Pap Smear
Is it Essential?
Dr David Kiragu explains why a Pap smear is necessary for all women of reproductive age.
PAP smear is a test performed on women of reproductive age in order to assess their risk of developing cancer of the cervix (the neck of the uterus which opens into the vagina).
Why do I need a Pap smear?
PAP smear is the short name for papanicolaou test. It is important as a screening method to rule out presence of cancer of the cervix or its pre-cancerous state. This helps in prevention of cancer of the cervix. Cancer of the cervix is one of the two most common cancers in Kenya, the other being breast cancer. However cancer of the cervix can be prevented, if changes in the cells of the cervix are detected early. When such changes are present the woman can undergo various modes of treatment to prevent cervical cancer from developing. These cellular changes ordinarily take a long time to transform to cancer and thus provide an opportunity for preventative interventions.
What causes cancer of the cervix?
This type of cancer is basically due to changes that occur when some of the cells lining the cervix are unstable. This instability occurs mostly in an immature cervix or one that has had excessive stimulation through multiple births and infections. It is currently suspected that most if not all cases of cervical cancer are initiated by the Human Papillomavirus (HPV)* or Genital Wart virus**.
Do all women need a Pap smear?
All women of reproductive age should have a Pap smear done at the recommended times. However, women who need it most are those who are sexually active, those with multiple partners, those with a history of Sexually Transmitted Diseases and those who started sexual life early (below 18 years), as their chances of contracting the cancer are higher.
How is the examination done?
It is done in a clinical set up. A patient lies on a table, flexes her hips and opens the thighs wide to position her pelvis for examination. A speculum (an instrument used to open up the walls of the vaginal canal to see the interior) is inserted into the vagina.
Using a fine brush, the surface of the cervix is gently scrapped to collect cells. This is smeared on a clean slide and fixed using 90% alcohol (this is a special preservative or fixative that maintains the cells the way they are without degenerating). The specimen is then processed in the laboratory and analysed by a pathologist who issues a technical report based on the appearance of the cells.
Can it be used as a test of identifying STDs?
It is not the ideal test for identifying Sexually Transmitted Diseases. There are other more accurate and affordable ways of testing for STDs.
How do I prepare for a Pap smear?
You need to have your Pap smear examination done when you are not menstruating. This is because blood and cells from the endometrial*** cavity may obscure cervical cells leading to inaccuracy of the examination. You should also inform your doctor if you are under any medications or taking birth control pills.
How long does it take before getting the results?
The results are usually obtained within a week at most. Waiting period is principally for logistical reasons.
How often do I need a Pap smear?
Ideally, a Pap smear should be done annually. However, current evidence suggests that the interval may be increased after a number of normal reports, usually three. An abnormal Pap smear can be repeated after 6 months or sooner if the results are suspicious. Depending on the results, a woman can undergo colposcopy (an examination of vaginal and cervical tissue with a colposcope, which is a sophisticated microscope, to detect the location of abnormal cells). This is a more specific analytical procedure. If results confirm presence of abnormality, treatment is recommended.
Is a Pap smear examination painful?
It is not a painful procedure provided the patient is relaxed, and has undergone counselling. Any discomfort can be overcome by proper counselling.
Can a Pap smear be done when one is pregnant?
Pap smear can be performed during pregnancy although the interpretation of the results can be challenging because of hormonal effects. Therefore it is best to schedule a Pap smear outside pregnancy. If done during pregnancy, the pathologist should be informed before he records his findings.
Note:
A vaccine has been developed (and was launched in Nairobi on July 6th) for cervical cancer, it is administered to girls between the ages of 9 and 13 year, but who have never been sexually active, it costs around 400 US Dollars.
*HPV is a name given to a group of viruses that includes more than 100 different strains or types. More than 30 of them are sexually transmitted and they can infect the genital area of both men and women.
**Genital warts are single or multiple growths or bumps that appear
***Endometrium is the mucous membrane lining the body of the uterus.
END:PG8/36-37