Pap Testing

Posted in Sexual Health

What is a Pap Test?

Is a test performed by a doctor or nurse that checks for changes in the cells of the cervix. These changes are generally caused by a virus called HPV (human Papilloma Virus) If these changes are not detected they can potentially lead to cervical cancer.  

 ‘Pap’ is short for ‘Papanicolaou’, named after the doctor who first described the test.

Why are Pap Tests important?

The Pap test is the best way we have of detecting cell changes before cancer of the cervix develops. Cancer of the cervix is one of the most common forms of cancer in women. However, if it is detected in the precancerous stage, it has a high cure rate.

Pap smear

Image Above : How is a Pap smear test done: You would be asked to lie down on a bed, a speculum (a small device to allow your doctor to see the upper part of your vagina and cervix) will be inserted into your vagina. Then, some sample of the cells lining your cervix is taken by scraping the cervix using a plastic brush or wooden spatula. Majority of the women have minimal or no discomfort at all during this test.

HPV explained

Human Papilloma Viruses (HPV) are common viruses that affects both females and males.

There are over 100 types of HPV which can affect humans. About 40 types of HPV are known as genital HPV as they affect the genital area. Some of these HPV types cause genital warts (see Genital Warts information sheet) whereas other types of HPV have no signs or symptoms.

HPV is highly contagious. It is estimated that up to 80% of people are infected with HPV at some time in their lifetime. Many people get their first HPV infection within the first few years of becoming sexually active. Where no signs or symptoms are present people can transmit the virus without knowing it. A person can also be infected with more than one type of HPV.

Anyone who has any kind of sexual activity involving genital skin to skin contact could get genital HPV. That means it’s possible to get the virus without having intercourse.

What does HPV have to do with cervical cancer?

A few types of HPV have been linked to causing abnormalities of the cervix, and in some cases the development of cancer of the cervix. When cancer of the cervix does develop, HPV is found in almost all cases. Having regular Pap tests is the best way to ensure that any changes are detected and managed to protect your health.

Research suggests that HPV may also be responsible for cancers in other parts of the body, such as the anus, penis and throat.
Studies are continuing in this area.

Does everyone with HPV get cancer of the cervix?

No. For the majority of people who have HPV, the body’s defence system is enough to clear the virus. Up to 90% of infections are cleared within 36 months.

For women who don’t clear the virus, certain types can cause abnormal changes in the cells of the cervix. This can lead to precancerous abnormalities which can develop into cervical cancer later in life if left untreated. Usually, the progression of pre-cancers into cervical cancer takes a number of years, although, in rare cases, it can happen more quickly. For this reason, early detection is very important so effective treatment can be given.

The HPV vaccine

Vaccination against HPV is available. Current vaccines protect against HPV types responsible for up to 70% of cases of cancer of the cervix. One of the two vaccines currently available also provides protection against HPV types responsible for 90% of genital warts.

Where do I get the HPV vaccine?

The HPV vaccine is now included in the National Immunization Schedule and all girls are offered the vaccination at age 12-13 through the schools based program (Year 7 in High School). Vaccination involves 3 doses over a period of 6 months.

The vaccine is approved for use in boys but is not currently available through the National Immunisation Schedule.

For adults or boys the vaccine can be accessed through their doctor or through the SHFPACT clinic. There is a cost to the vaccination. A prescription is supplied and the vaccine is purchased from a pharmacy, then given by a doctor or nurse on a return appointment.

HPV vaccination & Pap tests

Regular Pap tests are still essential. Since vaccination does not protect against all types of HPV that cause cancer of the cervix vaccinated women need to continue with their regular Pap tests.

The current recommendations for cervical screening are that women should have a Pap test every two years from the age of 18 or two years after having sexual contact, whichever is later.

Together, vaccination and regular Pap tests offer the best chance of preventing pre-cancerous cervical abnormalities and cervical cancer.

How is a Pap Test taken?

Firstly, an instrument called a speculum is inserted into the vagina and the walls held gently apart so that the cervix can be clearly seen. Then, using a small brush cells are gently taken from the opening in the cervix. Most women will not feel this at all, as the cervix is usually very insensitive.

The collected cells are spread onto a slide that is sprayed and allowed to dry. This is then sent to the laboratory to be looked at under a microscope.
With the Thinprep test, the brush is not discarded but rinsed in a jar of solution. This picks up more cells to analyse and disposes of vaginal secretions, which can make the interpretation of the cells easier. This technique is particularly useful if your test has been unsatisfactory or is borderline between categories.

The results are usually available in a week and you will receive notification of your results in the mail. If you agree to be on the Pap Test Register you will be notified if you are overdue for your next test.

How often do I need a Pap Test?

All women who have ever had close sexual contact (where genital skin touches the genital skin of another person) should commence having pap tests at 18 years of age or 2 years after the first sexual contact, whichever is later. If a women felt she may need a pap test before 18 years she would need to contact a medical practitioner to discuss.

All women should then continue having pap tests every two years unless otherwise indicated by a medical practitioner. It is not necessary to have Pap tests if the uterus has been removed (hysterectomy) unless the reason for removal was cancer or pre-cancer, in which case vaginal (vault) tests should be taken at regular intervals. If you are unsure whether you need a Pap Test, ask your doctor or nurse.

Pap Test Abnormalities

Cervical cells pass through a series of changes before they become cancerous. An abnormal pap test means a less serious low-grade abnormality (squamous intraepithelial – mild) or more serious high-grade abnormality (intraepithelial lesion – moderate to severe) where some of the cells of the cervix differ from the normal cells. It rarely means cervical cancer is present.  Many women will require more frequent pap tests for a period of time after an abnormal pap test result. In this time the cells may heal themselves, but further testing will help indicate if they continue to change or heal. A doctor or nurse will advise on the length of time between tests in these instances.

What Symptoms would indicate Cancer or Pre-Cancer of the Cervix?

Early changes in cervical cells rarely cause symptoms. If early cell changes develop into cervical cancer, the most common signs include:

  • vaginal bleeding between periods
  • menstrual bleeding that is longer or heavier than usual
  • bleeding after intercourse
  • pain during intercourse
  • unusual vaginal discharge
  • vaginal bleeding after menopause
  • excessive tiredness
  • leg pain or swelling
  • low back pain

Do Virgins need Pap Tests?

Cancer of the cervix is rare in virgins but it can occur. If a virgin has the symptoms of irregular bleeding between periods or an abnormal vaginal discharge, she should see a doctor for assessment. Otherwise, routine Pap tests are not necessary.

Do Lesbians need Pap Tests?

Yes as HPV can be transmitted simply through skin to skin contact women who only have sexual contact with women still needs to have pap tests.

Do women who no longer have any sexual contact with other people or are in long term relationships still needs pap tests?
Yes as HPV can lie dormant in the system un-detected for some years regular pap testing is still recommended unless otherwise indicated by a medical professional.

Do women with disabilities need pap tests?

Yes – women with sensory, physical, intellectual or psychiatric disabilities are less likely than other women to have regular pap tests, but it is just as important for these women to have pap tests.

Women with disabilities may face a range of barriers in getting a pap test including lack of information about pap testing, lack of support, difficulty in accessing the service or finding that a service that caters to their disability, lack of financial support, reliance on others to assist in accessing or being understood by the health care professional and having to battle other people’s perceptions and/or values around the person’s sexuality or sexual activity.

It is important to acknowledge and support women with disabilities in obtaining information and accessing services for pap tests. Making contact with an organisation like SHFPACT can help with suggestions on how to overcome any barriers or support someone in accessing the clinic for a test.

When was your last Pap smear? Make an appointment today by calling 6247 3077 - and consider asking your doctor or nurse for a Chlamydia test while you're there.

Find out more about Pap Smears, HPV & Cancer of the Cervix here

Download in PDF the SHFPACT fact sheet on Pap Smears here

Information on this page has been sourced and/ or adapted from:
Pap test: Factsheet / Better Health Channel. [accessed 04/10/2013]
Cervical cancer / Cancer Council Australia. [accessed 04/10/2013] 
Screening to Prevent Cervical Cancer: Guidelines for the Management of Asymptomatic Women with Screen Detected Abnormalities/ National Health and Medical Research Council - PDF. [accessed 04/10/2013]

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