By. Dr. Lan Ly, Family Medicine Physician
When you go in for your well-woman exam and the nurse asks if you need a pap, do you understand what she is asking?
Many patients use this term interchangeably with pelvic exam, but do you know the difference between the two? I know when I was younger, I didn't know that they were two different things.
A pelvic exam is exactly what it says. It is an examination of your female organs: vagina, cervix, uterus and ovaries, both visually and by touch.
A pap smear, however, is a test used to screen for cervical cancer or for surveillance of cervical cancer. It may be included as part of the pelvic exam but it is not always required with every pelvic exam depending your age and risk factors.
When do I need a pelvic exam?
Currently, the recommendation for a screening pelvic exam is nebulous. If you are not having any symptoms, it is up to you if you would like your physician to perform a pelvic exam at your well-woman exam.
Studies have shown that pelvic exam screenings in asymptomatic patients have not detected more ovarian cancers, gonorrhea or chlamydia infections. However, there is little evidence to show benefits of pelvic screening for vaginal cancers, inflammatory diseases or other benign conditions.
Overall, there is relatively minimal harm in doing screening pelvic exams, and you should have a discussion with your provider to make a shared decision on pelvic exam screenings.
This does not apply if you are having symptoms. Personally, I recommend screening pelvic exams with my patients. This not only allows me to build trust and rapport but also can help diagnosis and treat conditions that patients may be too embarrassed to bring up.
When do I need a pap smear?
On the other hand, a pap smear is targeted specifically to cervical cancer screening and/or surveillance. A sample of your cervical cells are taken to be looked at under a microscope. There are specific guidelines put out by various research societies on who and when to perform this test. Generally speaking, screening starts at age 21 and stops at age 65 so long as pap smear results are normal.
Currently, there is no recommendation for yearly pap smear screenings in patients with normal results. The frequency of pap smear screenings is anywhere between 3 to 5 years depending on the type of test that is ordered. After age 30, your provider may choose to test for high risk human papillomavirus (HPV) on the sampled cells.
HPV is a sexually transmitted infection and consists of different strains.
Certain strains of HPV are known to cause cervical cancer, and since HPV causes 80-90% of cervical cancers, this test can help further classify your pap smear results.
A few ways to reduce your risk for cervical cancer include:
Safe sex practices with consistent condom use
Getting your HPV vaccination series
Avoiding smoking cigarettes
Ask your provider if you qualify for the HPV vaccination.
The next time you are scheduled for your well-woman exam, discuss whether a pelvic exam is needed, a pap smear is warranted, or if you are age appropriate for your HPV vaccination.