Written by Alexis Dobranowski, Communications Advisor at Sunnybrook.
It can hurt. And it's certainly an uncomfortable position to be in. And I've yet to meet a women who doesn't dread the cold speculum.
Oh, the Pap test. ~cue crossed legs and sweaty palms~
But the discomfort certainly doesn't seem so bad when you consider a Pap screening test -- where a doctor collects cells from the inner part of your cervix -- is the only way to find early cell changes that might lead to cervical cancer.
To figure out why a timely Pap test is so important, I talked to Dr. Lisa Del Giudice, family physician on the Sunnybrook Academic Family Health Team and Regional Primary Care Lead, Toronto Central Regional Cancer Program.
What's a Pap test looking for?
A Pap test is looking for abnormal cells -- cancer or pre-cancer -- in the cervix. Sometimes other gynecological cancers can be detected during a Pap test.
A Pap test isn't the same as a test for sexually transmitted diseases (STDs).
"Sometimes an STD can be picked up on a Pap, but it is not really the appropriate way to test for STDs," Dr. Del Giudice says. "The appropriate STD tests can be done at the same time if there is any concern in this regard."
How can it help prevent cervical cancer?
In 2015, about 640 women were diagnosed with cervical cancer in Ontario and about 150 women died from the disease, according to Cancer Care Ontario. Cervical cancer is almost entirely preventable with regular screening, appropriate and timely follow-up of abnormal results.
"The Pap test can find the abnormal cells or high-risk human papillomavirus (HPV) early so that next steps can be taken or the patient can be screened more often," Dr. Del Giudice says. (Some HPV can lead to the abnormal cell changes and cause cancer).
How often should I have it?
It is recommended that women aged 21 to 69 have a Pap test every three years if they are or have ever been sexually active. Sexually active doesn't just mean sexual intercourse -- oral and digital contact also count. Women who have sex with women should have regular Pap tests.
Research suggests that smoking puts you at higher risk for cervical cancer. If you smoke and are sexually active, be extra certain to book your Pap test every 3 years.
"If you've had a total hysterectomy (uterus and entire cervix removed) then you no longer need to undergo Pap screening. But, if your cervix was left partially intact you still do. Same if you've had your ovaries removed -- you should still have regular Pap tests," Dr. Del Giudice explains.
Who can do the Pap test?
A Pap test can be done at your family doctor's office. If you don't have a doctor, you can get a test done at a walk-in clinic or sexual health clinic.
What happens if the Pap test 'finds something'?
If your doctors sees an abnormality (something that looks like it could be cancer or pre-cancerous cells), they may want to repeat the test, or do further testing to high-risk HPV and/or refer you to a gynecologist for a colposcopy (a test that takes a bigger sampling of your cervix to check for and to remove pre-cancerous or cancer cells.
Any tips for making it a little less uncomfortable?
If you've had a painful Pap test in the past, mention it to your doctor. All women are different -- your cervix might tilt to the front or back or side. Ask your doctor to note any tilt in your file (so you both can avoid the whole poke-around-down-there-trying-to-find-the-right-of-way next time).
For post-menopausal women, talk to your doctor about possibly applying topical estrogen for one to two weeks before your Pap test.
You can take an Advil a half hour before the test. And try your very best to take a deep breath and relax. (Easier said than done, but try!)
If during the test you are in pain, ask your doctor if you can tip your pelvis up to reposition (by putting your hands under your bum).
I can't remember if my last Pap was two years ago or three -- but I think it's definitely worth a call to my family doctor (or a look in my MyChart!) to see if it's time to book one. I think I can stand a few moments of discomfort knowing it's for a potential lifetime of better health.
Learn more about women's health from Sunnybrook experts at health.sunnybrook.ca
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You know your body best. If you notice any unusual changes like abnormal bleeding from your vagina, pain in your pelvis or lower back, or pain during sexual intercourse, don't ignore it. Make some time to talk to your doctor.
Eat a balanced diet and try not to smoke. Smoking and exposure to second-hand smoke have both been linked to cervical cancer. If you smoke, reducing your risk of cervical cancer is yet another reason to quit.
You should have a Pap test within three years of becoming sexually active, or by the age of 21. If you are currently not sexually active or have not been sexually active in years, experts suggest still getting the test.
You should have a Pap test performed every one to three years depending on previous results. If you have trouble remembering, there are a number of calender apps you can sign up for.
Doctors recommend you have the Pap test in the middle part of your menstrual cycle — that means between 10 to 20 days after the first day of your period.
Don’t have sexual intercourse 24 hours before the test, as this can affect your results.
If you've had a hysterectomy (surgical removal of the uterus), you may still need a Pap test. Talk to your doctor for more information.
The biggest risk factor for developing cervical cancer is an infection of the cervix with human papillomavirus (HPV), a sexually transmitted virus. HPV infections are quite common and most go away on their own, but some don’t. These are the infections that can lead to cancer if they aren't caught by Pap tests and treated early.
Get vaccinated against HPV. The HPV vaccine can help reduce the risk of cervical cancer, as well as vulvar, vaginal and anal cancer.
Know your medical history as well as your family history, especially if anyone in your family has had cancer. However, cancer can affect anyone at any stage of life, so give yourself the best chance for survival by getting it diagnosed early.
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