In honour of World Health Day, we’ve launched BURO Health Week, where we’re empowering you with the critical knowledge you need to stay on top of your health. For our next instalment, find out why you need to start getting a Pap smear.

Quick question for the ladies: Have you had a Pap smear yet? No? Oh dear, that won’t do. In case you haven’t yet heard, Pap smears are crucial to your health, and you should be getting the test done regularly from the age of 21 (or within three years of becoming sexually active—whichever comes first). Why? Let’s get into it.

We spoke to Dr Nor Elyana Noordin and Dr Eric Soh Boon Swee—the Consultant OB-GYNs at Sunway Medical Centre Velocity and Island Hospital Penang respectively—to answer your burning questions. From whether Pap smears are really that bad to why you need to get them and how often, find the low-down below:

 

 

Pap smears: The origin story

“In 1928, a Greek microscopist and cytologist, Georgios Nikolaou Papanikolaou discovered that early cervical cancer could be detected by studying cells collected from the cervix,” explains Dr Soh. “This procedure was popularised in the 1940s and was named Pap smear after him. The widespread use of Pap smears has since changed the epidemiology of one of the deadliest diseases in women for the past 70 years.”

 

Why are Pap smears so important?

Introducing: Your cervix. Also known as the opening of your uterus, this small, button-like bit of your anatomy can cause quite a lot of trouble. Namely, cervical cancer.

According to Dr Soh, “cervical cancer is the second most common cancer in women (after breast cancer, except in some countries where women smoke widely and lung cancer is more common).” 

It is caused by a sexually transmitted infection called the human papillomavirus (HPV). In fact, Dr Soh explains that “HPV is now recognised as the cause of cervical cancer in over 90 per cent of cases. Hence, looking for high-risk HPV (from the cervix) is a good predictor for the risk of getting pre-cancer and cancer of the cervix.” 

Pap smears are thus especially significant because if cervical cancer is discovered at the ‘precancerous’ stage, it can be treated and its full evolution to cancer can be thus prevented.

 

 

When should you start getting Pap smears and how often?

“Generally, women should get a Pap smear starting from the age of 21,” Dr Noordin asserts. Why start so young? According to Dr Soh, this is because the evolution of cervical cancer takes many years. Getting a regular checkup ensures that any changes can be detected early on. Plus, because HPV is a sexually transmitted disease, Pap smears are also encouraged within three years of becoming sexually active.

“For women in their 20s, screening is recommended for every three years if the previous pap smear result is normal. However, there is also a relatively new screening method for cervical cancer: The HPV DNA test,” Dr Noordin elaborates.

What is the HPV DNA test? “The HPV DNA test looks for the strains of HPV that are most likely to cause cervical cancer,” explains Dr Soh. “Now, women aged 30 to 65 have three options for testing. They can have both a Pap test and an HPV test every five years. Or, they can have a Pap test alone every three years. Or, they can have HPV testing alone every three to five years.” 

“After the age of 65, women could choose to stop having cervical cancer screenings if they never had abnormal cervical cells or cervical cancer and have three negative screening tests in a row (if they are in now a long-standing stable monogamous relationship).”

 

TL;DR? Here’s a summary, for your convenience:

• For under-21-year-olds, Pap smears are not necessary unless you’ve had sexual intercourse. 
• For 21 to 29-year-olds, a Pap smear is recommended for every three years. 
• For 30 to 65-year-olds, a Pap smear is recommended every three years OR an HPV test every five years OR a pap test and HPV test together every five years.
• For 65-year-olds and older, you may no longer need pap smear tests if you never had an abnormal pap smear or cervical cancer previously and you’ve had three negative screening tests in a row; talk to your doctor to determine your needs.

 

What happens during a Pap smear?

On the whole, Pap smears are pretty quick and straightforward. Obviously, it’s best to ask your healthcare provider to walk you through the process, but if you need a quick run-through of the process to ease your nerves prior to your appointment, here it is:

1. First, your doctor will insert a speculum (a device that holds the walls of the vagina open) to make examining the cervix easier.
2. Then, they will use a small brush (called a cytobrush) or spatula to collect the cells from the cervix and endocervical canal, gently rotating the tool to collect a sample.
3. The sample collected will then be sent off to a laboratory for testing. The result of the Pap smear can be ready as soon as three days after the procedure (depending on where you get the Pap smear done).

PSST: Dr Noordin notes that, ideally, a Pap smear is done after a period—so book your appointment for when you are not menstruating.

 

What to expect after a Pap smear…

“Some women may experience light vaginal bleeding after the test,” says Dr Noordin. However, beyond that and some potential light cramping, there aren’t really any other side effects.

 

 

Common misconceptions about Pap smears

Misconception 1: You need to prepare your nethers for smearing

Fun fact: You do not need to shave or prep your vulva for your Pap smear, nor do you need to douche yourself before your Pap smear. Believe it or not, your doctor has seen it all—your vagina will not offend them.

 

Misconception 2: You only need to get a Pap smear done if you’ve had sex

Unfortunately, while HPV is the cause behind 95 to 99 per cent of cervical cancers, it isn’t the only cause of cervical cancer. The other 1 to 4 per cent of women in the demographic have cervical cancer that is not HPV-related—this means that cervical cancer can theoretically develop in non-sexually active women. Therefore, annual Pap tests are still essential from the age of 21 and above. That said, in practice, most gynaecologists do not perform pap smears on younger ladies who aren’t sexually active as it may be intimidating for the patient. At the end of the day, the decision is in your hands—just be aware of the risks!

 

Misconception 3: Getting a Pap smear always hurts

It’s not entirely fair to say that Pap smears will never hurt—your personal tolerance for discomfort is subjective, after all. However, for most, it’s a pretty painless procedure. Plus, it’s also over so quickly that any pain or discomfort is fleeting!

 

Misconception 4: Pap smears can detect ovarian/uterine cancer

Unfortunately, ovarian and uterine cancer detection requires a completely different test. We recommend you speak to your doctor about your options.

 

When should you worry about your results?

Dr Noordin explains that there are two possible outcomes for a Pap smear—the test result will either return as normal (usually reported as negative for intraepithelial lesion) or abnormal. 

“If the results come back as abnormal, fret not—this does not mean you have cancer,” says Dr Noordin. “Depending on the severity of abnormal cells, your doctor will decide on the appropriate treatment. You may need a repeat Pap test, HPV DNA test or colposcopy (a procedure whereby the cervix is examined closely using a colposcope).” 

“Most cervical cell abnormalities can be cured,” she continues. “This is the whole point of doing regular Pap smears—to detect cervical cell abnormalities before they become cancerous.”

 

Where to get a Pap smear?

According to Dr Noordin, Pap smears can be done at most Klinik Kesihatan, general practitioner’s clinics and private hospitals or health centres.

 

 

Still wary about getting Papped? Here are some first-hand accounts to soothe your nerves:

“I reckon I did my first Pap smear screening a little later than I should have—it’s recommended to start at the age of 21, but hey, better late than never. Truth be told, the overthinker in me had a billion fearful thoughts running through my head as I spread my legs open on the screening table. I don’t know anyone who has loved the experience, but some do claim it was bearable. For me, it was uncomfortable, invasive and cold… so cold. But that’s all just the initial reaction to having a speculum up your vagina for the doctor to take a sample. The good news is that it all happens very quickly. The doctor is in and out in just a couple of minutes. My only advice is first to find a doctor you’re comfortable with since it’s an intimate procedure. It was my first time meeting the OBGYN, who handled my screening, and while she was gentle, she was also quite a fierce lady (laughs).” — Rachel Au, [redacted], Managing Editor

 

“I had my first Pap smear at 23. I’d actually booked an appointment for a totally unrelated issue (spoiler alert: I was diagnosed with both endometriosis and PCOS on the same day—a two-for-one deal!), but my gyne figured that we might as well kill two birds with one stone while she gave my ovaries an ultrasound. Honestly, I wasn’t too stressed about the Pap smear. I’ve got a pretty well-rounded background in reproductive health, so I was well aware of what was going to happen. That, and the ultrasound wand that had come before was a lot bigger than the speculum. Regardless, I was grateful that my gynaecologist had explained everything to me step-by-step, which helped me mentally prepare for the procedure. I think that your doctor can make or break the experience for you, so it’s important to go with someone you trust. I was recommended my gyne by a very close friend (who gave equally rave reviews), so my advice is to ask around for recommendations. Oh, and wear a skirt to your appointment!”—Redzhanna Jazmin, 24, Senior Beauty Writer

 

“I got my first Pap smear at 25, as recommended by my dermatologist because I was unable to finish the full three doses of my HPV vaccines (I’m allergic). Apparently, getting a Pap smear is important from the age of 21 onwards, especially if you’re sexually active. I also happened to have a yeast infection at the time, so the appointment was pulling double duty that day. I’ll be honest—it’s not a great feeling. Speculums are cold and doctors can often be very careless with the procedure. My advice is to find a gynaecologist you trust, who has good bedside manners. And don’t be afraid to ask for lots of lube!” — Silver Yong, 26, BURO Reader

 

Find more women’s health stories like this here.