What is the Pap smear?
Pap smear, also known as a cervicovaginal smear, is a cervical cancer prevention test . Its main purpose is to detect cancer cells in the cervix. The test should be performed on all women aged 21 to 65, at least once a year.
In addition to cervical cancer, the test can also determine hormone levels, diagnose inflammation or vaginal infections and sexually transmitted diseases such as HPV , gardnerella, trichomoniasis , candidiasis , gonorrhea , syphilis , chlamydia, among others.
The preventive examination for cervical cancer is also called a cervicovaginal smear or oncotic colpocytology, and the name Papanicolau was given in honor of the Greek physician Geórgios Papanicolau (1883-1962). The doctor, considered the father of cytopathology, a science that studies dysfunctions through microscopic examinations and cell evaluation, created the method in 1940.
Because it is a cervical analysis exam, the exam is indicated exclusively for women. It must be performed between 21 and 65 years of age, as long as they are in the fertile period and have a sexually active life.
When necessary, cervicovaginal smear can also be performed on virgin women. In this case, the virgoscope is used, a speculum (instrument that dilates the vaginal cavity, also known as “duckbill”) of special size and a cotton swab in place of the spatula.
The frequency of the exam is determined by the gynecologist and depends on the previous results. It is the gynecological societies of each country that decide the time between the performance of an exam and another. In Brazil, it is held once a year. When two consecutive cases with a one-year interval are negative, the next preventive ones can be performed every three years.
If there is an abnormality in the test result, it will have to be performed again six months later.
Can I perform menstrual Pap smears?
The time to be performed is a week before or ten days after the menstrual flow ends, because the desquamation of the uterus impairs the results.
Can I have intercourse before Pap smear?
Three days before the exam, sexual intercourse should be avoided, even with condoms , vaginal showers, gynecological exams with touch, use of vaginal creams and medications.
Can pregnant women do Pap smears?
Pregnant women can perform the preventive exam, as it does not interfere with pregnancy and can be requested if the doctor considers it necessary.
Initially, the gynecologist performs a vulvoscopy (visual examination of the vulva) with the help of a colposcope, which increases the size of the vulva 10 to 40 times, to identify the presence of possible infections, autoimmune diseases or sexually transmitted diseases.
Then he introduces the speculum to better visualize the cervix and inserts a special spatula with a brush at the end at the entrance to the vagina. This process is usually painless, but it can cause a slight discomfort that is lesser according to the woman’s relaxation.
Thus, uterine material is collected for analysis by scraping the cells of the cervix. The material is placed on a slide and taken to the laboratory, to be examined under a microscope by a cytologist and, if there is any change in the initial evaluation, it is later studied by a cytopathologist.
Does the Pap smear hurt?
The exam does not usually hurt, what can happen is a little discomfort during its performance due to the introduction of the speculum and the spatula.
The Pap smear can take 3 to 14 days to complete. Until recently, the reports were divided into classes and to find out if there were changes or not, it was necessary to know the histological classification of injuries, created by the World Health Organization (WHO).
Another classification invented to emphasize the variety of lesion abnormalities and to help standardize treatment is CIN, cervical intraepithelial neoplasia. However, the NIC has ceased to be indicated in Pap smear reports since 2001, being used today only to indicate the results of biopsy. The Bethesda system serves to inform the results of the cytological examination. Even though they are related to each other, they are the results of different exams, and may not correspond. These results must be reported to the pathologist who wants to perform the biopsy.
|Within normal limits
|Benign cellular changes, usually caused by inflammation
|Benign cellular changes
|Presence of abnormal cells
|Low grade SIL (dysplasia with low risk of cancer, usually caused by HPV; tends to appear after 1 to 2 years)
|High-grade SIL (dysplasia with a high risk of being cancer, or indeed being already established cancer)
|SIL high grade
|Carcinoma in situ
|SIL high grade
SIL intraepithelial lesions
Currently, it is more common for reports to be presented in a more descriptive manner, and they can indicate:
This result needs to inform which cells were taken for sample, which tissue gave rise to them and if it was sufficient for the evaluation. Next, there should be a description of the microbiological flora of the region. The presence of an infection can be described according to the amount of leukocytes (defense cells) found. In this case, the report also shows the name of the invading germ.
Abnormal pap smear
The most common cases when the test result is abnormal are ASC-US and ASC-H. ASCUS (atypical squamous cells of undetermined significance) indicates a change in the normal characteristics of squamous cells, which can be caused by inflammation, infections or vaginal atrophy during menopause . This change very rarely becomes a premalignant lesion, most of the time it is benign and tends to disappear with time. There are two ways to proceed with this result: repeat the test after six months or ascertain the presence of the HPV virus.
When the report points to ASC-H, the presence of malignant anomalies is certain. The risk of high-grade epithelial lesions is high, and a colposcopy and biopsy of the uterus will be necessary .
The Pap smear is performed mainly to diagnose cervical cancer, a disease that affects about 18 thousand Brazilians a year.
The early stage of cervical cancer has no symptoms, so it is important to perform colpocytology frequently. In a more advanced stage, the symptoms are bleeding or vaginal discharge, contact bleeding (after intercourse), pain during intercourse, distention of the abdomen, lungs and other organs. You may also experience loss of appetite, weight loss, fatigue , pelvic pain , low back pain or swelling in your legs.
Cervical cancer has risk factors that, when avoided, can decrease these statistics. Check out the forms of prevention:
- Avoid taking oral contraceptives;
- Do not start sexual activity too early;
- Have few sexual partners;
- Have few children;
- Do not have a history of sexually transmitted disease;
- Have good personal hygiene;
- Compromised immune system.
Cervical cancer and HPV
Human papilloma virus (HPV) is a virus that affects the skin and mucous membranes and can cause warts or precursor lesions of cancer. In most cases, HPV-infected cells heal spontaneously. However, when the virus is able to spread, there is a very high chance that it will produce invasive cancer.
More than 90% of cervical cancer cases are caused by the human papilloma virus. This is because this virus causes changes in the cells on the surface of the cervix. Initially, these cells are only benign tumors, but if left untreated, they can develop into cancer.
In Brazil, the HPV vaccine is available in the Unified Health System (SUS) for girls from 9 to 26 years old and boys from 12 to 13 years old, and also for men with HIV between 9 and 26 years old. In the latter case, a medical prescription is required. The vaccine is of the quadrivalent type, that is, it protects against four variations of the virus, and should be taken preferably before the first sexual activity.
The Papanicolau test is only for screening, that is, when it raises suspicions, it needs confirmation through a biopsy (surgical procedure that takes a sample of the injured tissue for study in the laboratory). In Brazil, the Papanicolau test is offered free of charge by SUS and also in all medical schools in the country.
In addition to being an inexpensive test (this when not done by SUS), Pap smear prevents cervical cancer from being discovered at an advanced stage, allowing for faster treatment and increasing the chances of recovery. Even so, many women feel ashamed and end up not having the exam. Share this text with your family and friends, so that more and more women know the importance of having a Pap test.