types – the ones from the vagina lining (squamous cells) and the ones from the uterus (adeno or glandular cells) – meet (transformation zone).
  
• Imagine having two streams of water flowing into each other. Where they meet, there is a bit of
  turbulence and the water is rougher. The same kind of turbulence is thought to be going on at your cervix, making the transformation zone vulnerable to irritation and infection.
  

• When you have your period, the old lining and blood from your uterus passes through the cervix into your vagina.
  
• If you get pregnant, the cervix will keep the uterus closed until you go into labour. During labour, the cervix opens to let the baby pass.
  
• When you have sex your cervix can increase your excitement if touched by your partner’s fingers or penis, or a vibrator.

What does an abnormal Pap test mean?
The cells that are rubbed from your cervix are sent to a lab for study under a microscope. This will show if the cells are normal or abnormal.

The Pap test detects very early cell changes, like a warning system before you may develop Cervix cancer. It is rare that we find Cervix cancer.

Do cell changes mean I have cancer?
If you have an abnormal Pap test, it often causes fear and anxiety. Try not to freak out... too much.

• In most cases, an abnormal result does not mean cancer, or even a risk of cancer developing in the future.
  
• You likely have early abnormal cell changes (dysplasia) which can be mild, moderate or severe. These are called low grade or high grade squamous intraepithelial lesions (LSIL or HSIL) – very long words for abnormal changes.
  
• It is rare that these become cancerous if you have the correct treatment and follow-up.

...so now what?

• If the Pap result is abnormal, your Pap test may need to be repeated or you will be referred for a colposcopy.
  
• A colposcopy (see section on Colposcopy) is an examination where the vulva, vagina and the cervix are viewed with a magnifying instrument (microscope) that does not enter the body.
  
• During the examination, a small piece of abnormal tissue, called a biopsy, might be collected and sent to the lab for study. You will always get local anaesthetic (“freezing’) if this is done.
  

What if the repeated Pap test also comes back as abnormal?

• It is important to remember that this still does not mean you have cancer.
  
• Most cervical cancers take about ten years to develop, so there is no need to panic.
  
• There are different treatment options to help prevent the cells from turning into cancer.
  
• Abnormal cells can be removed by minor surgery done in our centre (LEEP or LASER). We will discuss the different choices with you. At no time will you feel pain during any of these procedures. We promise!

Does this affect my chances of getting pregnant?

• Having an abnormal Pap test does not affect your chances of getting pregnant, and neither do any of the treatments.
  
• If you do need treatment done, there is a small risk (less than 1%) that some treatments (LEEP and LASER ) can affect the cervix from keeping the pregnancy during the first few months, or you may need to have a Caesarean Section if the cervix does not open completely during labour. It is rare that you deliver your baby early.
  
• These risks are so rare, and there is an almost 99% chance of nothing happening to affect your future pregnancy.
  
  

• We do not always know what causes cervical cell changes. The most common cause is a virus infection caused by the human papilloma virus (HPV).
  
• This is a very common virus and almost 60% of us have it if we are sexually active.
  
• This virus can be especially problematic if your body is unable to fight them off adequately because of a weaker immune response.
  
• This can happen if you smoke or have a weakened immune system (Diabetes, HIV or some
  medications).
  
• There are many other less common causes for dysplasia.

What does an HPV infection mean?

• There are more than a hundred types of the human papilloma virus (HPV), most of which are harmless,give no symptoms, and will go away by themselves.
  
• Some types cause genital warts.
  
• The warts can be treated with medication, freezing or LASER (The best one time treatment).
  
• Some HPV can cause cell changes and damage causing dysplasia(cell changes) over a long time.
  
• Most women with HPV will not develop cervical cancer.

HPV causing Cervix Cancer

• Most HPV types do not cause Cervix Cancer.
  
• There is a small number that can cause cancer (oncogenic types – we call them the ‘bad” HPV).
  
• We sometimes do a DNA test for this group. This can help us work out a better treatment or
  surveillance strategy for you.

How did I get HPV?

• HPV is usually spread through sexual activity.
  
• It may be spread by touching or wiping your genital area if you have virus particles on your fingers.
  
• It is so common that most sexually active people will carry it sometime during their lifetime.
  
• It is a latent virus, which means a person can carry it without knowing it for years.
  
• You did not necessarily get the virus from your current partner - an abnormal Pap result could be theoutcome of unprotected sex from many years ago.
  
• Also, it only takes one sexual contact to get HPV, so being infected does not mean you had many sexual partners.
  
• The virus is so small that even Latex condoms may not stop it spreading.

Am I putting my partner at risk?

• If you are sexually active, it is hard to prevent exposure to HPV. Up to 60% of us have it already.
  
• Latex condoms offer some protection but are no guarantee.
  
• Both men and women can be infected with HPV, and both can have genital warts. However, only
  women are more likely to develop cancer from it.
  
• Not smoking and keeping a strong body defence by eating well and exercising can reduce the risk ofhaving a HPV infection.
  
• Women need to have Pap test regularly.

Preventing HPV: The HPV Vaccines:

• There is no real natural way to prevent genital HPV other than not having sex, EVER! This is not likely for most people.
  
• The good news is that there is a HPV vaccine available especially for girls (and perhaps boys) before they are sexually active (age 9 to 13) and for women up to 26 who may get some benefit.
  
• The vaccines do not cover all the HPV types, just the 4 most common ones.
  
• About 30% of Cervix Cancers will not be prevented.
  
• Other reading see: http://www.cdc.gov/std/HPV/STDFact-HPV-vaccine.htm and
  http://en.wikipedia.org/wiki/HPV_vaccine )

We hope that this has been helpful to you and we welcome any questions or corrections related to this article.