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HPV/ Pap Smears

Also called a Pap Test, Pap Smears are named for George Papanicolaou, a professor in the Department of Anatomy at Cornell Medical College. Indeed, it is an honor to share that lineage with this esteemed man.


Papanicolaou developed the process of sampling cells from the cervix and evaluating them under the microscope. He found that cervical cancers could be seen in this way – but importantly he also found that pre-cancerous changes could also be seen.


Finding pre-cancerous changes in the cervix allows us to treat these early cellular changes and prevent the development of cervical cancer.


What Is a Pap Smear?


During an office exam, the cervix is gently brushed with a swab. The cells collected are transferred into a liquid-containing tube and forwarded to the lab. There, both trained experts and computers are used to evaluate the cells and diagnose early changes.


Are There Different Degrees of Abnormalities on a Pap Smear?


Yes. It’s easiest to think about problems as mild, moderate, and severe. Unfortunately, over the years there have been many different terms used to describe these degrees of problems. This has contributed to a lot of confusion.


What Causes an Abnormal Pap Smear?


Cellular changes of the cervix are caused by an infection with the virus HPV, or Human Papilloma Virus.


How Do You Screen for HPV?


During an exam, the same type of gentle swab done for a Pap smear can be used to look for HPV. Today, some doctors test for only the Pap smear, some test only for HPV, and some test for both. It’s always a good idea to discuss with your doctor what test is being performed.


How Often Should I Have a Pap Test or an HPV Test?


There is a lot of debate among professional societies about this question. This is something you should discuss with your doctor. Testing type and frequency is based on your individual risk factors. We usually begin Pap smears by age 21 and continue them through at least age 65. We usually begin screening for HPV by age 25.


Can Men Be Screened for HPV or Have a Pap Smear?


Sadly, no. There are currently no screening tests for men. However, if their partner is discovered to have warts or an abnormal Pap test, men should consider a special exam by the urologist or dermatologist to see if they have problems caused by HPV which can be found on a visual exam.


How Do You Catch HPV?


HPV is usually spread through direct skin contact during sex or other skin-to-skin contact.


How Many Types of HPV Are There?


There are more than 150 different varieties of HPV of which about forty can infect the genital area.


What Problems Can HPV Cause?


Certain varieties can cause warts in the genital areas. Other varieties can cause warts on the hands or feet. Still others can cause precancerous changes or cancers.


HPV can be present and not cause any problems at all. In some, HPV can cause changes on a microscopic level that can slowly progress over time into a cancer. HPV has been associated with cancers of the cervix, vagina, vulva, penis, anus, and head and neck. It typically takes 20 years or more for most cancers to develop. Most of these cancers can be prevented by regular screening, early detection, and treatment.


What Happens If You Have an Abnormal Pap Smear or HPV?


The response to an abnormal Pap test or persistent HPV is usually an office exam called colposcopy. A colposcope exam begins much like a Pap smear, with the cervix visualized during a pelvic exam. The colposcope is essentially a microscope and light source on wheels, which is placed near and external to the patient. The colposcope is used to greatly magnify the genital surfaces, making it easier to visualize abnormalities. If an abnormality is detected, a biopsy may be performed to confirm the diagnosis through a lab evaluation of that tissue.


How Are Cervical Abnormalities Treated?


Depending on your age, the presence or absence of HPV, your risk factors, and the location and degree of abnormality, some problems may be conservatively managed with more frequent exams only. Other problems may require removal of abnormal tissue.


Removal of abnormal tissue is usually performed in the office under local anesthesia. There are many options, including a LEEP procedure, laser ablation, or freezing tissue (cryosurgery).  Some abnormalities are treated in the operating room, such as a cone biopsy. Removal of the cervix or uterus is indicated only for the most severe abnormalities.


How Can I Reduce My Risk of Catching HPV?


The vaccine Gardasil is FDA approved to prevent you from catching 90% of the HPV strains that cause genital warts and 90% of genital cancers. It is approved for both males and females from age 9 through age 45. It is usually given by the pediatrician around age 11-12, and by the gynecologist from age 18 and older.


Anyone who has not previously received Gardasil, and who anticipates having another sexual partner, should consider getting this vaccine.


Using a barrier method of contraception and reducing your number of sexual partners can also decrease your risk of catching HPV.


How Can I Get Rid of HPV?


About 90% of people who catch HPV will mount an immune response that can rid their body of HPV. This generally takes several years. You can improve the function of your immune system with a healthy lifestyle, including proper nutrition, exercise, and adequate sleep. Certain supplements have been demonstrated in vitro to also aid in ridding the body of HPV.

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