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Pap Smear

Australian guidelines recommend two yearly pap smears from the age of 20 years or within two years of starting sexual activity. Regular screening enables early detection and treatment of cervical abnormalities to prevent progression to cervical cancer. Abnormal vaginal bleeding patterns such as intermenstrual bleeding or postcoital bleeding should be discussed with your GP as this may indicate cervical abnormalities.

All women between the ages of 18 and 69 years, who have ever been sexually active, should have a Pap test every two years.

Abnormal Pap smear

A Pap smear or Pap test is conducted as part of a woman's routine health examination, after the age of 20. It is not a diagnostic test, but is a screening tool used to detect any abnormal cells in the cervix, which is the lower part of the uterus that opens into the vagina.

A Pap smear helps in early detection of serious medical conditions such as cervical cancer.

However, an abnormal Pap smear does not necessarily denote cancer, it may also indicate the presence of infection or abnormal cells called dysplasia. Abnormal results highlight the requirement of supplementary testing to identify and confirm an underlying problem.

Causes of abnormal Pap smear

An abnormal Pap smear may indicate any of the following:

  • Infection or inflammation
  • Herpes
  • Trichomoniasis
  • Dysplasia (abnormal cells that may be precancerous)
  • HPV (Human Papilloma Virus) infection

Presentation

Usually, abnormal cells do not produce any symptoms for the woman. Moreover, even the presence of HPV in an abnormal Pap smear is asymptomatic. A regular Pap smear is therefore very useful in early detection of any abnormalities.

An abnormal Pap smear, secondary to a sexually transmitted infection, however, may induce the following symptoms:

  • Abnormal discharge from the vagina, such as change in the amount, colour, odour or texture
  • Abnormal sensations such as pain, burning or itching in the pelvic or genital area during urination or sex
  • Sores, lumps, blisters, rashes or warts on or around the genitals

Treatment

Following an abnormal Pap smear, the next step is further testing to confirm the cause of the abnormal cells.

A repeat Pap smear or test for human papilloma virus (HPV), a major risk factor for cervical cancer, may also be recommended.

Depending on the age of the patient and the type of abnormal cells, the doctor may recommend the following treatment options:

  • Cryosurgery, which involves freezing the abnormal cells, which are then surgically removed.
  • Cone biopsy or LEEP procedure, where a triangular segment of cervical tissue, including abnormal cells, is removed, by specially designed instruments, for evaluation.

Abnormal Pap smear during pregnancy

A Pap smear during pregnancy is very safe. In case of an abnormal Pap smear, a colposcopy can be performed during pregnancy. However, further treatments are delayed until the birth of the baby. Often, the birth process washes away the abnormal cervical cells.