What are paps for?

The main point of the pap smear is to look for abnormal cervical cells. It's important for your doctor to keep an eye on any abnormal cells because abnormal cells can turn into cancer. Unlike most other forms of cancer, cervical cancer is usually caused by a virus (called HPV) that can be sexually transmitted. HPV is very common, and people with HPV often have no symptoms at all.

During the pap the doctor can also look for signs of infection or other issues, such as redness, swelling, unusual discharge, etc. Many doctors will also do a breast exam when you come in for a pap.

What does it feel like?

Paps may be uncomfortable, but they shouldn't really hurt. The more tense you are, the more uncomfortable it will probably be though. So take a deep breath, relax your body, and think good thoughts.

The doctor knows you're uncomfortable, so he or she will try to hurry and be gentle. They start by sticking a lubricated tool into the v****a. This holds the v****a open. Then the doctor sticks a little brush or a Q-tip looking thing in, touches your cervix, and that's it. The whole thing is usually over within a minute or two.

When does it need to be done?

That actually varies depending on whom you ask. The general rule used to be that girls needed paps when they turned 18 or became sexually active, whichever happened first. And from there girls with normal paps would need to be checked every year.

But our medical technology gets better all the time, so sometimes the recommendations for stuff like this change over time. Some doctors are now saying that it's ok to wait a bit longer for the first pap and to wait longer between each pap.

So ask what your doctor recommends and ask what will be covered under your health insurance.

I had an abnormal pap. Now what?

If the doctor tells you your pap is abnormal, it means your pap showed abnormal cervical cells. That doesn't necessarily mean you have cervical cancer though. In fact, you probably don't have cervical cancer, and you probably won't get cervical cancer. Abnormal paps are common (my doctor said she sees about three abnormal paps a day), and most abnormal cells never become cancerous.

But the doctor will probably want to take a closer look to double check and get a better look at what your cervical cells are doing. So the next step is to get a colposcopy. It feels just like a normal pap, but it lasts longer (usually about 10 minutes instead of one or two). The doctor will often do a biopsy (cut off a little tissue to check it for cancer) during the colposcopy as well.

You'll probably feel cramping as if you had your period during the colposcoypy, and you might continue to feel crampy for the next day or two. They numb the cervix, but many women say they still feel the pinch when the tissue sample is taken for the biopsy (but I never have). Then you're done! After that, the doctor may recommend coming in more often (usually every six months to a year).

What happens after the colposcopy?

The doctor might give you a pad, but I'd recommend bringing one with you just in case. That's because you could have a little bleeding. And they put a bunch of goo on your cervix to numb it and stop bleeding, and all that goo might come out at some point during the week, so you might want to wear a pad or underwear that you don't care about for a few days after. (I have had one messy colposcopy and three not messy ones. Either way is normal, so don't panic if it's messy, and don't panic if it's not messy!).

After that, you should avoid sex for a little while (my doctor said two weeks) to allow the cervix to heal.

What does HPV mean for my future?

It means you'll have to make doubly sure you get your paps regularly. If you do not have health insurance, you can get free or low cost paps from clinics like Family Planning and Planned Parenthood.

Discuss it with your doctor to make sure you fully understand it. And discuss it with your partner(s) as well.

Most people will be mild/low grade. That means only a few cervical cells are abnormal, and it will probably never turn into cancer or cause any problems. And after a few years the body will usually fight the HPV infection on its own.

Some people will go past mild/low grade though. That means more abnormal cells and a higher risk of cancer. In those cases, the doctor may decide to cut out some of those bad parts so that they can't even get a chance to turn into cancer.

What about the HPV/cervical cancer vaccine?

There is a vaccine for HPV called Gardasil. It offers protection from some of the more common types of HPV (there are over 100 different kinds of HPV), but it does not offer protection from every type of HPV. So even girls who get the vaccine will not have total protection and will still need to get their regular paps. The vaccine also will not cure an existing HPV infection, it only helps to prevent new ones.

The vaccine is mainly for people ages 9 to 26. It is most effective if a person gets it before becoming sexually active.

Many doctors recommend the vaccine but many others do not. That's because the long-term effects of the vaccine have not been well tested, and many people are reporting serious side effects (and even death) that are not listed in the product information after receiving the vaccine. The vaccine has also not been well tested in people over 26 or in pregnant women. So some doctors recommend holding off on the vaccine until more research is done.

How else can I protect myself against HPV?

Don't rush into sex. The cervix is made up of two kinds of cells. One kind is pretty tough, the other kind is weaker. Our cervix starts out mostly made of the weaker cells, then it gets more of the tough cells once we reach adulthood. Teens have a weaker cervix and are therefore more prone to HPV infection.

Limit your number of sex partners. Every sex partner you have increases your chance of getting HPV and other STDs.

Use condoms. Condoms do not offer complete protection from HPV, but they can help.

Other issues?

Don't be afraid to visit your doctor even if you are not due for your pap. Schedule an appointment if you have pain and bleeding during urination, if your discharge takes on an unusual smell or color, if you need hormonal birth control, or if you have other questions or issues.