PAP exams (cervical screening)
A pap exam is an internal exam done by a licensed health care provider (Dr/Registered Nurse/Nurse Practitioner/Midwife/Registered Naturopath) to check the cells of your cervix (the entrance to the uterus) and detect any changes. Abnormal cells can change to cervical cancer cells over time so it is important to detect changes early when they can be monitored and removed easily. We know that regular cervical screening saves lives. Most cervical cancer cases occur among people who have not undergone screening or who have had a long interval between Pap tests. In BC, about 58% of the 178 patients diagnosed with invasive cervical cancer in 2014 were five years or more overdue for screening5 . The majority of cases are diagnosed in the 30-39 and 40-49 age groups. (Source: BC Cancer Agency, 2016)
Cervical cancers are caused by specific high risk types of the Human Papilloma Virus (HPV) which is the most common sexually transmitted infection. If you are sexually active, you may be exposed to this virus because it’s very contagious and many people don’t even know they have it. Most often HPV goes away on its own, but sometimes it doesn’t and certain types of HPV can cause abnormal cervical cells that can eventually (years later) change to cervical cancer. According to the latest research from BC Cancer agency, the infection needs to persist for many years to transition from the infection to invasive cancer. This is why it’s so important to have your 1st Pap test at the age of 25 if you have a cervix and you’ve been sexually active (including oral and digital sex) with a partner(s) of any sex. You’ll continue having pap tests regularly (every 3 years or sooner if advised by your health care professional) even if you are no longer sexually active usually until age 69. We follow the clinical standards and timelines set out by the BC Cancer agency.
Does a pap test hurt?
No, it doesn’t hurt, but it sometimes feels less than comfortable. You may feel some different sensations or some pressure in your pelvic area. Taking deep breaths helps to relax all of your muscles. It helps to have an empty bladder before the exam so you’re more comfortable. You can focus on relaxing your pelvic floor muscles by letting your bottom rest down on the table and breathing deeply. Wearing socks helps to make the foot rests less cold on your feet. The exam will be over in a matter of minutes.
Does it matter what time in my cycle I should have my Pap?
Yes, it’s best not to have one during your period. Mid cycle (between periods) is ideal.
How do I prepare to have a Pap?
- Avoid putting anything inside your vagina for 48 hours before your appointment – avoid sex, spermicides, etc.
- Remember any unusual signs, for example bleeding between periods or bleeding after sex, so you can tell your health care provider
- At ISHS, you can request a female doctor when you book your appointment. All of our male doctors will have a female assistant in the room.
- Feel free to invite your partner or friend into the exam room if this will make you more comfortable (they can stay behind a curtain so they don’t see any of your personal parts)
- Write down your questions and bring them along
- Remember that cervical screening isn’t painful, you may feel pressure in your pelvis during the exam but it should definitely not hurt. If you’re feel more than pressure in your pelvis at any time during the exam or you’ve experienced discomfort in the past during a pap exam, let your health care provider know.
What happens during a full pelvic exam including a pap at ISHS?
First, you go into the exam room where the Dr. or nurse will ask some questions, such as when your last period was. The doctor will leave the room so you can get undressed in private.
You get undressed (from the waist down except socks!) behind the curtain, lie down on top the exam table and cover yourself with the paper sheet provided. (Check out our ceiling art or dream about a tropical beach!) When the Doctor or nurse returns, he/she/they will ask you to slide your buttocks down to the end of the table, bend your knees and put your heels into the foot rests and let your knees relax open.
Next the doctor/nurse will lift the paper sheet back and look at your vulva including the labia to make sure everything looks healthy. He/she/they will use an instrument called a speculum to look inside your vagina and at your cervix. After warming and lubricating the speculum, the doctor will gently slide it into your vagina, similar to you sliding in a tampon.
Remember to breathe, and let your legs be floppy and concentrate on relaxing your pelvic muscles. The more you can relax, the more easily the speculum will slide in.
Once the speculum is in position, the doctor opens it to see your cervix which is at the top of your vagina. Sometimes the speculum makes a clicking noise as it opens – don’t be alarmed! The health care provider then uses a small pap stick to remove a few cervical cells which are placed onto a slide which is marked with your name. Most people don’t feel this at all! The slide is sent away to a lab for analysis. This is the pap portion of the exam
Next the doctor/nurse may touch your cervix with a swab, similar to a long Q-tip, to check for sexually transmitted infections such as chlamydia and gonorrhea (both of which can easily be treated with antibiotics). At ISHS, we routinely screen for chlamydia and gonorrhea following pap exams but not all clinics do. If the doctor/nurse feels it’s necessary, they may also swab for yeast, bacterial vaginosis and/or trich during the same exam.
After the speculum is removed, the doctor inserts a gloved finger inside your vagina and checks the size, shape and position of your pelvic organs while gently pressing on the outside of your lower abdomen with the other hand. This is called a bi-manual exam.
After the exam is over, the Doctor will offer you some tissues, wash their hands and remove their gloves before leaving the room to allow you to get dressed in private. The doctor will knock up on return to chat some more before your appointment is over. This is good time to ask any final questions.
How long does it take to get the results back from an exam?
Pap test results can take 6-8 weeks to come back from the provincial lab. If you have been screened for infections at the pap exam appointment, the infection results take 5 days.
You should plan to book a follow-up appointment with the clinic to go over your results.
Does a pap exam test for Sexually Transmitted Infections (STIs)?
No. It only takes a sample of the cells of the cervix. At our clinic, we routinely follow the pap exam with separate swabs for STIs such as chlamydia and gonorrhea but other clinics may not. It’s important to ask your health care provider what their process is.
If I have been vaccinated for HPV, do I still need to have a pap exam?
Yes, if you are or have been sexually active with a partner of any sex. While the vaccines are important tools of prevention, it is still necessary to have a pap exam because this screening tool ensures that the cells in the cervix are healthy and normal.
Does an “abnormal” result mean I have cancer?
No. If you receive an abnormal result back from the clinic where you were tested it means that you have some different looking cells that need another look. Generally, you will be asked to repeat your pap in 6 or 12 months to monitor cell changes. The changes may be insignificant and return to normal or they may be caused by HPV or another infection. Most people will clear these abnormal cells but some people may not. Remember, it usually takes many years before cell changes caused by HPV become cancerous.
BC Cancer has some great information about what cell changes mean.
What will the doctor think if I’m waxed, shaved or pierced down there?
Trust us, nothing will surprises us, and how ever you choose to express your self is cool with us! Our job is not to judge your grooming you; it’s to make sure you’re healthy.
How do I remember to have my regular pap?
Life can be busy. There a number of apps that you can use to remind you of screening tools. Some clients will have schedule a cervical screening for a noteworthy time for them during the year so they make an association with that each year.
Do you have additional questions about pap exams?
Contact us for an appointment
Does a pap exam test for Sexually Transmitted Infections?
No, a pap exam only examines the cells on the cervix. We can do a separate procedure to test for some STIs immediately following your pap if you’d like. In our clinics, it’s standard practice to do so unless a client declines testing but not all clinics have similar standards of care so it’s important to ask.
What’s a colposcopy?
A colposcopy is a procedure done by a specialist at a colposcopy clinic. The colposcopy exam is very similar to a pap exam except that during the exam the specialist uses a special instrument called a colposcope to more closely examine your cervix. Similar to the pap exam, a colposcopy should not be done during your period and nothing should be put into the vagina for 48 hours before your procedure. If there is nothing that needs to be followed up, you will be advised to follow up with a pap exam at a later date. If something needs further investigation, the specialist will advise you at the time as to the next steps involved.