Stryker FamilyCare

400 West Gowe St, Suite 400     Kent, WA 98032     253.859.CARE (2273)     Fax: 253.850.8894

Why You Need a Pap Smear Now More Than Ever!

Abnormal Pap smears with evidence of human papillomavirus (HPV) infection and/or precancerous changes (dysplasia) are appearing more frequently in sexually active women.

These changes may be simply the result of the greatly increased number of young and middle-aged women in this country -the baby boomers. Causes for this national trend could include sexual intercourse at an early age, multiple sexual partners, unprotected intercourse, and possibly, increased virulence of some types of human papillomavirus (HPV). Whatever the reason, Pap smears taken from these women are frequently showing precancerous cellular changes or dysplasia, indicating cervical disease that may progress to more severe disease in 5 to 15 years, if not treated.

There is strong evidence to suggest that the majority of cervical precancers occur because of previous HPV infection. HPV is probably the single most important factor in the development of cervical precancer and cancer. Fortunately, the majority of women with HPV infection will never develop cervical cancer. Studies are presently underway to determine which women with HPV and mild cell abnormalities need immediate treatment and which can be followed with repeat Pap smears. (For more information about HPV, see our brochure, "Human Papillomavirus (HPV) and Cervical Cancer -What a woman needs to know!")

The Pap smear test has decreased deaths from cervical cancer by 73% in the U.S. in the past 50 years. Since most cervical cancers develop slowly and treatment is almost 100% successful if the cancerous process is discovered early, the Pap test is your second best defense against cervical cancer; your first defense is to avoid exposure to human papillomavirus by safe sex.

What is the Pap Smear Test?

The Pap smear test is a simple, convenient, and painless way of detecting early cellular changes so that cervical diseases can be treated early and simply.

During your pelvic examination, the clinician will place a speculum in your vagina and slowly spread the walls of the vagina apart, until s/he can see your cervix. Then a sample of the cells and fluids from the cervix are collected with a plastic or wooden scraper and from the endocervix with a brush, moistened cotton swab, or plastic suction tube. The collected sample of cells and fluids is spread onto a glass slide, that is then placed in a preservative solution and sent to a cytopathology laboratory.

For clinicians who have access to a laboratory equipped with a ThinPrepÒ Processor, instead of smearing the sample onto a slide, s/he rinses the entire collected sample directly into a vial of preservative and sends the vial to the laboratory. There, the ThinPrep Processor is used to automatically place a thin layer of cells onto the microscope slide, making it easier to see the cells.

In both cases, the slide is stained to reveal cellular detail when examined under a microscope by a specially trained and certified professional cytotechnologist. A pathologist will confirm any questionable or abnormal findings and will provide a report to your clinician.

When you have carefully followed the "Instructions for Pap test preparation" in this brochure, and your clinician has collected a sample with a scraper and a brush from the correct area of the cervix, and the Pap smear (slide) has been carefully prepared and examined by a well-trained cytotechnologist in a "quality" cytopathology laboratory, then a single Pap smear can be 95% accurate in detecting abnormal or precancerous cells.

Who Should Have a Pap Smear and Pelvic Exam?

All women should get routine Pap smears, beginning at the time of first sexual intercourse or by the age of 18 years, whichever comes first.

Women with symptoms of genital disease should schedule an examination as soon as possible. Signs of possible genital disease (not necessarily precancer or cancer) are:

• unusual vaginal bleeding-after intercourse, after douching, between periods, after menopause
• vaginal discharge or unusual odor
• genital itching, irritation, or burning
• genital sores, warts, or rash
• painful intercourse
• painful urination and/or urinary urgency
• pelvic pain (especially with chills or fever)
• anal or rectal pain and/or discharge.

Who is At Risk?

You have a higher than average risk for HPV, cervical precancer and cancer, and other sexually transmitted disease, if you are sexually active and are included in two or more of the following categories:

• intercourse before age 18, particularly at puberty
• atypical cells on a previous Pap smear that were not explained by the presence of infection, inflammation, irritation, menses, or menopause
• you currently have sex with more than one partner or have had two or more sexual partners in your lifetime
• sexual activity with a partner who has had an STD, especially genital warts, or who has had many previous partners
• your sexual partner has HPV or has had intercourse with women who developed HPV, cervical cancer, or precancer
• you take birth control pills and/or have unprotected sex, for example, not using condoms, vaginal spermicides, a cervical cap, or a diaphragm
• you smoke or you live with someone who smokes
• you have altered immunity or take drugs that depress the immune system
• your mother took DES (diethylstilbestrol) while pregnant with you
• you test positive for HIV
• your diet lacks normal amounts of folic acid, beta carotene, or Vitamins C and E, commonly found in fresh fruits and vegetables
• early age at first pregnancy and multiple pregnancies
• if you douche more than four times a month.

How Often Should You Have a Pap Smear Test?

Generally, after 3 satisfactory, negative annual Pap smear examinations, the Pap smear test can be repeated every 1-3 years. This schedule may be more frequent, depending on your "level of risk" for HPV, cervical precancer, and other STDs.

• Very high risk situations:
  • six or more partners a month
  • partners from large cities where STDs are more common
  • anonymous contacts and casual sex
  • infrequent use of condoms and spermicides
  • frequent anal intercourse
  • frequent use of mind-altering drugs and alcohol

• High risk situations:
  • three or more partners a month
  • partners from large cities where STDs are more common
  • sex with known STD-infected partners
  • occasional use of condoms and spermicides
  • infrequent anal intercourse
  • infrequent use of mind-altering drugs and alcohol

• At risk situations:
  • one or two partners a month
  • sex with known STD-infected partner(s)
  • frequent use of condoms and spermicides
  • no anal intercourse
  • do not use mind-altering drugs and alcohol

• Low risk situations:
  • monogamous relationship for years
  • no sexual intercourse
  • do not use mind-altering drugs
  • never had an abnormal Pap smear

Instructions for Pap Test Preparation:

It is important that you follow these pre-test instructions for ensuring an accurate Pap smear test.

• Try to schedule your appointment between the 11^th and 19^th day of your menstrual cycle. Count day 1 as the beginning of the menstrual flow and avoid having the test during the days of your menses.
• Postpone your Pap test if you have an active yeast infection.
• Avoid intercourse and the use of tampons for 24 hours before the Pap test.
• Do not use contraceptive jellies/foams for 3 days (72 hours) before your appointment.
• Do not douche or use vaginal medicine for 3 days before your appointment.
• You may shower, but do not tub bathe 24 hours before the Pap test.
• Inform your clinician about additional medication/conditions that may interfere with an accurate Pap test.
• Be honest and candid about your sexual health (genital signs or symptoms) and discuss any sexual practices that place you at risk.
• Discuss the Pap smear procedure with your clinician, and ask about the laboratory examining your Pap smear.

Sometimes the laboratory has difficulty in interpreting a specimen, because of insufficient cells or inflammation and will request another sample. If so, your clinician will call and request a return visit. For more information about Pap test results, read our brochure, "Pap Smear Results-An atypical Pap smear does not necessarily mean cancer."

What Happens After the Pap Smear Test?

It is not uncommon to have spotting of blood immediately after a Pap smear.

Otherwise, you will probably not notice any change nor have any discomfort as a result of the procedure.

Ask your clinician about obtaining the results of the Pap smear. Clinicians have different arrangements for communicating the results, so ask your clinician how and when you will be notified. Many clinicians do not notify their patients if the report is normal, but they will call or mail the results if you ask. You can also ask for a copy of the laboratory report from your clinician.

This brochure was prepared as an expression of our dedication to high quality Pap smear testing and our concern for your health and well-being.

Used with permission from:

ACCUPATH Laboratory Services, Inc.
10740 Meridian Ave. N., Suite G3
Seattle, WA 98133-9010
206/365-5177
800/222-8727
Fax: 206/362-0943

Ó 1993 R. Hasselbrack, M.D., M.S., F.C.A.P.