Pap Smear 101: Overview, Procedure & Results

What is a Pap Smear Screening?

A Pap (Papanicolaou) smear is a screening procedure that checks if there are abnormalities in a woman’s cervix, the lower portion of the uterus (womb) that opens to the vagina. After collecting the cells, the healthcare provider then places them inside a bottle with a special solution for preservation. Once sent to the laboratory, a pathologist will check the cells for abnormalities. A pathologist is a doctor who specialises in laboratory results.

Can a Pap Smear Detect an STD?

Now, given that a Pap test checks for cellular abnormalities in the cervix, you may wonder if it also detects sexually-transmitted diseases. However, that’s not the case. Pap smear results do not tell you if you have STDs; you’ll need other tests for that such as the vaginal wet mount test.

The main objective of a Pap smear is to look for abnormal changes in cervical cells that may be indicative of precancerous cells or early-stage cervical cancer. Through routine Pap tests, women will be able to identify the abnormal cells and treat them in a way that prevents or cures cervical cancer.

Moreover, some doctors recommend “co-testing,” which means that some cells collected during the Pap test will also be tested for the Human Papilloma Virus (HPV), a major risk factor for cancer of the cervix. However, please note that you can also choose to have HPV testing alone, especially when your Pap smear shows abnormal results.

Who Needs a Pap Smear?

Given that a Pap test detects precancerous cells or cervical cancer, every woman needs it. But, of course, there are certain criteria.

Women who have the following criteria are eligible for a Pap smear in Singapore:

• 25 to 29 years old
• Have engaged in sexual intercourse
• Are sexually active

How Often Should I Get a Pap Smear?

There are several answers to this question, so let’s begin with the general approach: according to the Singapore Cancer Society, you should undergo the Pap smear testing once every 3 years provided that your results do not show abnormalities. In case your doctor sees reasons for it, he or she may recommend that you undergo the test more frequently than once every 3 years.

At the age of 30, you become eligible for the HPV testing, which you can undergo every 5 years; again, provided that you have normal results.

Now your next questions will probably be, do I need Pap smear and HPV testing? Is it possible to get just one of these tests?

Generally, a Pap test is recommended for women ages 25 to 29. Once you reach the age of 30, your doctor will most likely advise you to undergo HPV testing instead.

However, you may also have both tests conducted, together or separately. After all, these tests check for two different things: one looks for abnormal cells while the other identifies the presence of a virus that may predispose you to develop cervical cancer.

Do I Need a Pap Test if I am Not Sexually Active?

Having had sexual intercourse or being sexually active is one of the criteria to undergo Pap smear. Does that mean that you won’t need the test if you haven’t had sex yet or you’re not sexually active?

Experts say that those who haven’t had sex yet or are not sexually active have a lower risk of developing cervical cancer. However, they can still consider having a Pap smear. Doctors explain that while the majority of cervical cancer cases are due to the sexually-transmitted HPV, there are still other risk factors like family history and smoking.

Where Can I Get Pap Smear Screening in Singapore?

You can get a free pap smear in Singapore at Singapore Cancer Society Clinic located at 9 Bishan Place Junction 8 Office Tower #06-05 Singapore 579837.

At a certain cost, you can also undergo a Pap smear at a polyclinic or at a Community Health Assist Scheme General Practitioner clinics or CHAS GP clinics.

Cost of Pap Smear Screenings in Singapore

The cost of Pap smear in Singapore varies, but here’s a general breakdown:

• $15 for Singaporeans at polyclinics
• $22.50 for Permanent Residents at polyclinics
• $2 or $5 at CHAS GP clinics

How Do I Prepare for a Pap Smear?

To prepare for your Pap smear, be sure to book an appointment two weeks after the start of your menstrual period. If that schedule is not possible, try to set the appointment at least a week before your next menstruation. According to reports, it is within this period that the cleanest cervical cell samples can be obtained.

Once you’ve set an appointment, avoid doing the following 48 hours before the procedure:

• Sexual intercourse
• Swimming
• Soaking in a bathtub
• Using lubricants
• Applying vaginal spermicides, creams, and medications
• Using tampons

These activities may alter the results of the Pap test because they can irritate the tissues or wash away abnormal cells.

Furthermore, you are advised to wear a two-piece outfit. It’s also a good idea to bring a sanitary pad or a panty liner as there’s a possibility of light spotting after the Pap test.

What Happens During a Pap Smear?

Now let’s talk about what happens during your Pap smear.

The first part is usually the health interview section, wherein the doctor sits you down to ask you some questions regarding your health, particularly, your reproductive and sexual health. For this reason, it’s wise to prepare the answers to the following common inquiries:

• Are you pregnant?
• Are you using any birth control method?
• Do you smoke?
• Are you currently taking any medications? How frequently do you take them?
• When was the first day of your last menstrual period (LMP)? How long did it last?
• Are you currently experiencing symptoms in your genital region, including light bleeding, itching, burning sensation, or painful sexual intercourse?
• Have you had any surgery involving your reproductive organs?
• Is it your first time having the Pap test? If not, then have you had abnormal test results?

After the health interview, the doctor will show you to a room and give you some time to remove your underwear and change into a gown. It’ll also be helpful to empty your bladder. Afterwards, the following will take place:

1. You’ll be asked to lie on your back on the exam table with your knees bent, and heels supported by stirrups.
2. Next, the healthcare provider will observe your genital area for notable symptoms such as redness or swelling.
3. They will then gently insert a lubricated speculum inside your vagina. A speculum is an instrument made of plastic or metal which functions to spread the vaginal walls.
4. Please note that speculum insertion may cause a little discomfort, but in most cases it’s not painful. At this point, taking deep breaths may help you feel more relaxed.
5. After visually inspecting your cervix, the healthcare provider will then use a brush or cotton swab to collect cells. During the collection process, you may feel a little pressure, but it usually doesn’t hurt.
6. Note that cells will be collected into two places of your cervix: the ectocervix, which is the part closest to the vagina, and the endocervix which is closest to the uterus. Doctors also call the endocervix the transformation zone since this is where cervical cancer usually develops.
7. If the pathologist is available at the moment, the healthcare provider will place the cells on a glass slide to be observed immediately under the microscope. If there’s no pathologist onsite, the provider will place the cells inside a bottle with a special solution to preserve it.

Once the procedure is completed the doctor will give you time to change back into your clothes, and then sit you down to inform you of when the results will be available. If you have additional questions, this is also the best time to ask them.

Besides the possibility of slight spotting, you can go about your day as usual since there are no expected side-effects.

How Long Do Pap Smear Results Usually Take?

The duration it takes to receive your Pap smear result depends on the clinic where you underwent the procedure, but generally, results will be ready within 3 weeks. Some may even take as long as a month and a half.

What Do Pap Smear Results Mean?

In general, there are two types of results: normal or abnormal.

Normal Results

A normal result means the pathologist did not find any abnormal cell in your cervix.

However, please note that while it’s generally the best tool to detect cervical cancer, Pap smear is not always 100% accurate. In a small number of cases, the screening procedure may miss the cancer cells. Furthermore, cancer of the cervix usually develops slowly, so routine testing is necessary.

Abnormal Results

Now, what if your doctor tells you that your results are abnormal; what does it mean? There are 5 possibilities here, and they are as follows:

ASCUS

ASCUS is the most common abnormal Pap smear results; it stands for atypical squamous cells of undetermined significance. It means the pathologists found some abnormal cells and they may be indicative of an HPV infection, but the changes could also be due to other causes such as inflammation or menopause.

LSIL or HSIL

LSIL stands for low-grade squamous intraepithelial lesions. It means that the pathologist found some cellular changes that may be abnormal; usually, they occur due to HPV infection and go away on their own.

HSIL, on the other hand, stands for high-grade squamous intraepithelial lesions. This usually suggests more serious cellular changes that may indicate precancer or cancer.

ASC

Atypical squamous cells (ASC) means the doctor has discovered suspicious squamous cells that may also include HSIL.

AGC

Atypical glandular cells (AGC) is another abnormal Pap smear result. Glandular cells are common cells in the cervical canal and uterus. This result indicates that the doctor found suspicious glandular cells that may indicate precancer or cancer.

What’s Next After Abnormal Pap Test Results?

After getting abnormal test results, what’s next? The next step actually depends on several factors like your age and the type of abnormal results you got. Some options that your doctor may advise you on are:

• Repeat Pap Test. This means you need to repeat the test after a designated time. For instance, the doctor may order a repeat Pap smear after just 1 year instead of 3. Please note that it’s not advisable to have a repeat Pap test immediately after the previous one as it may only yield the same results (remember that cervical cancer typically develops slowly).
• HPV Test. The doctor may also order HPV testing, especially if they suspect that the abnormal cells occurred due to HPV infection.
• Colposcopy and biopsy. In colposcopy, the doctor will magnify the area where they have identified the abnormal cells and then decide whether biopsy is needed. Biopsy is a procedure wherein the doctor will collect some cells or tissues and check for cervical intraepithelial neoplasia (CIN), which is a precancerous condition. If it’s present, the biopsy will also be able to determine its grade or severity.

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