Worldwide, about 500,000 new cases and almost 274,000 deaths are linked to cervical cancer annually, according to the World Health Organization. This makes cervical cancer the second most common cause of death from cancer in women. Over the past 30 years, cervical cancer has gone down largely due to the Pap smear or cervical cancer screening which examines cervical cytology.

What is a PAP test?
A pap test, also called a Pap smear, is a screening examination of the cervix to detect abnormal cells that could lead to cervical cancer. Pap smear tests may find cellular changes or other changes caused by HPV (human Papillomavirus)

What is HPV?
HPV is the human papillomavirus. It belongs to a family of double-stranded, circular DNA viruses that can infect skin or mucosal cells. It can infect a variety of cells and tissues including the cervix, vagina, penis and other organs in the anal-genital region. It can also infect the oral cavity and HPV infection has been linked to oropharyngeal cancer. HPV can be transmitted via sexual intercourse or direct contact.

There are many different strains of HPV. Evidence shows that approximately 99-100% of cervical cancers are caused by strains like HPV 17 and 18. HPV 6 and HPV 11 are associated with genital warts and rarely develop into cancer.

When is a Pap smear/test done?
A pap smear may be part of your annual exam or it may be done as part of a problem visit. During your examination, you will likely be in stirrups, and the Health Care Professional (HCP) will place a speculum (metal or plastic) into your vagina to better visualize the cervix. A tiny spatula or cytological brush will then gently collect cells from the outside of your cervix as well as cells of the endocervical canal. These cells are then sent to the laboratory for analysis.

When should I get a Pap smear?
While guidelines are always changing, many HCPs recommend a Pap smear at the age of 21. How often and how regularly you receive a Pap smear will depend on your age, medical and gynecological history, and the results of your pap smear. Typically, younger women can get a pap test once every 3 years. Your provider may switch to only getting a HPV test. If you are 30-65 years of age, some HCPs recommend decreasing the interval between Pap smears to 5 years depending on your history. Some women may also choose to discontinue getting Pap smears if they have a series of negative smears (after getting advice from the HCP).

The frequency of pap smears depends on the individual. You should discuss your specific situation with your healthcare team. Sometimes you may require a pap smear more frequently, like if you are immunosuppressed, have HIV, or if your mother took a medicine called DES during pregnancy.

What if I have an abnormal Pap smear result?
First, there’s no need to panic. It is common to have some minor changes in the cells and it certainly does not mean you have cancer. Results may be unclear if the abnormality is related to a HPV infection of the cervix, or atypical cells of undetermined significance. Changes in the cells may be considered mild or minor (low grade). High grade or precancerous cells are more serious cellular changes and will need specific follow up.

What are the next steps for an abnormal Pap smear?
Guidelines for managing abnormal pap smears are constantly evolving to better detect cervical pathology.

Some of the options may include:

1. Surveillance and repeat Pap smear:
Watch and repeat. You may be asked to return for a repeat test sooner than anticipated to see if the changes have resolved on their own.

2. HPV test:
This is an additional test (often ordered with your original Pap smear) that looks for the high-risk types of HPV that may be linked to the development of cervical cancer.

3. Schedule for a colposcopy:
A colposcopy is a specialized procedure where the cervix is visualized using a special piece of magnifying equipment. At the provider’s office you will be placed in stirrups. Once a speculum is placed into the vagina, the provider will place some special liquid (dilute acetic acid) on your cervix to enhance any cellular changes. The HCP will then use the specialized lenses of the colposcope to better visualize the cervical cells. Don’t worry, it does not enter the vagina, but acts as a magnifying. A biopsy or small fragment of cervical tissue may be necessary if there is concern for pathology or precancerous cells. If abnormal cells are found on your colposcopy, you may need further treatment such as laser, cryotherapy, a LEEP procedure or excision.

Another way to minimize your risk for cervical cancer is the HPV vaccine. It is approved for women up to the age of 45. Talk to your HCP to see if you are a candidate.

Pap smears save lives!

Don’t forget to schedule your health care visit to get your screening Pap smear today.

Michael Krychman
Michael L. Krychman, MDCM, is the Executive Director of the Southern California Center for Sexual Health and Survivorship Medicine located in Newport Beach California. He is the former Co Director of The Sexual Medicine and Rehabilitation Program at Memorial Sloan-Kettering Cancer. He also is a clinical sexologist and has completed his Masters in Public Health and Human Sexuality. Dr Krychman has a degree in Erotology, Sexual Education and Forensic Sexology. Dr Krychman is also an AASECT certified sexual counselor. He is an Associate Clinical Professor at the University of California Irvine, Division of Gynecological Oncology and the Medical Director of Ann’s Clinic, a high-risk program for Breast and Ovarian Cancer Survivors.

His special interests include menopausal health, hormone therapy, sexual pain disorders, and loss of libido, chronic medical illness and medical devices and their impact on female sexual function. He is a well-known speaker who is featured locally, nationally and internationally. He has published many articles in peer-reviewed journals and has been featured in many scientific journals and lay magazines. Dr Krychman is an active reviewer for the Journal of Sexual Medicine. He was the Scientific Chairman for the 2010 International Society for the Study of Women’s Sexual Health annual educational meeting. He is an active member in good standing in North American Menopause (NAMS), International Society sexual Medicine (ISSM), European Society Sexual Medicine (ESSM), International Society Study of Women’s Sexual Health (ISSWSH), American Society of Sex Educators, Counselors and Therapists (AASECT) and American College of Obstetricians and Gynecologists (ACOG). He was a member of the Standard Committee for ISSM and has been a guest professor at the ESSM Sexual Medicine Summer School in Oxford, England. He was the creator of the recent WISH Initiative (Women’ Initiative on Sexual Health: and the 2013 recipient of the WISH Outstanding Achievement award given by the ISSWSH. He is also on the professional advisory board for the Patty Brisben Foundation.

Dr. Krychman’s has published 7 books including his most recent one: The Sexual Spark, 20 Essential Exercises to Reignite the Passion, 100 Questions & Answers for Women Living with Cancer: A Practical Guide to Female Cancer Survivorship has been recently published, 100 Questions and Answers about Women’s Sexual Wellness and Vitality and Breast cancer Sexuality, Sensuality and Intimacy. He has been featured on the Today show and in the New York Times and US News and World Report World Report, The Wall Street Journal, New York Times, Health Magazine and many others. He was named one of Orange County Top Doctors for 2015 and 2016 in Menopause, Sexual Dysfunction and Vulvar Pain. In 2019 and again in 2020, he has been named an Orange County Physician of Excellence by Orange Coast Magazine in Survivorship, Sexual Medicine and Menopause.