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Pap Smear

Guidelines from the Department of Obstetrics + Gynaecology, University of Cape Town

WHAT IS A PAP SMEAR

This is a test which is performed on the cervix (mouth of the uterus). It is performed by a doctor or nurse who inserts a speculum, which is a small metal instrument, into the vagina, sees the cervix, and with a wooden spatula, gently removes some cells for testing

WHY?

The cells of the cervix can undergo changes without one noticing it or experiencing any discomfort or bleeding . It is important that we pick these changes up, as they can be precursors to cancer.

WHAT CAN WE EXPECT?

You should be informed about the results of your pap smear, (irrespective of the result) by the doctor, nurse or clinic where it was taken. Read the following very carefully, as
it is very important:
Abnormal/atypical cells do not mean cancer. The cells of the cervix undergo changes long
before they become cancer. If you do get a phone call or letter saying you have abnormal cells on you pap smear DO NOT PANIC. It is not an emergency. All this means is that cells have been discovered which can be treated with a small procedure and you can prevent further changes form occurring.

WHAT RESULTS CAN I EXPECT?

  1. NORMAL— in which case the pap smear should be repeated 1-3 yearly.
  2. ASCUS (atypia) or LSIL (Low grade dysplasia) or CIN I (Cervical Intra-Epithelial Neoplasia) In these instance you will be asked to return for a pap smear in 4-6 months. The reason for this is that these cells can actually return to their normal state within this time. The question often asked is: “Is 6 months no too long?” The answer to this question is that changes, even if they get worse happen over a period of 10—15 years. Therefore we do have time.
  3. HSIL (High grade dysplasia) or CIN II or III
    In this case you will be called back for a colposcopy. This is a small test that examines the cervix with a magnifying glass. It enables us to have a further look at the cervix to identify these abnormal cells (which are not cancer cells). We may then need to treat them with a very small procedure. In this way we can prevent cancer of the cervix developing.
    These abnormalities of the cervix are usually associated with HPV (Human Papilloma Virus). We know that HPV always play a role in the development of abnormal cervical cells, but you need not be alarmed if your doctor tells you that there is HPV present. 35% of the population has HPV and there is no need to be worried about it.

SUMMARY

The pap smear is a very useful preventative test performed on the cervix to alert us to atypical or abnormal cells which may or may not need treatment to prevent cancer from developing.

Note: The pap smear only shows what is happening to the Cervix — Not to the uterus or ovaries!