Pap Smear – Treatment, Effects & Risks

A medical smear is a microbiological or cytological examination method. For this purpose, cell material is swabbed from the skin surface or mucous membranes by means of cotton swabs, spatulas or swabs and then examined by laboratory diagnostics. Swabs can be taken on different areas of the body. These include: mouth, respiratory tract, urethra, vagina, cervix and anus.

What is a Pap smear?

The Pap smear is one of the simplest and most efficient methods to counter the dangerous cervical cancer already in its precursors. Cervical cancer, and especially the precursors of this cancer, can be easily diagnosed by examining the cells of the cervix.

The Pap smear was developed by the Greek gynecologist George Papanicolaou in 1928. With the result of the Pap smear, evidence of vaginal fungi, HPV infections or sexually transmitted diseases such as chlamydia can still be found. The Pap test is now part of the standard prevention at the gynecologist and should be performed once a year – in risk candidates also more frequently.

Function, application and objectives

Typical applications of the Pap smear:

• Cervical cancer

• Venereal diseases

• Chlamydia

• Vaginal fungus
• HPV infection

The Pap smear is mainly used for the early detection of dangerous cervical cancer. It is one of the few types of cancer whose precursors are easy to detect – this alone can save many women’s lives. Treatment of precursors can even be done without chemotherapy and prevent cervical cancer from actually breaking out as cancer. Furthermore, the Pap smear is used to examine for various pathogens that can infect the vagina.Since a cell sample of the cervix is taken, pathogens would be found in this cell sample. For healthy women without a medical history or current complaints, it is recommended to perform the Pap smear once a year as soon as they become sexually active. Women who have already developed precursors of cervical cancer and have been treated for it are usually examined more frequently for relapse prevention.

What does the patient have to consider in advance?

The gynecologist can usually perform the Pap smear under all conditions. For him, it is irrelevant whether the patient is shaved in the genital area or whether she just has her period. However, many women see it differently and do not want to be examined unshaven or during menstruation. It would be desirable to have a Pap smear within two weeks of the last day of menstruation.

No further preparation is necessary; However, it is more pleasant for the gynecologist if the patient appears freshly showered for the appointment for her Pap smear. A Pap smear, like any form of cancer screening, is error-prone. So it may be that an inconspicuous finding comes out, although a cancer precursor exists or the patient already has complaints. In the case of existing complaints, she should insist on further clarification – and above all, she herself should make sure to have the Pap smear taken regularly, as this increases the likelihood of detection.

How is the investigation going?

For the pap smear, the patient frees her lower body and sits on the gynecologist’s chair as instructed by the doctor or the doctor’s assistant. The gynecologist will first insert the speculum. This is the well-known gynecological tool in the shape of a beak, intended to gently spread the vaginal walls apart. If the patient has any discomfort or finds this uncomfortable, she must tell the doctor so that he can proceed more cautiously.

Then he inserts a small brush or cotton swab and takes a sample of the cells of the cervix from a suitable place. The right place depends on the age of the woman – this is the so-called transformation zone, where two different types of cells come together. In young women, it is located externally at the cervix, in postmenopausal women IT moves to the cervix.

The sample taken is then fixed on a glass plate and sent to the laboratory for examination under the microscope. Here, the cells taken from the Pap smear are stained – if they show conspicuous colors, the gynecologist will contact the woman. Otherwise, as a rule, she does not hear from him. If the finding is conspicuous and accompanied by slight to moderate changes, the cell change will be observed over the next few weeks and months with further Pap tests before the doctor recommends a further examination – because many changes resolve on their own.

Self-service or health insurance – who will bear the costs?

In Germany, statutory health insurance requires a Pap smear per year for women over the age of 20. It’s the same with private insurance. However, if a woman goes to the gynecologist with complaints, symptoms or a concrete suspicion, the subsequent examinations are no longer part of the preventive care, but are part of the diagnostics and are covered by the health insurance company anyway.

Another, more accurate method, thin-layer cytology, is now available to accompany the Pap smear. It should make cell changes even easier to see under the microscope. This is a personal contribution. The test for HPV pathogens, which are considered to be decisive in the development of cervical cancer, is also not part of cancer screening. Exceptional cases for annual early detection are women with a severely weakened immune system, for example as a side effect of medication, or women with a medical history of cervical cancer. The doctor will draw up an individual prophylaxis plan for you.

Risks, complications and side effects

A Pap smear is considered a low-risk test. Young women in particular, who have not been sexually active up to now, may find it uncomfortable to insert the speculum into the vagina and touch the cervix, but it is rarely painful – if it does, you should tell the gynaecologist. However, there are also risks in the reliability of the pap smear. It is assumed that altered cells can be detected in a single examination in 50% of cases.The more severe the cell change, the more likely an alarming Pap test result. However, with repeated testing over the course of a calendar year, one study showed detection of cellular changes in 90-100% of all women. A pap smear can therefore only be accurate if it is carried out regularly. However, women do not need to worry about injuries during the Pap smear itself.