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From Pap smears to pelvic exams to HPV vaccines, there are a lot of steps to upkeeping a healthy cervix.
But when it comes to preventive care for cervical cancer — one of the top three types of gynecological cancers — these proven screening and prevention strategies can keep you safe.
So, what’s important to know, and what’s a myth?
Myth: If you have HPV, you’ll get cervical cancer
This is unlikely.
Yes, it’s true that most cases of cervical cancer are caused by the human papillomavirus (HPV) after the virus is transmitted through sex. However, most people will have an HPV exposure in their lifetime, and most times, the infection will go away on its own.
Getting routine Pap smears can help you stay on top of what’s happening with your cervix and alleviate some fear. The Papanicolaou (Pap) screening takes cells from the surface of the cervix, which is what your medical team will look at for signs of cancer or precancerous changes.
Of course, in between screenings, let your doctor know if you’re having any strange vaginal symptoms.
“Symptoms can look like vaginal discharge, abnormal vaginal bleeding like bleeding after vaginal intercourse, vaginal odor or pain,” says Dr. Eric Rios-Doria, a gynecologist at UW Medical Center – Montlake who specializes in gynecologic oncology. “These symptoms can also be caused by other non-related issues, which is why it’s important to seek medical care if these symptoms arise.”
Myth: You should get a Pap smear every year
False — an annual pap smear isn’t recommended. Unless there are special circumstances, like being immunocompromised, the recommendation is every 3 years from age 21 to 29.
Pap smears are recommended starting at age 21 and every three years until age 29. After that, someone can get a Pap smear every three years or another screening method — like co-testing (getting a Pap smear and an HPV test at the same time) or the high-risk HPV test — every five years until age 65.
After 65, you don’t need to get screened anymore — as long as you’ve had consistent and negative test results ten years before stopping. Rios-Doria says that someone who’s had a hysterectomy with the removal of the cervix won’t need any further screening if they haven’t had past evidence of precancerous disease (dysplasia or CIN) or cervical cancer.
Myth: You need to start getting Pap smears when you become sexually active
Nope. Although HPV is typically sexually transmitted, there’s no need to get a screening when you become sexually active if you’re younger than age 21.
“Even if higher-risk strains of HPV are transmitted during vaginal intercourse at a younger age, these are likely to regress,” says Dr. Barbara Goff, chair of Obstetrics and Gynecology at the University of Washington School of Medicine. “This happens because your immune system attacks the virus.”
This means there’s less of a chance of HPV transmission resulting in cervical cancer when you’re younger.
Myth: A pelvic exam and a Pap smear are the same things
While both procedures can cause discomfort, they’re definitely different.
So, while it’s common to get a Pap smear in combination with a pelvic exam, don’t assume you’ve been screened for cervical cancer just because you’ve put your feet up in the exam table’s stirrups.
A pelvic exam is a physical exam of your vulva, vagina, cervix, ovaries and uterus. During the pelvic exam, you’ll lie on your back on an exam table, with your knees bent and feet placed in supporting holders at the end of the table. Your doctor will insert one or two fingers into your vagina and press on your abdomen with their other hand to feel your uterus and your ovaries. A speculum — that duck bill-shaped tool in your gynecologist’s office — or a tool to collect samples may be used, like if you’re also getting a sexually transmitted infection (STI) test.
During your Pap smear, you’re in the same position as the pelvic exam (yes, including the speculum). Rios-Doria says that the speculum is used to gently open the vagina so your doctor can see your cervix. He says this may cause a sensation of pressure in the pelvic area and may be cold upon insertion. Then, a soft, narrow brush or tiny spatula is used to collect a sample of cervical cells, where they’ll be sent to the laboratory to look for abnormalities — aka the Pap test.
Myth: You can stop getting Pap smears after the HPV vaccine
This is untrue —cervical cancer screenings should be continued even after you’ve received the HPV vaccine. However, the HPV vaccine is one of the best ways you can protect yourself against cervical cancer (in combination with your routine screening).
“The HPV vaccine protects against the most common high-risk strains of HPV,” says Rios-Doria. “Screening for cervical cancer should continue as there are other strains of HPV that aren’t included in the vaccine. Most cervical cancers are due to HPV, but there are also rare non-HPV causes that could lead to cancer. We are starting to understand these causes but screening remains paramount.”
And if you’re well into adulthood and haven’t been vaccinated, that’s OK — while the vaccine was previously recommended to those up to age 26, it can now be given to people through age 45.
“I cannot emphasize enough the benefits of the HPV vaccine,” says Rios-Doria. “Since the vaccine’s introduction, cervical cancer rates have reduced, especially in younger patients.”
Goff highlights that the HPV vaccine protects both men and women from HPV-related cancers, including cervical, vulvar, vaginal anal, head and neck and penile cancers.
There’s a little bit of nuance when it comes to testing if you’re between ages 30 and 65. During this age range, you can choose to get only an HPV test in lieu of a Pap smear — but keep in mind, both involve a date with the speculum.
HPV self-collection kits have been studied in recent years. While not yet universally adopted in clinical settings, this may eventually allow for ease of use in cervical screening.
Myth: Cervical screenings are the same as testing for sexually transmitted infections (STI)
While you can get an STI test at the same time you get your cervical cancer screening, they are not the same. You should talk to your doctor if you’d like to be tested for STIs while you’re having a pelvic exam or Pap smear.
Rios-Doria also says that cervical cancer screening should be performed regardless of sexual activity level (so, even if you’ve had the same partner for a while, or if you’ve never had sex).
Myth: An abnormal screening result means you have cancer
Getting an abnormal result can feel scary, but it doesn’t always mean there’s an immediate reason for concern. It could be wrong — no test is perfect — or there might be other reasons besides cancer that the cells appear abnormal.
Further evaluation after the abnormalities are found should be discussed with your doctor for next steps. In general, a colposcopy, which uses a magnification device to look at your cervix and determine if a biopsy should be performed.
Rios-Doria emphasizes that no screening test is perfect.
“The most important strategy someone can use is to have regular screenings with your healthcare provider,” he says. “Regular screenings increase the overall likelihood that abnormalities will be picked up in a timely fashion.”
Your next office visit
So, don’t forget to schedule that Pap smear … or don’t forget that Pap smear you have scheduled a few years from now. In the meantime, if you’re 45 or younger, remember that it’s not too late to get the vaccine to keep you — and your reproductive health — in good shape.
