What the hell is a Pap Smear?

As a new practitioner, I’ve notice a lot of knowledge deficits when it comes to women and their health. I’m here to help! Pap smears are one of the most common misunderstandings I have come across with my patients.

I feel like almost none of my patients even know what it is I’m…..you know…doing down there! Not to mention why I’m doing it! Most patients don’t think I’m dong anything other than a pelvic exam (which I imagine they think is just looking).

Well, I’m here to tell you I’m looking, but I’m looking for something very specific!

CERVICAL CANCER. A Pap smear is a screening for CERVICAL CANCER. So listen up!

What does the American Cancer Society have to say about Cervical Cancer?

For 2024, The American Cancer Society’s estimates about 13,820 new cases of invasive cervical cancer will be diagnosed, and about 4,360 women will die from cervical cancer.

Cervical pre-cancers are diagnosed far more often than invasive cervical cancer AND when found procedures can be done to prevent Cervical cancer. That’s why we screen!

A pelvic exam is NOT a pap smear! A pap smear is NOT a pelvic exam, but can be apart of one. A pelvic exam is when a provider examines your pelvic region: your vulva, vagina, cervix, ovaries, and uterus for any abnormalities – they also may perform testing for STI’s or look for the answers to other issues through examination. A pelvic exam typically includes a speculum (the instrument you hate that opens the vagina) to look at the inside of the vagina and cervix.

metal speculum (there are also plastic, disposable ones)

A bimanual exam may be included in the pelvic exam which fingers are inserted to feel the cervix, uterus and ovaries.

Bimanual exam

A Pap test MAY OR MAY NOT be done during a pelvic exam. If you are 21 + you should be getting a Pap smear every 1-3 years depending on your results. If your results are anything other than Negative (NILM) you should return in 6 months to a 1 year, or sooner at your provider’s discretion.

How is it done?

During a pap smear, a small instrument is used to take some cells off of the cervix and the sample is sent off to be evaluated by a lab under microscope. A pap is to make sure the cells of your cervix are normal and noncancerous. Under a microscope they are checked for changes leading up to cancer.

Based upon the evaluation of the cells these are the following results you could have:

Negative (NILM) > Atypical Squamos Cells of Underterminded Signficance (ASCUS) > Low Grade Squamos Intraepitheleal Lesion (LSIL or LGSIL) > High Grade Squamos Intraepitheleal Lesion(HGSIL) > Cancer

More about what these results mean in future posts!

Oh, and what is a cervix you might ask?

It is the tunnel like organ that connects to the uterus and that a baby travels down and out of it out through the vagina (it is usually closed, but opens up during delivery), your menstrual blood also comes out of it. It can be felt by the a provider during the bimanual exam. It can also cause some discomfort in sex when/if the penis hits it during intercourse. Ouch! Change positions, it helps!

G’vanni Whyte, DNP