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What do Pap smears detect, and what do my results mean?

One of the things women have to do each year is go to the gynecologist for their annual checkup, commonly referred to as the "well woman visit." This yearly visit includes discussions about any changes over the past year, a breast exam, and a vaginal exam. Only sometimes does it actually include the Pap test!

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Pap Smear Guidelines and Frequency

Pap smears (or paps for short) only need to be done every 3 years under 30 years of age and every 5 years over 30 years of age. I'm sure this is news to many of you, as my own patients are also surprised when I tell them this. Understanding the results is important, but remember, if you don't understand, just reach out to your provider for a better explanation. The results and combination of results are too much to explain in one article, but I will break it down as best as I can.

Breaking Down Pap Tests: What They Analyze

The Pap tests for two different things:

  1. The cells of the cervix being analyzed as normal versus abnormal. And

  2. The presence or absence of the human papilloma virus (HPV).

If you are under 30 and the cells are normal, then your test stops there. Over 30, both the cells and virus presence are tested simultaneously. That is because HPV is so common in the under 30 group and usually goes away on its own when you are younger. So, if the cells of your cervix are normal and you are under 30, the test stops there. If your cells are abnormal under 30, then the HPV test is done as well.

Understanding Cervical Cell Abnormality: Levels and Follow-up

There are different levels of cervical cell abnormality. In order from least to most worrisome in result:

  1. Normal, Atypical cells (ASCUS),

  2. Low-grade change (LGSIL),

  3. High-grade change (HGSIL).

Normal and ASCUS are most common, usually not requiring extra close follow-up as long as HPV is not present.

Decoding HPV Results: Types and Implications

In terms of HPV results, there are over 100 types of HPV that exist and they are numbered - HPV 16, HPV 33, etc. However, some have been identified as the high-risk types that can lead to changes on the cervix and others identified as the low-risk types that may lead to things such as genital warts. So sometimes your pap result, if HPV is positive, will also report on which type you have. And this helps us gynecologists guide your follow-up.

HPV is a sexually transmitted virus that, if it goes unchecked for many MANY years, can lead to cancer of the cervix. And this potential for cervical cancer is the entire reason Pap smears are performed. But, as long as you see your gynecologist yearly and get your paps every 3 to 5 years, the chance of cervical cancer is very low. In addition, it's important to get the HPV vaccine at as young of an age as you possibly can, potentially 11-12 years old, to prevent the most common types of HPV that can lead to cancer of the cervix. So, No!, cancer of the cervix is not genetic - it is all through sexual transmission of a virus.

Pap tests are very important, as well as your annual visit with a gynecologist to have your yearly breast and vaginal exams. Trust me, I understand the busy lives most of us lead but you can't forget the importance of taking care of yourself!


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