Well woman exams

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Why your routine Pap smear is important to your health.

Cervical cancer screening saves lives. Over the past 30 years in the United States, the number of cases of cervical cancer and deaths has decreased by one half. This is mainly the result of women getting regular cervical cancer screening.

 screening is used to find changes in the  of the  that could lead to cancer. Screening includes  (also called the  or Pap smear), testing for , or both. Most women should have cervical cancer screening on a regular basis.

It usually takes three to seven years for high-grade changes in cervical cells to become cancer. Cervical cancer screening may detect these changes before they become cancer. Women with low-grade changes can be tested more frequently to see if their cells go back to normal. Women with high-grade changes can get treatment to have the cells removed.

When do I need to be screened?  

The American College of Obstetricians and Gynecologists (ACOG) says screening should begin at 21 years old, regardless of when you first start having sex.
 
How often you should have cervical cancer screening and which tests you should have depend on your age and health history. A general schedule guideline typically follows:
  • Women who are 21 to 29 should have a Pap test alone every three years. HPV testing alone can be considered for women who are 25 to 29, but Pap tests are preferred.

  • Women who are 30 to 65 have three options for testing. They can have a Pap test and an HPV test () every five years. They can have a Pap test alone every three years. Or they can have HPV testing alone every five years.

If you're unsure of when you were last screened or have questions about your personal care, have a conversation with your primary care provider or gynecologist. They can answer questions like how often you should be screened, especially if you're at higher risk of cervical cancer, and when you can stop cervical screenings. Gynecologists can provide you with specialized care if you need. View a list of gynecologists' below:

How is cervical cancer screening done?

Cervical cancer screening includes the Pap test, an HPV test, or both. Both tests use cells taken from the cervix. The screening process is simple and fast. You lie on an exam table and a  is used to open the vagina. The speculum gives a clear view of the cervix and upper vagina.

Cells are removed from the cervix with a brush or other sampling instrument. The cells usually are put into a special liquid and sent to a laboratory for testing:

  • For a Pap test, the sample is examined to see if abnormal cells are present.

  • For an HPV test, the sample is tested for the presence of the most common high-risk HPV types. Usually, the sample taken for the Pap test also can be used for the HPV test. Sometimes, two cell samples are taken. It depends on the type of Pap test that is used.

Does HPV always lead to cervical cancer? 

Human papillomavirus (HPV) is a family of viruses that spread through skin contact. Certain types are almost always spread through sexual contact. Some HPV types cause genital warts (condyloma). But not all types of HPV cause symptoms you can see.

Only a small number of women with high-risk types of HPV will get cervical cancer. Because of the body’s natural ability to fight infection, most HPV infections go away on their own. These short-term infections typically cause only mild, or “low-grade,” changes in cervical cells. The cells go back to normal as the HPV infection clears.

In a small number of women, HPV does not go away. If HPV infection lasts for a long time, it is described as a “persistent” infection. Persistent HPV infection with high-risk types can cause more severe, or “high-grade,” changes in cervical cells. High-grade changes that persist for one or two years are more likely to become cancer if they are not treated.

Factors such as cigarette smoking, a weak , and infection with  are thought to increase the chance that HPV infection will persist, but persistent infections also occur in women without these factors.

What happens if I have an abnormal Pap? 

Many women have abnormal cervical cancer screening results. An abnormal result does not mean that you have cancer. Remember that cervical cell changes often go back to normal on their own. If they do not, it often takes several years for even high-grade changes to become cancer.

If you have an abnormal screening test result, additional testing is needed to find out whether high-grade changes or cancer actually is present. If results of follow-up tests indicate high-grade changes, you may need treatment to remove the abnormal cells. Your health care provider will thoroughly explain your test results to you and guide you through next steps for care, if needed. It’s important not to panic if your learn that your Pap test results are abnormal. This just means there are cells on your cervix that don't look like normal healthy cells. Just how abnormal they are varies a lot. These changes may be classified as mild, moderate, or severe.

Do I still need to see my provider every year if yearly cervical cancer screening in no longer recommended?

Yes. It's still important to see your provider regularly for a routine woman care visit. This visit is an opportunity for you to get answers to your personal health questions, review proper breast exam techniques, and learn more about topics like preparing your body for pregnancy, addressing menopause issues, or discussing birth control options. Your provider can also help you identify whether you are at risk of certain medical conditions, like diabetes or heart disease

If I have had a hysterectomy, do I still need cervical cancer screening?

Women who have had a  may still need to have screening. The decision is based on whether the cervix was removed, why the hysterectomy was needed, and whether there is a history of severe cervical cell changes or cervical cancer.

Even if the cervix is removed at the time of hysterectomy, cervical cells can still be present at the top of the vagina. If you have a history of cervical cancer or high-grade cervical cell changes, you should continue to have screening for 20 years after the time of your surgery.

How else can I protect myself from cervical cancer? 

The HPV vaccine is an important way to help protect against the HPV infections that most commonly cause cancer. But the HPV vaccine does not protect against all types of HPV that can cause cancer. So women who have been vaccinated against HPV still need to follow the cervical cancer screening recommendations for their age group.

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