Papanicolaou What?


I just finished “The Fault in Our Stars” by John Green and it inspired me to write a post on the cervical cancer screening project I am working on in the clinic. I will be explaining in more detail:

  • WHO: YWomen
  • WHAT: The Pap Test
  • WHEN: Ages 21-69, sexually active (past/present) women
  • WHERE: At your family doctor’s clinic or gynaecologist
  • WHY: “Screening with a Pap test is the only way to find cell changes in your cervix that may lead to cancer” a.k.a. Because if there is a simple way for me to prevent myself from getting cancer, I’d do it.

The following is based on the information I know and my own opinions. I encourage you to do research on your own outside of this blog about cancer screening tests so that you can make an informed decision about your health. 

What is Cervical Cancer

Have you heard about the virus called Human Papillomavirus (HPV)? It is one of the most common sexually transmitted disease (STD)! HPV is passed from one person to another through sexual contact. Almost all cervical cancer is related to HPV infection. Anyone who is sexually active can be exposed and be infected by HPV. For those women with a healthy immune system, the body will clear the virus on its own within two years. For others, it stays in the body.

According to Cancer Care, 550 women are diagnosed with cervical cancer and 160 die each year from it in Ontario. BUT WAIT! Cervical cancer is PREVENTABLE! Women do not have to suffer from cervical cancer!

How can it be prevented

“Cervical cancer is almost entirely preventable with regular screening and HPV immunization.”

Cervical cancer grows very slowly. With screening tests, these abnormal cells can be caught early and be removed before it becomes a full-blown cancer! Being an Ontarian with our trusty OHIP card, the government offers us a cervical cancer screening test every three years as part of the Ontario Cervical Screening Program, namely the Papanicolaou test. 

The Papanicolaou what?

You may know it better as a Pap Test, Pap Smear, Cervical Test, etc. The test involves swabbing the outside of a woman’s cervix to retrieve some of the cells there. The medical laboratory will then check for potentially abnormal, pre-cancerous or cancerous cells caused by an HPV infection.

This is done by your family doctor or gynaecologist. It does not need to be done annually. The Ontario program recommends sexually active women, starting at the age of 21, to be regularly screened every three years.

Risks: As with any tests, there is the problem of

  • False negatives – test results indicate you do not have cancer, but do. However, if you keep up with regular screening, the second test three years later is still enough time to catch any abnormal cells.
  • False positives – test results indicate you may have cancer, but actually do not. This may cause unnecessary anxiety for the patient.

Benefits: Catching abnormal cells early enough to remove them before they become cancerous. Huzzah!



The picture on the right depicts the endocervix (inside the cervix – columnar epithelium) and the exocervix (outside the cervix – nonkeratinized, stratified squamous epithelium). The picture on the left depicts the tapered brush used to collect cells at the cervix where the epithelium changes. Can you guess where the most precancerous cells develop in the cervix? That’s right, the junction where the two different epithelium meets.

Do I need one?

Understand that no one in health care will force you to do anything you do not want to do. Technically speaking then, you do not need one but it is recommended  and encouraged that you do get a pap test if:

  • You are between the ages of 21-69
  • You are/ever have been sexually active (whether you are now or have been in the past, you should get a pap test)

You do not need a pap test if:

  • You are under the age of 21 or over 70 with past normal pap test results
  • You have never been sexually active (not exposed to HPV via sexual contact)
  • You had a hysterectomy (surgical removal of the uterus)

What to expect

Knowing what to expect will decrease anxiety about the whole process. It will also dispel some of the stigmas behind pap tests. 

Make an appointment with your health care provider (HCP) on a day where you are not on your period. Also, do not have intercourse or use creams around the vagina 48 hours before the test. It might skew the results.

Inside the examination room, you will be asked to remove your pants and underwear (you can keep your top on). There will be a medium sized cloth for you to cover up. You should lie down on the examination bed and wait for the HCP to knock, in which you can let them know you are ready for them to come in. 

The HCP will sit at the end of the examination bed and will first examine the external genital area to see if anything is abnormal (eg. skin lesions, redness, etc).  Then the HCP will gently insert the speculum. A small, soft brush is used to collect a sample of cells surrounding the cervix. The brush is then preserved in a solution to be taken to the lab. The pelvic exam may occur after the Pap test in which the HCP will place two fingers of one hand into the vagina and press on the your belly to feel the ovaries and uterus for any abnormal mass or pain.

The whole process should take around 10 minutes. Test results come back in two weeks. Most women get normal pap results (I have only seen 3-5 abnormal results at most out of the 50 test reports I have filed in the clinic so far). Abnormal results do not mean cervical cancer. You will be asked to do a repeat pap test in 6 months to rule out false positive results. 

Common Concerns/Barriers to not getting a Pap test

1. I feel uncomfortable doing a Pap test with a male doctor.

Pap tests are usually done with a female HCP. If your family doctor is a male, and there is no female HCP at your clinic, you may ask your doctor to refer you to a gynaecologist.

2. I heard it hurts.

A Pap test can be uncomfortable but should not hurt. It helps to relax – this will help the speculum enter the vagina easier. You may ask the HCP to use lubricant on the speculum. Speculums come in different sizes and are used to widen the vagina so that the brush can reach the cervix. A small speculum will be used for women who have never given birth and who are on menopause.


It may be a bit more uncomfortable for women on their menopause since these patients tend to have vaginal atrophy but the doctor would use more lubricant.



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