What IS a Pap Smear Anyway?

You know you need one every few years (and sometimes more frequently if you’ve had a recent abnormal result), but what exactly is the infamous pap smear, what does it have to do with HPV, and do you really need it?

The clearest and most simplistic way to think about it is this: pap smears are quick tests that check for cervical cancer, and the abnormal cells that lead to cervical cancer. Because the majority of cervical cancer comes from exposure to the very common virus, HPV (human papilloma virus), which most sexually active people have been exposed to at least once in their lives (again, very common and mostly not dangerous), it’s important that all sexually active people with a cervix have routine testing.

Here are some quick facts about pap smears:

1. Cervical cancer screening used to begin once a person became sexually active, no matter how young they were. Now, the official recommendation is to start at age 21, regardless of whether or not a person is sexually active. This is because there will always be a small percentage of cervical cancer cases that happen “de novo,” or out of nowhere, with no prior exposure to HPV.
2. Speaking of HPV, the human papilloma virus is incredibly common and nothing to be ashamed or, or worry about. I like to think of it like an upper respiratory cold, but for your cervix (hang in there with me for a sec). When you get a cold, there’s nothing really you can do to clear it except wait it out. That’s because the vast majority of common colds are viral and do not respond to antibiotics (the over the counter cold medicines you take do not make it go away, they only make you feel slightly better in the meantime, while you wait out the natural course of the cold). The same is true for the HPV virus on your cervix. Once exposed, the natural course is for your body to clear it on its own in 1 ½ to 2 years. If for some reason the virus doesn’t clear (due to a poor immune system response or a particularly bad strain of the virus, for example) then that’s when we move on to other interventions like a colposcopy (procedure to look up close at your cervix with a microscope and even take biopsies).
3. If you’re vaccinated against HPV, you still have to get regular pap smear. So sorry, but this is true. It’s because the vaccine, while an amazing public health advance, can’t possible protect against every possible viral strain in existence, so there is always the random chance that you could be exposed to and affected by one of the strains from which you weren’t exposed.
4. In case you were wondering about the actual mechanics of a pap smear, here are all the details. First, the provider inserts a speculum (that’s the metal or plastic tool that goes into the vagina and opens to expose your cervix). Then the provider uses a small brush to gently touch the outside of your cervix and sample the cells of what’s called, the transformation zone. If there was ever an opportunity for cells to go rogue, this is where it happens, and that’s because this zone is where two different types of cells meet and change (the glandular cells above that are more similar to the cells inside your uterus, and the squamous cells below that are more similar to the cells of your vagina). That is literally it.
5. Pap smears and even colposcopies are totally fine in pregnancy. In fact, we want you to be up to date on your pap smear during pregnancy, to make sure that nothing untoward with the cervix affects your growing nugget.
6. Pap smears aren’t forever. As long as the preceding 20 years of pap smears have been normal, you officially graduate from cervical cancer screening at age 65!

And those are the nuts and bolts of the pap smear. See, nothing to fear or be afraid of! Now, call your gyno to make sure you’re up to date with yours.