A Pap smear is a simple, routine test that looks for any abnormalities of the cervix in women. The cervix is the lower part of the uterus that opens into the vagina. Although it is rare, cervical abnormalities can lead to cervical cancer and it is important to take action early to prevent any future problems. Cervical abnormalities are also called cervical dysplasia.

Symptoms:
Cervical abnormalities usually do not cause symptoms. Sometimes it causes bleeding during or after sexual intercourse.

Diagnosis and Treatment:
For a Pap test, your HUHS Primary Care Clinician swabs your cervix and cervical canal with a long cotton swab, brush, or wooden stick. Cells from the cervix are sent to a lab to be viewed under a microscope. If there are any abnormalities, you may be referred to the ob/gyn service to have a colposcopy. For this procedure a colposcope (an instrument with a magnifying lens) is placed at the opening of the vagina and used to look closely at the cervix. Small samples of any tissue that appears abnormal may be removed and sent to the lab for tests. The removal of this sample is called a biopsy. A Pap test that is not normal is usually caused by an infection such as Human Papillomavirus (HPV) or other types of vaginal irritation.

The specific treatment depends on the type of abnormal cells found. HUHS Pap test results are reported in the following groups:

• Normal
  No signs of cancer or precancer.
• ASC-US (Atypical squamous cells of undetermined significance)
  Some abnormal cells are seen. An additional test for the HPV infection is usually added to the Pap. If the test is positive, a colposcopy would be recommended to evaluate further. If the test is negative, a routine follow up Pap in one year is recommended.
• LGSIL (Low-grade squamous intraepithelial lesion)
  Early, mild changes are seen in the cells and may be a sign of precancer. These abnormal cells usually return to normal on their own within 18-24 months and usually can be managed with frequent follow-up care.
• HGSIL (High-grade intraepithelial lesion)
  Moderate or severe cells changes are seen that can develop into cervical cancer and are usually treated surgically.

Surgical procedures are recommended in a minority of patients with abnormal Pap tests. If a biopsy shows high grade changes or for persistent low grade abnormalities, the abnormal tissue can be removed in the office with a thin wire loop attached to an electrical unit. This is called the loop electrosurgical excisional procedure (LEEP). Most women who have had a treatment are able to become pregnant and carry the baby to term without problems. If you become pregnant and have had a prior treatment for an abnormal Pap, tell the provider who will be taking care of you during your pregnancy.

Follow your health care clinician’s advice for treatment and checkups. Your clinician may recommend that you have a Pap test at least twice a year for the next 2 to 3 years. This will allow him/her to detect any recurrence of the dysplasia and treat it promptly. Then, if your Pap tests have been normal, you may need the test just once a year.

Prevention

• Having numerous sexual partners can increase the risk of infection with HPV.
• If you are sexually active, use latex or polyurethane condoms.