The Pap Smear
George Papanicolaou, a pathologist, pioneered this non-invasive screening test in the 1920s. It is not diagnostic. False negative results will occur 10-20 percent of the time.
The Art of Suzanne GrayA Pap smear is a sample of the tissues of the cervix (and sometimes vagina). In order to collect this sample, women are asked to lay back and put their feet up in stirrups. If this position makes you uncomfortable in any way, tell the examiner you want to put your feet on the examining table. With your knees spread, a speculum is gently fitted into your vagina and opened, making the cervix visible. Breathing deeply and relaxing will make any strange sensations easier to bear.
A small implement and a tiny brush are used to collect cells from the outside of the cervix and from inside the cervical os, like using your fingernail to scrape cells from the inside of your cheek, it is not painful, and there is rarely any bleeding.
The collected cells are either preserved in liquid (best) or smeared directly on a slide. Liquid preservation is required for HPV-DNA testing. Pathologists "read" Pap smears with a microscope, looking for cellular changes, such as cells with large black nuclei (cancer).
The vagina is best kept in its natural state for at least 24 hours prior to the Pap smear: avoid douching, intercourse, spermicides, vaginal hygiene products and sprays, and the insertion of boluses, pessaries, or hormonal creams. For the best results, keep it totally natural for three days before your Pap. Cancel your Pap smear if you are menstruating or have had vigorous sex the night before, as it won’t be accurate.
The original classification of Pap smear results - into four broad categories - created confusion on the part of patients and doctors, and resulted in hundreds of thousands of women being frightened into harsh treatments.
Since 1988, a clearer system, the Bethesda, has been used. It was hoped that expanding the categories and giving more specific information about the cells in the smear would limit the amount of over-treatment. Unfortunately, the new classifications have doubled the number of women with abnormal results, so, instead of fewer needless hysterectomies and drug prescriptions, twice as many women are told they need treatment.
"Unfortunately, informed consent rarely enters the Pap test equation. … The need to be fully informed about the risks as well as benefits is even stronger for anyone undergoing a screening test, which by definition is given to healthy people without symptoms."
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