What's the deal with pap smears and HPV?
Pap smear. Those two words alone are enough to send a shudder through most Australian women. But have you heard, the pap has changed? So what exactly does it mean for people with a vagina?
We get the low down (ha! pun unintended) from Hannah, a doctor working in sexual health in Sydney.
At the last census it was looking like roughly 50% of Australians had a cervix. Wild right?
So why are we not all provided with the information we need to understand cervical care?! Why doesn’t anybody seem to know where it is or what it does?
Some basic definitions:
- Womb = uterus
- Neck of womb = cervix
Why we care about the cervix:
- It is important for pregnancy and childbirth (yay, that’s good)
- It can be affected by disease, including cancer (not so good)
What is cervical cancer?
Cervical cancer is a disease where the cells that line the cervix mutate, and become abnormal. The abnormal cells can grow and spread, which can result in significant illness and even death.
The large majority of cervical cancers are caused by Human Papilloma Virus (HPV) - a common sexually transmitted infection (STI). Most people don’t know when they’ve been infected with HPV, because it doesn’t usually cause symptoms. The other major risk factor for cervical cancer is cigarette smoking.
This is not meant to be all doom and gloom. There is actually good news in the area of cervical cancer! A summary of the good news:
- Cervical cancer has a long precancerous stage - so treatment can start before it even turns into cancer
- There is a cheap and accessible screening test - the Cervical Screening Test (CST). It used to be called the Papanicolau (Pap) Smear
- There is a vaccination (gardasil) that protects against 9 strains of HPV, including the ones most commonly associated with cancers
So what is the Cervical Screening Test (CST)?
When you go to your doctor for a CST, you can expect to feel a bit awkward, maybe a bit uncomfortable. But remember - your doctor has probably done hundreds or thousands of these - you shouldn’t feel embarrassed. In fact, it should be the opposite, you should feel empowered for looking after yourself.
So when you go to the doctor, they’ll explain everything to you before you’re naked from the waist down. If you need to pee, pee. It will make it more comfortable for you. Then you’ll lie on a clinic bed with your pants and underwear off, which always feels scary and abnormal. Some clinics will have fancy beds that have stirrups for your legs. Google it, it’s very glamorous. The doctor may put a pillow under your hips, or ask you to put your fists under your bottom. This is to make the procedure easier for them and more comfortable for you.
They will then insert a (hopefully well-lubed) speculum into your vagina. There’s lots of pressure and a bit of discomfort. The speculum is then opened, so that the doctor can see your cervix. A sample is then collected from the cervix to test for HPV.
You then have a few nervous weeks waiting for your results. If you have a normal result, you don’t need to have another CST for 5 years! Which is amazing, because until 2017, you had to have it done every 2 years.
I have summarised the differences between the old test (Pap smear) and new test (CST) in the table below.
|Pap Smear||Cervical Screening Test|
|What is it?||The old test that stopped in 2017||The new test that we will grow to love and respect|
|First test required||Age 18||Age 25|
|Frequency of screening (unless there is an abnormal result||Every 2 years||Every 5 years (the first one needs to be 2 years after your last pap smear)|
|The test||Looks for abnormal cells on the cervix that could indicate cancer or pre-cancer||Looks for Human Papilloma Virus (HPV) the virus that causes cervical cancer|
|How it is done||A doctor or nurse inserts a speculum into your vagina to see your cervix. A sample is collected.||A doctor or nurse inserts a speculum into your vagina to see your cervix. A sample is collected.|
So here is a list of ways to protect your cervix:
- Get the Gardasil vaccination. This is licenced in women age 9 to 46. However it is most effective if given before an individual becomes sexually active. The current vaccine covers for 9 strains of HPV and once you’ve had two doses you’ll be protected for life.
- Engage in regular cervical screening. Bit the bullet and do the uncomfortable thing. It might genuinely save your life.
- Practice safe sex. Use condoms with casual partners. Although HPV is transmitted by skin-to-skin contact so it will not eliminate the risk entirely.
- Stop smoking!
If you have any questions let us know in the comments below. Obviously, none of this should be taken as a diagnosis and if you have any concerns it’s best to speak to a qualified healthcare professional.
You can find more from the Empty Uterus here.