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Should you still get a Pap smear if you don’t have sex?

Updated: Nov 15, 2023


Pap smear tool

We know that some people may be worried that having a screening test before they have had sex may mean that they are no longer a virgin. However, it is only having had sex that means someone is no longer a virgin. It’s recommended that people with a cervix, regardless of sexual history, start Pap tests (also known as a Pap smear) by age 25. People younger than 25 likely do not need a Pap test. A Pap smear can also diagnose benign conditions such as infection and inflammation of the cervix. A Pap smear is a quick, non-invasive test that doesn’t hurt. It only takes a few minutes to do the procedure.


During a Pap test, the doctor will collect cells from your cervix. To do this, they will scrape the end of the uterus with a swab or spatula. The cells are then placed on a slide and sent to a lab for examination. In addition to a Pap smear, an HPV test is another important screening tool for cervical cancer. This test allows your doctor to look for HPV in your cervical cells. HPV can be detected about a year after infection in the cervix. While a Pap test can only detect abnormal cells once they have formed, an HPV test may be able to detect the infection before any precancerous cell changes have developed. This way, you and your doctor can monitor your cervix for signs of cancer development.


So, even if you’re not having sex now, if you were sexually active in the past, an HPV test would be a helpful screening tool to rule out the presence of HPV in your cervical cells. An HPV test can be done either on its own (known as a primary HPV test) or at the same time as a Pap test (known as a co-test). Having a co-test won’t seem any different to having a normal Pap smear.



What’s the difference between an HPV test, a Pap Smear test, and an HPV/Pap co-test?


A Pap test, often called a Pap smear, looks for abnormal cells that can lead to cancer in the cervix. An HPV test looks for the human papillomavirus, a virus that can cause cervical cancer. For an HPV/Pap co-test, an HPV test and a Pap test are done together. For a patient at the doctor’s office, an HPV test and a Pap test are done the same way—by collecting a sample of cervical cells with a scraper or brush.


The Pap test has been the mainstay of cervical cancer screening for decades. HPV tests are a newer method of cervical cancer screening. Two HPV tests have been approved by the Food and Drug Administration (FDA) for use as a primary HPV test, meaning it is not part of an HPV/Pap co-test. Other HPV tests are approved as part of an HPV/Pap co-test. HPV/Pap co-testing is only slightly more sensitive than HPV testing, but it is less efficient because it requires two tests. And it detects a lot of minor changes that have a very low risk of turning into cancer. For an entire population, that’s a lot of additional effort and cost.


All three tests can find cervical cancer precursors before they become cancer. But studies have shown that HPV tests are more accurate and more reliable than Pap tests. Also, you can rule out disease really well with HPV tests so they don’t have to be repeated as frequently.


Cervical cancer screening guidelines


Routine cervical cancer screening is very effective for preventing cervical cancer and deaths from the disease. The American Cancer Society (ACS) cervical cancer screening guidelines are as follows:


For women age 21 to 24 years

  • No screening

For women aged 25 to 65 years

  • Primary HPV testing every 5 years (preferable) or

  • Co-test every 5 years that combines an HPV test with a Pap smear or

  • Pap smear alone every 3 years

For women over 65 years

  • The decision to continue screening beyond 65 years depends on individual risk factors and past medical history.

  • Women who have undergone regular screening in the past 10 years with normal results and no history of abnormal cells can stop screening.

  • Once screening is stopped, it should not be started again.

  • Women who have had a total hysterectomy should stop screening (unless it was performed to treat cervical precancer or cancer).

The American Society for Colposcopy and Cervical Pathology (ASCCP) supports the use of either test for cervical cancer screening. Women over 30 with a “normal” or “negative” Pap smear may be able to have a Pap test done every 3 years. People with an “abnormal” test result may need to have the test more frequently.


How often you should get a Pap test depends on several factors, including:

  • your Pap test results history

  • your sexual history

  • other risk factors for cervical cancer

It’s important to keep in mind that the ACS and other organizations frequently make changes to their cancer screening guidelines. That’s why it’s important to talk with your doctor about the recommended testing frequency and what’s right for you.


What’s going on when you have the cervical screening test?


It is useful to know the date of your last period (if you are still having them). You cannot have a test during your period, so please make sure you make an appointment before or after your period is due. It is normal to feel embarrassed especially if it is your first test, please let your sample taker know if you feel worried or anxious about having the test.


You will need to remove your underwear. You will need to climb onto a couch and lie on your back, with your knees bent and your feet on the couch. Some clinics have special couches, which support your legs. If you have any physical disabilities or conditions that mean it would be difficult for you to be in this position, or to get onto the couch, please discuss this when you make the appointment.


The person taking your test will then gently put a speculum into your vagina. Once inside, the speculum can be opened gently to allow your cervix to be seen. Your cervix is the lower part of your womb (also called a 'uterus'). It is sometimes called the 'neck of the womb'. Your cervix connects with the top end of your vagina. The person taking your test needs to see your cervix before they can take the sample. Once they have seen your cervix, they then sweep a soft nylon brush over it to take a sample of cells. Some individuals do not feel the sample being taken, but others can find it uncomfortable. It is not unusual to have a small amount of bleeding afterwards. After the sample has been put into a pot of fluid, the speculum is gently removed. The sample is then sent to the laboratory. You will receive your results letter within six weeks. Your results will also be sent to your doctor.




 

This article is written by: dr. Natalia Liau, MBBS, Msc.


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