First of all what is the pap?
The ‘pap’ test (developed by and named for Greek pathologist George Papanikolaou) is a screening test for cancers and pre-cancers of the uterine cervix. That’s it. It’s what most people think of when they think about the “well woman exam.” It’s different than a speculum (aka the clamp thingy, usually made from metal but sometimes plastic) exam, which is performed for a variety of reasons. Following the insertion of a speculum, your doctor/midwife/nurse practitioner uses a little brush and spatula to collect some cells from the surface of your cervix, which are then analyzed (usually using computer technology) for features worrisome for cancer or pre-cancer. Most abnormal paps result from infection with one or more strains of Human Papilloma Virus (or HPV)
What isn’t the pap?
When you have your wellness exam, (hopefully after discussing it with you) your provider may also collect specimen for STD testing, HPV, or to evaluate that smell you complained about. When you went to the ER because you were doubled over in pain from an ovarian cyst or thought you were going to die with your last period, hopefully they performed a pelvic exam and looked at your girl parts using a speculum. They probably didn’t do a screening test for cervical cancer, nor should they have.
What does this mean?
The pap test is designed to detect pre-cancers and cancers of the cervix. Like most medical screening tests, it casts what I like to call a wide net. That means, when we do a screening exam, we want to make sure that we pick up everybody who might potentially have a problem. In the process, we also pick up a lot of people with no actual problem. Think about the mammogram. If we only did breast biopsies on people with obvious cancers, we’d miss a lot of cancer and lose the opportunity to help women who’d benefit from early treatment.
For most women (especially the 20-something set), an abnormal pap is not a game-changer. You can still get pregnant. You are still as hot as you ever were. In fact, most HPV infections will be self-limited and won’t require treatment. This is rationale behind less frequent pap testing: your body will clear the infection itself, and the treatment may be worse than HPV!
If it’s no big deal, then why bother?
Because it can turn into a big deal. Worldwide, cervical cancer is still a leading killer of young women. Most cases of cervical cancer in the US are in women who have not been screened. Nobody ever died prematurely from pre-cancer. Cervical cancer is a game changer. In the US, cervical cancer is an (almost) entirely preventable tragedy.
What happens next?
More than likely, you’re going to have a colposcopy. More Greek: colpo = vagina or kolpos meaning ‘womb’; + scopy from the greek skopia or watching. You’re going to have your womb watched. The doc will insert a speculum and look at your cervix with a fancy magnifying lens called a colposcope. Depending on how bad your pap was, they probably will do one or more biopsies, or tissue samples. The purpose of the test is 1. To make sure you don’t have cancer and 2. To determine if you have a pre-cancer that would benefit from treatment. Like I said, most abnormal paps are due to HPV infection, which, for most patients, will go away without treatment. However, there are some patients in whom HPV can stick around and cause real havoc. Without the colposcopy, we can’t tell who’s who.
So I have HPV. Does this mean I/my partner/his old girlfriend/the person I hooked up with on Saturday is a dirty ho-bag?
The short answer is no. HPV is part of the human condition. 60-80% of the young, sexually active population will test positive for HPV at some point in their lives. HPV can also lurk in the system at low levels and go undetected. Don’t jump to the conclusion that your long term bed buddy is having extracurriculars just because your pap is abnormal. Don’t let it affect your self-image either (see What STD’s have to Teach Us).
Can I blow it off?
Please don’t. These extra tests can be expensive. They’re annoying and uncomfortable. Again, cervical cancer in the US is primarily a disease of women who have not had access to screening or have dug their heads in the sand. Get the test and go on with your bad self.
Share your experiences, adventures and misadventures with HPV.
Gynogirlfriend, May 11, 2015
