A Pap test or Pap smear is a sampling of the cervix to allow for early detection of abnormal cells. If left untreated, these abnormal cells can develop into cancer. Most abnormal pap smears are caused by infection with one of the many types of the Human Papillomavirus (HPV). 80% of all sexually active people have been exposed to one form of HPV or another. In other words, abnormal pap smears are extremely common. Sometimes we see some slightly abnormal cells that are not specifically precancerous. In these cases we will check for HPV. If there is no HPV present you need no further follow-up.
In patients over 30, your Pap test will automatically be combined with a screening test for HPV . If your Pap test is negative but the HPV is positive we will repeat both tests in a year.
If you have an abnormal Pap smear, your doctor may contact you to schedule a colposcopy. This procedure takes about 15 minutes and uses a microscope to see things that are not visible with the naked eye. After a speculum is placed in the vagina and a vinegar solution is placed on the cervix, the colposcope is used to visualize any precancerous changes that have taken place. One or more biopsies are taken as well as a sampling of the canal that leads to the uterus. Most people feel a cramping sensation during the colposcopy-taking 600mg ibuprofen (3 Advil) about an hour before can alleviate any pain you might have. You should feel well enough to resume normal activity immediately.
- Bleeding or brownish-black discharge is normal for several days.
- Avoid intercourse and tampon use for 72 hours after the colposcopy if biopsies were taken.
- If at anytime you are bleeding so heavily that you soak through a maxi pad call our office.
Results of the biopsies take 4-5 business days and are graded as mild, moderate or severe. Mildly abnormal cells almost always return to normal with time and just need to be watched closely with frequent pap smears.
Cells that are graded “moderate” or “severe” should be removed. A LEEP (loop electrosurgical excision procedure) can be done in our outpatient surgical suite. This procedure takes 15-20 minutes and removes abnormal cells by cutting away a thin layer of the cervix using a thin wire loop that is attached to an electrical current. A numbing injection is given prior to the procedure, but if you are very anxious you should talk to us about other options for anesthesia.
- Mild cramping and
- Watery discharge that is pink or brownish-black can be normal for up to two weeks
- Ibuprofen is the best pain reliever for the cramping.
- Avoid intercourse and tampon use for two weeks
- Call if you have heavy bleeding.
A post-operative visit should be made two weeks after the LEEP. Your doctor will examine your cervix and review your pathology report and any necessary follow-up.
It is important that you are monitored closely after an abnormal pap smear to ensure that the cervical cells return to normal. This close surveillance can last for several years-we usually recommend going back to annual screening after you have several normal pap smears in a row.