We routinely do things we do not enjoy because we know they need to be done. Just as much as I enjoy scrubbing the toilet and filing my tax return, so too do I enjoy my annual physical exam! 

We know we have to do it, so we grit our teeth and get it over with. Few people (men and women) find physical exams pleasurable, but they are necessary. Exposing areas of your person that have never seen the light of day can be not only uncomfortable, but for some very intimidating.  The experience of assuming the position and looking at your doctor’s head over a strategically-draped sheet (which does nothing to stop cool drafts) is at minimum—awkward.       

Regardless of how you feel about it, you should always make time to take care of yourself, including getting a routine Pap test. This test can detect cancer or changes in cervical cells that may lead to cancer. Each year, about 12,000 women get cervical cancer in the U.S. These changes have no specific symptoms, so prevention is the key. The big question is: when should they become part of your health program and how often should they be done?

Previously it was recommended that women should get their first Pap smears 3 years after they start having sexual intercourse. However in 2009, the American College of Obstetricians and Gynaecologists (ACOG) suggested women get their first Pap test at age 21 and every 2 years after.  This revised thinking is because adolescents have a very low risk of cervical cancer and a high likelihood that cervical cell abnormalities will go away on their own.

Women aged 30 years and older may get the test every 3 years if they have had three normal Pap test results in a row, unless:

• You have a history of cervical abnormalities or cancer

• You are HIV positive

• You are immunocompromised (after organ transplant, chemotherapy, steroid use)

• You or your mother took DES*(diethylstilbestrol) while pregnant

*DES was a drug given to millions of pregnant women between 1941 and 1971 to help prevent miscarriages.

If you are 70 years or older and have had three normal tests within the last ten years, you do not have to continue having Pap tests. As well, a total hysterectomy (with removal of the cervix) means you no longer need the test. However, if you had a subtotal hysterectomy (cervix not removed) you should continue screening.

When planning your visit, try to time it between 10 to 20 days after the first day of your period (mid cycle). Fight the urge to 'prepare' for you appointment and 'tidy up'.  Avoid using vaginal douches, contraceptive jelly and vaginal suppositories for at least 2 days prior as they can wash away or hide abnormal cervical cells.

In addition, try not to have sex 24 hours before your appointment.  Remember thatthe test is being taken by a professional who has most likely taken thousands of smear tests throughout their career.  If it will make you more comfortable, the test can be done by a female.  The most important thing is that you have it done. It may take several weeks for the results of your Pap test to be sent back to your doctor or nurse's office, so be patient.

Should your test come back with an abnormal or unclear Pap smear, do not panic!  This just means there are changes.  You do not automatically have cancer!  Cervical cells can change if:

1. You have a vaginal infection (bacterial, viral or yeast) or sexually transmitted infection (STI)

• Presence of Polyps or Cysts

• Hormonal changes that occur during pregnancy or menopause

• Have an inflammation (redness and swelling)

if you do get an abnormal or unclear Pap smear,your doctor will recommend appropriate follow-up and possible treatment if necessary to ensure these abnormal cells do not become cancerous cells. Remember, nearly all cervical cancers are treatable if caught early.    

There are some factors which can increase your risk of developing cervical cancer and cause changes in your cervix:

• About 95-100% of cervical cancers are related to the human papillomavirus (HPV), also called genital wart virus. There are more than 40 HPV types that can be passed from one person to another through sexual contact (genitals, anal, or mouth regions). Condoms may lower the risk of HPV infection. 

• Smoking is a well-known risk factor for cervical cancer.  A direct carcinogenic action of cigarette smoking on the cervix has been upheld on the grounds that nicotine metabolites can be found in the cervical mucus of women who smoke.

• There is an increased risk of cervical cancer associated with long-termuse (12 years or more) of oral contraceptives.

• Having multiple sexual partners and becoming sexually active at a young age.

• Women whose immune systems are weakened or have become weakened by medications have a higher risk of precancerous changes in the cervix.

When you go to your doctor for your Pap smear make sure they also do a pelvic exam to ensure the health of your reproductive system (vagina, uterus, and ovaries).  They should also screen for other sexually transmitted infections (such as HPV).   A Pap test cannot detect other cancers such as those of the ovary, vagina or uterus. 

If you are a low-income woman with little or no health insurance the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides free or low-cost mammograms and Pap tests.  Protect your health and take the opportunity to get a routine exam, regardless of how uncomfortable they make you feel.

Taking a few precious minutes every second year to get a Pap test can help to protect you from a cancer that could have been treated in the early stages. 

Claude Gallant