Pap Smears During My Monthly Cycle?

This question worries more patients coming in for their pelvic exams and pap smears than any other general question we get when they come in for checkup.

Different doctors may have different policies on whether to do pap smears during the menstrual cycle. So if you start your cycle prior to your appointment call your gynecologist‘s office to get advice about rescheduling.

It is a very intimate exam and can be stressful because they worry about having to undress and be examined, and hope it won't hurt or uncomfortable. Hygiene is a big concern. Most of us in this country are very clean, but many women also make sure they have their legs and underarms shaved and all other areas trimmed or waxed, according to personal preference, and a lot of patients feel uncomfortable being examined during their cycle. It is always a patient’s choice to reschedule if she is uncomfortable.

What has changed for doctors? It used to be that if a woman started her cycle she had to reschedule because the pap sample was smeared on a slide and then sprayed with fixative. The pathologist would then have to examine the slide under the microscope. So if there was a lot of blood & mucous it would obscure their ability to see the cervical cells and make a correct diagnosis. Today we obtain the sample exactly the same, but instead of smearing it on a slide the entire sample goes into fluid. Once the pathologist receives it, the bottle is placed upside down in a centrifuge to separates the blood, mucous, and discharge from the cervical cells. Once separated those cells can be placed on a clean slide to be thoroughly examined.

That said it is usually best to reschedule if you are having your period. The pap test is the most effective screening tool for cervical cancer, and hormonal changes that occur during the time of the menstrual cycle can cause cell changes which make it slightly more difficult for the pathologist to interpret the sample. The changes would not be mistaken for cancer, but could cause the pap test to be reported in such a way that a repeat may be needed to clear up the confusion. I'm sure we all agree that one pap test a year is enough! So why go through that trouble and worry.

The best time during the cycle for a pap test is, day 10 to day 20 if possible. Day one is the very 1st day that blood is seen, even if it starts as spotting. You should also stay away from vaginal intercourse, douching, tampons, vaginal foams and jellies, vaginal inserts, and any sprays or deodorants 48 hours prior to the appointment. These can interrupt an accurate reading of the sample.

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How Often do I Need to Have a Pap Smear?

 "If I'm healthy, how often do I need to have a pap smear and pelvic exam?” 

The answer is not the same for everyone as it often depends on several factors, such as age, general health, and previous results of Pap smears.

A Pap smear test involves scraping a small sample of cells off of the cervix using a special brush. These cells are sent to a pathology lab to check for abnormalities that could indicate cervical cancer. Cervical cancer can be cured, and a pap test can detect changes that allow it to be treated before it becomes a serious cancer situation with symptoms.

All women should start getting pap tests once they become sexually active. Once sexually active, a woman is at risk for HPV (Human Papilloma Virus), which is the cause of cervical cancer. It is recommended that the first pap should be done within 3 years of becoming sexually active and then annually. Once there have been three normal paps in a row, one year apart, some women may be able to have paps every 2 - 3 years.

However, any woman with risk factors should continue yearly exams until the age of 65 years. The major risk factors for cervical cancer are HPV infection, history of abnormal paps, multiple sexual partners, sexual intercourse early in life, history of sexually transmitted diseases, smoking, and previous cervical cancer.

Some of you may have had abnormal pap smears and/or tested positive for HPV, and are worried about getting cervical cancer in the future. I also know many of you worry about being infected with HPV. The Human Papilloma Virus is passed sexually and is very common. It can lay dormant and flair up during times of stress. But, greater than 89 percent of all infections will spontaneously clear by age 45 and just need to have the pap tests followed until that time.

Since HPV is often passed through contact with semen, many women use WaterWorks, our personal vaginal cleansing system that uses only natural tap water with the special stainless steel nozzle to rinse out the vaginal area after sex to remove vaginal odors and excess semen. I know this makes them more confident about their hygiene and does not disrupt the normal vaginal flora that protects them from yeast and bacterial infections.

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HPV - Human Papillomavirus: What You Need to Know

I know many of you are worried when you are sent to me from your primary care doctor (or return after a pap I have done showing abnormal results) with dysplasia or Human papillomavirus - HPV. HPV is the name for a group of more than 100 types of viruses; more than 40 types of HPV can be passed through sexual contact.

We may feel like we are the only ones who have such a thing when we get it, but HPV is so easy to get and so common that over 70% of sexually active people will have HPV at some point in their lives. In fact, HPV is the most common STD in America, with well over 25 million cases and rising. Some people will never know they even have it because they never break out with warts or never have an abnormal pap test. HPV usually has no symptoms, but can have periods of flaring up and then hibernating. Most of the time there are no signs of infection or "flare ups" (such as abnormal discharge or itching) to alert us of a problem.

The pap test is designed to detect abnormalities of cervical cells and also HPV infections. The pap test will focus on High Risk abnormalities, as these types are known to cause cervical cancer. Low Risk types can cause genital warts - which are obvious when they are present and which can be removed. The HPV that causes cancer cannot be seen visibly when your doctor looks at your cervix or anal area. HPV is a flat warty virus that is invisible to the naked eye. The vaccine focuses on preventing only the top High Risk types of HPV.

If you have an abnormal pap test it is important to follow-up for further testing by your doctor to determine the reason for it. Sometimes yeast or bacterial infections, cervical irritation or hormone changes can be the cause. An abnormal pap does not always mean HPV infection or cervical cancer. A colposcopy is often done to help your doctor see the abnormal tissue on the cervix. It is a lot like getting a pap smear except a special magnifying scope can be used with a strong iodine solution or acetic acid solution that causes the HPV to show up white. This helps your doctor know where to do a biopsy to send a sample to pathology for further evaluation. Some colposcopies are being done with colpo biopsy brushes which are much faster and less painful.

If you do have HPV, there are different ways it can be treated right in your doctor's office. Using Cryosurgery, abnormal tissue is frozen off. The Loop Electrosurgical Excision procedure (LEEP) uses a hot wire loop to remove tissue. Laser treatment uses a beam of light to destroy abnormal tissue.

Cone biopsy, where a cone-shaped sample of abnormal tissue is removed from the cervix and looked at under the microscope, is done in the operating room and reserved for instances when biopsies show early signs of cancer. This biopsy also can serve as a treatment if all the abnormal tissue is removed.

If you have had the HPV vaccine, it does not mean you do not need to worry about HPV or about getting a pap test. HPV can lay dormant for years, and even undetected HPV can show up after the vaccine because the vaccine does not cure HPV. It simply prevents us from getting infected or reinfected.

Being in an exclusive relationship is the best way to prevent HPV infection or reinfection. Note, condoms don’t always protect you from HPV. But, they may reduce your risk of getting genital warts and other STDs.

Just remember, the best thing is to follow up with your doctor and get your annual pap smears, so you know you are healthy. Encourage your partner to visit the doctor as well.

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Is Cervical Cancer Preventable?

Cervical cancer can be preventable with regular Pap tests and pelvic exams. Unlike many cancers, cervical cancer can be detected very early, and Pap tests can detect if you are at risk for getting cervical cancer way before it is there.

The reason I'm bringing this up is because I was recently in surgery with my favorite Gynecological Oncologist (a cancer specialist for women) and we were very busy removing tumors from one patient after another - large tumors in the pelvis from the ovaries and the uterus. We were at the end of our day with one patient left who had been diagnosed with cervical cancer by a recent Pap test in her doctor’s office.

Cervical cancer is the type of cancer that grows from the origin of the cancer out until it invades the vagina, bladder, colon and moves up into the uterus. It can invade blood vessels and lymph nodes along the way, and that can help it to travel to other parts of the body.

It is important that we physically examine every patient prior to starting surgery and make sure all their vital signs are normal, like blood pressure, heart rate, and temperature. We do physical exams after someone is asleep (Exam Under Anesthesia - EUA) to determine if someone is a candidate for surgery or if they need to go directly for chemotherapy and radiation instead. Unfortunately, when we examined her, the cervical cancer had grown into her vagina and had become very large. We had to make the decision at that point to wake her up and recommend chemo and radiation as that would give her the best possible chance for a cure. Seems strange, but true.

I know we all like the idea of "getting the cancer out" and then chemo and radiation if necessary, right? I know the nurses in the room were really shook-up about this: “Wow, Dr. Boyd is it because she didn't get her paps every year? How fast did it get to this stage?” I know it is shocking and something we all worry about.

So could you have cervical cancer and not even know it? The truth is, yes, because it causes no pain or symptoms and is caused by the HPV virus that needs to be detected when you go in for your yearly exams and Pap tests. It cannot be detected on a blood test.

A Pap test can save your life. It can find the earliest signs of cervical cancer. If caught early, the chance of curing cervical cancer is very high. Pap tests also can find infections and abnormal cervical cells that can turn into cancer later on. Getting regular Pap tests is the best thing you can do to prevent cervical cancer. In fact, regular Pap tests have led to a major decline in the number of cervical cancer cases and deaths.

It is important for all women to have Pap tests, along with pelvic exam as part of their routine health care. If you are 21 years or older and have been sexually active, then you need a Pap test. Even women who have gone through menopause still need regular Pap tests. Even after a hysterectomy, paps and pelvic exams are very important as Vulvar, vaginal and anal cancer are caused by HPV, and with oral sex many women are getting oral and throat cancer from the virus.

Bottom line, put your health first. Find a doctor you trust and can talk to. You are worth it.

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