March 25, 2017 Liza Colimon, MD Honoring Health Vow # 6 I Vow to Advocate for Myself and Pledge to Prioritize My Healthcare Needs I feel like passing out hugs when my patients come in with problems and say, “But I had my pap smear and everything was fine.” And then, there I am, the bearer of bad news. Let’s get one thing straight. A Papanicolaou, or Pap smear, is a screening test for cervical cancer. It provides no other information about your uterus, ovaries, or overall gynecologic health. And then, the second layer of disappointment sets in when I inform a patient we are no longer recommending screening every year for the majority of women. We have our reasons and large medical studies focusing on the outcomes of hundreds of thousands of women to guide us. Of course your screening plan will depend on your medical and sexual history. But stay tuned. Pap Smears 101 is a three part series and I’ll be discussing screening recommendations next time. Our goal is to prevent cervical cancer and keep you healthy. So if worry sets in, keep that in mind and let it be your motivation to make time to have the test done. Studies in the American Journal of Public Health found that over 50% of women diagnosed with cervical cancer had never had a pap smear. Another 10% had not had the screening test in a five-year period. We are particularly screening for squamous cell or adenocarcinomas of the cervix. The test is performed by collecting superficial cells from of the outside of your cervix with a plastic spatula and by using a small brush, which we place inside the opening of the cervix. By turning the brush, we are able to remove cells from the inside of the cervical opening. The cells are then placed in a vial with a preservative solution, which will allow a pathologist to look at the cells under a microscope and ensure they appear normal. Occasionally we may find abnormal cells on your pap smear that have trickled down from your uterus. If so, we may need to perform a biopsy of your uterine lining to make sure no uterine cancer or pre-cancerous abnormal cells are present. But you should know that your normal pap smear should not reassure you that everything is fine if you are having other symptoms such as pelvic pain, abnormal bleeding, or irritating vaginal discharge. We prefer that you are not on your period on the day you are scheduled for you pap smear. It can still be done, however blood can make the cervical cells more difficult to see for the pathologist. And often times, it will have to be repeated if your bleeding is heavy. So if you don’t love having a speculum exam, schedule your pap smear when you are not on your period. It’s not uncommon that I have patients come for their pap smear with a vagina full of Monistat or anti-fungal creams they are using to treat a yeast infection, Metrogel they are using to treat Bacterial Vaginosis, or vaginal estrogen cream. Any cream or gel you put inside your vagina 2-3 days prior, may interfere with the results. So keep it simple and don’t put anything inside your vagina before your appointment.