Pap smears are a screening tool used to detect abnormal cells in the cervix, which is the lower part of the uterus that opens into the vagina. Abnormal cells can indicate changes that may lead to the development of serious medical conditions such as cervical cancer. When caught early, these changes can be treated to prevent their development into cancer. This is why regular screening is so important.
An abnormal Pap smear can also indicate the presence of infection or abnormal cells called dysplasia, which does not necessarily denote cancer.
Abnormal cellular changes sometimes resolve on their own, so your doctor will often ask you to have a repeat Pap test in 6 or 12 months to look at whether changes have resolved, remained the same, or developed further. If the changes have not resolved after a period of time, or if they have developed, your doctor will most likely suggest that you undergo further investigation such as Colposcopy and/or treatment to remove the abnormal cells.
Causes of Abnormal Pap Smear
An abnormal Pap smear may indicate the presence of one or more of the following:
• An infection or an inflammation
• Dysplasia (abnormal cells that may be pre-cancerous)
• HPV (Human Papilloma Virus) infection
HPV is an asymptomatic sexually transmitted virus, very common in sexually active men and women. It is estimated that up to 80% of sexually active men and women will contract genital HPV at some point in their lives. Whilst usually harmless and asymptomatic, HPV can lead to cervical cellular changes that can then lead to cancer.
Usually cervical cellular abnormalities and their root cause do not present symptomatically, which is why screening is so important. However, in some cases there may be detectable symptoms, so if you experience any of the following it is worth visiting your GP or gynaecologist for investigation.
• Abnormal discharge from the vagina, such as change in the amount, colour, odour or texture
• Abnormal sensations such as pain, burning or itching in the pelvic or genital area during urination or sex
• Sores, lumps, blisters, rashes or warts on or around the genitals
Following an abnormal Pap smear, the next step is further testing to confirm the cause of the abnormal cells. A repeat Pap smear, Cervical Screening Test for HPV and colposcopy are all means for confirmation of abnormal cell changes.
Once changes are confirmed, treatment options are available and depend on the stage of change as well as the specific type of abnormal cells. Some options include the following:
• Cryosurgery: This involves freezing the abnormal cells which are then surgically removed.
• Cone biopsy or LEEP procedure: In this procedure, a triangular segment of cervical tissue, including the abnormal cells, is removed by specially designed instrument.
Following all kinds of treatment, a repeat Pap smear will be performed to ensure that the abnormal cells were removed entirely and you will be monitored closely for a period of time to ensure that they do not return. If there are still abnormal cells after treatment, or if the changes return, further treatment will be discussed with your doctor.
Abnormal Pap Smear during Pregnancy
A Pap smear during pregnancy is very safe. In case of an abnormal Pap smear, a colposcopy can be performed during pregnancy. However, further treatments are delayed until the birth of the baby. Oftentimes the birth process washes away the abnormal cervical cells.
Dr Farag will perform a Pap smear for all patients regardless of former Pap test results at your post-natal appointment, approximately six weeks after the birth of your baby.