What are paps for?

The main point of the pap is to look for abnormal cervical cells, which could indicate cervical cancer. Cervical cancer can be a serious threat to women, and most women noticed no signs or symptoms when their pap came back abnormal. So paps can detect abnormal cells long before a woman would ever realize she had cancer or was at risk for cancer. Early detection means more treatment options.

During the pap the doctor can also look for signs of infection or other issues, such as redness, swelling, unusual discharge, etc. Many doctors will also do a breast exam when you come in for a pap.

How do women get cervical cancer?

Unlike other forms of cancer, cervical cancer is usually caused by a virus.  The virus is called HPV, and it can be sexually transmitted.

HPV is not uncommon.  In fact, it's estimated that 80-90% of people either have it, had it, or will get it!  HPV often has no symptoms at all.  That's why paps are so important, and that's why they're recommended for all women.

What does a pap feel like?

Paps may be uncomfortable, but they shouldn't hurt. The more tense you are, the more uncomfortable it will probably be. So take a deep breath, relax your body, and think good thoughts.

The doctor knows you're uncomfortable, so he or she will try to hurry and be gentle. They start by sticking a lubricated tool into the vagina. This holds the vagina open. Then the doctor sticks a Q-tip looking thing in, touches your cervix, and that's it. The whole thing is over within a minute or two.

When does it need to be done?

Doctors all used to say that women needed a pap once they turned 18 or started having sex, whichever happened first.  And from there, they'd need to come in for paps every year.  And some doctor still do recommend that.  But cervical cancer is slow to progress, and our medical technology gets better all the time.  That means we're detecting cervical cancer and abnormal cells earlier.  So doctors don't all agree, and you may notice a good deal of variety in terms of their recommendations!  Some doctors are starting to say it's ok for women to wait longer before their first pap (around age 21 or within three years of first having sex, whichever happens first) and to wait longer in between paps (up to three years for women under 40 who have normal paps). 

I had an abnormal pap. Now what?

If the doctor tells you your pap is abnormal, it means your cells didn't look quite right. That doesn't necessarily mean you have or will get cervical cancer though. In fact, you probably don't have cervical cancer and you probably won't get it.

Abnormal cells are common (my doctor said she sees about three abnormal paps a day), and most abnormal cells never become cancerous.  Some things can also interfere with a pap and give you an abnormal result even if your cells aren't actually abnormal.

But the doctor will want to take a closer look. So the next step is to get a colposcopy. That just means they take a good long look at your cervix. It feels just like a normal pap, but it lasts longer (about 10 to 15 minutes instead of one or two - I'd recommend bringing a magazine or something to take your mind off it a little bit and help you relax.).

If the pap was wrong and your cervix looks normal then you probably don't have HPV, and you get to put your clothes on and go home.

But if it does look like you have abnormal cells on this close up exam, that means you probably do have HPV.  The doctor will then take a tissue sample to biopsy to make sure you don't have cancer. You'll probably feel cramping as if you had your period around this time (and you might continue to feel crampy for the next day or two). They numb the cervix, but many women say they still feel the pinch when the tissue sample is taken. I didn't feel anything other than the cramping though. Then you're done!  After that, the doctor may recommend coming in more often (usually every six months to a year).

What happens after the colposcopy?

The doctor should give you a pad, but I'd recommend bringing one with you just in case. That's because you could have a little bleeding. And they put a bunch of goo on your cervix to numb it and stop bleeding, and all that goo is going to come out at some point during the week (mine came out about three days after the colposcopy was done).

Avoid sex for at least two weeks. Seriously. Your cervix needs time to heal or else you put yourself at risk of infection.

My results took about two weeks to get.

What does HPV mean for my future?

It means you'll have to make doubly sure you get your paps regularly.  If you do not have health insurance, you can get free or low cost paps from clinics like Family Planning and Planned Parenthood.

Discuss it with your doctor to make sure you fully understand it.  And discuss it with your partner(s) as well.

There is no cure for HPV, but most people fight off the infection after a few years.

Other than that, most people with HPV have no signs, symptoms, or problems.

What about the HPV/cervical cancer vaccine?

There is a vaccine for HPV.  It helps prevent HPV but will not cure an infection that you already have.  It protects against some of the more common types of HPV, but it does not protect against every type of HPV (there are over 100 different kinds!).  So even girls who get the vaccine should get their regular paps.

The vaccine is mainly for girls ages 9 to 26.  It is most effective if a girl gets it before becoming sexually active.  The vaccine has not been tested in women over 26 or in pregnant women. 

But the vaccine is fairly new and hasn't been well tested even in the age group that it's recommended for.  That means we don't know if it will offer lifelong protection or if it will have nasty side effects ten years down the road.

So some doctor are recommending the vaccine, while others are saying it's best to hold off until more testing is done.  In other words, we already know cervical cancer probably won't kill you.  We're not entirely sure what the vaccine will do to you though.

How else can I protect myself against HPV?

Don't rush into sex.  The cervix is made up of two kinds of cells.  One kind is pretty tough, the other kind is weaker.  Our cervix starts out mostly made of the weaker cells, then it gets more of the tough cells once we reach adulthood.  Teens have a weaker cervix and are therefore more prone to HPV infections.

Limit your number of sex partners.  Every sex partner you have increases your chance of getting HPV and other STDs.

Use condoms.  Condoms do not offer complete protection from HPV, but they can help.

Other issues?

Don't be afraid to visit your doctor even if you are not due for your pap.  Schedule an appointment if you have pain and bleeding during urination, if your discharge takes on an unusual smell or color, if you need hormonal birth control, or if you have other questions or issues.