Dear Doctor,

I heard of pap smear tests when I was about 20 years old and was afraid to go thinking it is painful. However, a friend convinced me and we went together, and I’ve had a pap test every year for 10 years, since I was about 25. It’s always normal. Do I still need one every year or is it not necessary? How often should I go now?

Benita

Dear Benita,

Papinacolau smear or pap test is a test widely used for screening of cancer of the cervix (lower portion of the uterus).  It even detects precancerous lesions.  This helps in early detection of cervical cancer, which can then be treated early. Thus, it helps bring down the burden of sickness and deaths due to cervical cancer in women.

Cancer of the cervix is caused by HPV (human papilloma virus (starting sexual activity at an early age, multiple sex partners, poor genital hygiene, and HIV infection are some of the risk factors for causing cervical cancer).  The vaginal canal is opened by a speculum and cells of opening of cervix taken for examination. Normally it causes slight discomfort due to vagina and cervix both being soft and sensitive parts of the body. But pain usually does not occur. It takes just a few minutes. The amount of discomfort depends on the hand of the person doing the test, whether he does softly or harshly with a heavy hand. However, in case of inflammation/infection or previous trauma of the vagina or cervix, the procedure may be painful. There may be some vaginal bleeding or spotting after the procedure, but it is transient.  Some women may experience diarrhea after the procedure, which is again transient. Diarrhea occurs due to the lower end of the intestines being irritated if touched accidentally and disturbed. The cells taken are seen under the microscope and any abnormality detected is reported. Paps smear is avoided during menstruation, as the shedded endometrial cells during menses can obscure the cervical cells, giving false results.

It is an effective way of detecting cancer of the cervix, but not all types of cancers can be detected.  Like adenocarcinoma of the cervix cannot be detected. There are different strains of human papilloma viruses, causing cervical cancer and some may not be detected by this test. But about 70 to 80 per cent of cancers can be detected.  The average guidelines regarding the age to do paps smear tests vary across countries and change every three to five years. However, on an average, it is recommended to be done from 20 years to about 60 years of age.  After one test, if normal, another can be repeated after three to five years. However, if some dubious lesion is found in first result, it can be repeated after six months for confirmation or exclusion of the cancer.  Generally women of 40 years and above are recommended to do pap smear tests every year.

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

rachna212002@yahoo.co.uk