I am 27 years old and what you would call a social smoker. I have been at it for about six years now. When I’m at work, I won’t even think about a cigarette. However, every time I’m in a bar, I light up one after another, giving people the impression that I am a chain smoker. I’m aware of other serious dangers that come as a result of smoking but I’m particularly concerned by one thing. Last week, a discussion arose in which I learned that smoking is one of the biggest causes of cervical cancer. I plan to go for a pap smear but some of the stories I’ve heard from women who have had one are downright embarrassing. What is the procedure really like and how often should I have one?

Clarisse

Dear Clarisse

Smoking is a sure way to become sick in life as it has multiple health hazards. Smoking releases smoke, nicotine and several other chemicals which cause direct damage to lungs, and upper respiratory tract. But the toxic chemicals absorbed and carried by blood stream damage inner lining of genital parts as well as other parts of the body. 

They also damage the cells of the body including those of immune system thus increasing vulnerability to various diseases including cancer of the cervix in women.  Currently though one may be a social smoker but this can change to compulsive smoking over time. Because nicotine present in cigarettes is a habit forming substance and causes physical and mental dependence over time.

Cancer of the cervix is caused by human papilloma virus (HPV), which is acquired and transmitted predominantly by unprotected sexual intercourse.  There are other various risk factors like poor pelvic hygiene, early onset of sexual activity,  sex with multiple partners, immune deficiency due to HIV infection, renal failure, , e.t.c

The Papanicalou test or Pap’s test is used to detect cervical cancer in women. In this a sample is taken from the cervix (lower part of uterus that opens in the vagina) by a brush to screen for abnormal cells which indicate cancer in the very early stage (pre cancer stage). It also detects inflammation and abnormalities of endocervix and endometrium.  A biopsy from the cervix is also taken by this procedure to see abnormal cells in the cervix.

Guidelines regarding   repetition of Pap’s smear are variable and the duration suggested for a control of tests is from three to five years. However if some abnormality is detected at first screening, it is recommended to repeat the test after every six to twelve months.  If the abnormality detected during premier testing needs to be seen in greater detail, a woman  is evaluated by colposcopy. This enables the cervix and vagina to be viewed with good illumination and magnification.

A cervical smear is also taken for detection of high risk strains of HPV that are more likely to cause cervical cancer and their total load.

In all these procedures, a woman is made to lie on her back, with legs spread apart, in stirrups and knees flexed.  Only the part essential to be examined is open, for rest, a cover is put to preserve the dignity.  The speculum before being inserted is lubricated to minimise the pain and discomfort. Though these tests are embarrassing and uncomfortable, the advantage offered by early detection and cure of a potential debilitating and fatal illness far outweighs the discomfort experienced by a lady. 

Dr. Rachna is a specialist in internal medicine at Ruhengeri Hopsital