Why are Pap Smears Done During Pregnancy?
A Pap Smear, usually done during your first prenatal visit is a test used to look for changes in the cells of the cervix which indicate cervical cancer or conditions that may develop into cancer.
Pap smears do not diagnose cancer, but they detect 95% of cervical cancers at a stage when they cannot be seen with the naked eye. They can then be treated and are almost always cured. Though Pap smears do not specifically test for other gynecological problems or sexually transmitted diseases, Pap smears will indicate the presence of abnormal cells for which further testing or examination would be required.
What if I am pregnant, and I have an abnormal Pap smear?
A Pap smear is a routine part of your prenatal care and poses no risk to the fetus. If you have an abnormal Pap during pregnancy your physician will discuss treatments which can be done safely during pregnancy, or depending on diagnosis, delay treatment until after your baby is born. If your physician suggests a colposcopy or cervical biopsy, there can be slight bleeding from the external part of the cervix, but this is not a serious complication. If your physician is considering doing an internal biopsy into the endocervical canal, there may be a slight risk of a pregnancy complication. But your health care provider has your best interest in mind and will only do what is medically necessary. Your doctor may perform additional Pap smears during your pregnancy if necessary. Many times the birth of your baby will wash away any abnormal cervical cells.
What happens during a Pap smear?
As part of your pelvic exam, your physician will use a small spatula, brush, or swab to remove a few cells from your cervix. You may feel some discomfort, but it is not painful. The cells are placed on a microscope slide and sent to a lab for results. You can help your clinician obtain a good Pap smear by not having intercourse, not douching, or not using any products/medications in the vaginal area for at least two days prior to the examination.
What do the results mean?
A negative result means that your cervix is normal. A positive result indicates the presence of abnormal cells. Your physician may also call this an abnormal Pap. Remember that this is a test, not a diagnosis. A positive result does not prove that you have cancer or even dysplasia (a pre-cancerous condition). However, it usually means you should have further evaluation, such as a colposcopy (microscope used to look into the cervix) or a biopsy (removing a small amount of tissue from the cervix). Your doctor will discuss the results with you. One in ten Pap smears indicates some abnormality, though most are not serious. Further testing will be required to determine if you have an infection, inflammation, a yeast infection, trichomonas, herpes, or the human papillomavirus. Researchers believe that cervical cancer is directly related to human papillomavirus (HPV).
There are over 100 different types of HPV. About 30 types are spread through sexual transmission and can possibly lead to cervical cancer. HPV is the main risk factor for cervical cancer, but most women who receive treatment for abnormal cells caused by HPV, do not develop cervical cancer. In 2003, the FDA approved a screening test that can be done in conjunction with a Pap smear to determine if you have the HPV virus. The HPV DNA test can detect high-risk types of HPV before any abnormal cells can be detected on the cervix. This screening is recommended for women over the age of 30, who are at an increased risk of an HPV infection turning into pre-cancerous cells. Some Pap smears indicate an unsatisfactory sample because of recent sexual activity or use of vaginal creams and douches. Regardless of the reason, an abnormal Pap will require another Pap smear in a few months. With proper screening, cervical cancer is preventable and avoidable.
When should I have a Pap smear?
It is recommended that all women get a Pap smear done at age 21. Recent changes to testing guidelines have removed the need for anyone under the age of 21 to be tested, regardless of sexual activity. Pap smears should then be done every 3 years until they are 29. Women between the ages of 30 and 65 can either be Pap-tested every 3 years or every 5 years with a Pap/HPV co-test. Discuss with your health provider what they recommend for a Pap smear schedule as some still encourage that they are done yearly. Even if your health care provider recommends you have a Pap smear every 2-3 years, you still should see your gynecologist every year for pelvic exams, information regarding other women’s health issues, and breast exams. Women should have a Pap smear in the middle of their monthly cycle, or about 10-20 days after the LMP (last menstrual period) began. At least 2 days before the test, women should avoid having anything in the vagina including sexual intercourse, douching, vaginal creams/suppositories, or spermicide. These could interfere with the results of the test and cause an abnormal result.
When can a woman stop having this test performed?
According to the National Cancer Institute, women who are over the age of 70 and have a history of normal Pap smears are very unlikely to develop cervical cancer and therefore can discuss the option of not needing any further pap smears. Women who have had a hysterectomy with both the uterus and cervix removed, for reasons not related to cancer, can also discuss the option of not needing any further Pap smears.
Who needs pap smears more often?
Women who are taking immunosuppressant medications or have a condition that weakens the immune system should have more frequent Pap smears. These women need to discuss what type of testing schedule they should be on with their health care providers.
Want to Know More?
Compiled using the following sources:
Danforth’s Obstetrics and Gynecology Ninth Ed. Scott, James R, et al, Ch.26
National Cancer Institute, www.cancer.gov
FDA News Release, March 2003 https://www.fda.gov