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Pap Smear

Slide Pap smear for diagnosis in the community.

A Pap smear is a screening test for cervical cancer. It tests for the presence of pre-cancerous or cancerous cells on your cervix. The cervix is the opening of the uterus and cervical cancer is one of the commonest cancer amongst women in Malaysia.

During the routine procedure, cells from your cervix are gently scraped away and examined for abnormal growth. It may be mildly uncomfortable, but doesn’t usually cause any long-term pain.

Who Should do it?

Malaysian MOH guidelines recommend that women get regular Pap smears every two to three years starting at age 20, following 2 consecutive years of normal pap smears 1 year apart. Some women may be at increased risk for cancer or infection and need more frequent tests if:

  • HIV-positive
  • have a weakened immune system from chemotherapy or an organ transplant

If you’re over 30 and have not had abnormal Pap tests, ask your doctor about having one every five years if the test is combined with a human papillomavirus (HPV) screening.

HPV is a virus that causes warts and increases the chance of cervical cancer. HPV types 16 and 18 are the primary causes of cervical cancer. If you have HPV, you may be at an increased risk of developing cervical cancer.

When should I stop screening?

You should still consider regular Pap smears after 20years of age, regardless of your sexual activity status. That’s because the HPV virus can be dormant for years and then suddenly become active.

Women over the age of 65 with a history of normal Pap smear results may be able to stop having the test in the future.

What should I do before a pap smear?

Try to avoid having sexual intercourse, douching, or using spermicidal products at least 48 hours before your test because these may interfere with your results.

In most cases, it’s safe to have a Pap smear in the first 24 weeks of a pregnancy. After that, the test may be more painful. You should also wait until 12 weeks after giving birth to increase the accuracy of your results.

Since Pap smears go more smoothly if your body is relaxed, it’s important to stay calm and take deep breaths during the procedure.

What happens during pap smear?

Pap smear is a screening procedure for cervical cancer.

Pap smears can be a bit uncomfortable, but the test is very quick.

During the procedure, you’ll lie on your back on an examination table with your legs spread.

Your doctor will slowly insert a device called a speculum into your vagina. This device keeps the vaginal walls open and provides access to the cervix.

Your doctor will scrape a small sample of cells from your cervix. There are a few ways your doctor can take this sample:

  • Some use a tool called a spatula.
  • Some use a spatula and a brush.
  • Others use a device called a cytobrush, which is a combination spatula and brush.

Most women feel a slight push and irritation during the brief scraping.

The sample of cells from your cervix will be preserved and sent to a lab to be tested for the presence of abnormal cells.

After the test, you might feel mild discomfort from the scraping or a bit of cramping. You could also experience very light vaginal bleeding immediately following the test. Tell your doctor if discomfort or bleeding continues after the day of the test.

How accurate are the results?

Pap tests are very accurate. Regular Pap screenings reduce cervical cancer rates and mortality by at least 80 percent . It can be uncomfortable, but the brief discomfort can help protect your health.

Why is my smear result inadequate?

When a smear is reported as inadequate, it usually means that not enough cells  from the cervix were in the sample for the lab to give an accurate result.

There can be several reasons for this:

  • Not enough cells were collected due to presence of vaginal discharge, or dryness (usually in menopausal women)
  • The cells collected were not able to be seen properly, due to presence of blood or sometimes discharge
  • The correct sort of cells were not samples (this is especially important if you have had a previous ‘glandular’ abnormality)

How many samples are inadequate?

About one in 50 samples are inadequate

Is there anything I can do to help for next time?

If you have any discharge or irregular bleeding, it is important that you report to your doctor. This may need investigating or treating before you have your test repeated.

It is important that samples are not taken when you are having a period. Sometimes your doctor may suggest that you use a cream or gel that you put inside your vagina for a couple of weeks before having your test repeated.

What if my next test is inadequate too?

If this is your first inadequate test and your next one is inadequate, you will be advised to have it repeated again.

If you have three inadequate tests in a row, you will be referred to a gynaecologist for further test.

Does a Pap smear test for HPV?

The main purpose of a Pap smear test is to identify cellular changes in the cervix, which could be caused by HPV.

By detecting cervical cancer cells early with a Pap smear, treatment can start before it spreads and becomes a bigger concern. It’s also possible to test for HPV from the Pap smear specimen, too. And this test should be done every 5 years.

You can contract HPV from having sex with men or women. To lower your risk of contracting the virus, practice sex with a condom or other barrier method. All sexually active women are at risk for contracting HPV and should get a Pap smear at least every two years.

IMPORTANT POINTS FOR PATIENTS

  • It can be normal to feel embarrassed about having cervical screening, especially at your first appointment. Remember, your nurse carries out screening tests every day.
  • If you have never had sex, talk to your practice nurse to help you decide if you want to have screening.
  • Even if you have not had any sexual activity for a long time, it is still important you go for screening.
  • You can still get HPV if you only have one sexual partner.
  • You can take somebody with you for support.

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