Cervical Health and Pap Smears: All You Need to Know

As a woman, particularly those 25 and older who are sexually active, it is our basic responsibility to take care of our cervical health. But how exactly do we do that, and why is it so important? This article explains everything you need to know about your cervical health and the importance of cervical cancer screening.

What is the cervix?

The cervix is a small canal or pathway that connects the uterus to the vagina. It is otherwise known as the neck of the uterus. The cervix has many responsibilities in the functioning of females; it has an essential role in the following:

• Menstruation: it opens and closes to allow menstrual blood to leave the uterus when the endometrial (uterine) lining sheds. 
• Fertility: it acts as a canal through which sperm must swim to get to the ovum (or egg).
• Pregnancy and childbirth: it stays close to keep the pregnancy until term and dilates during labour to allow a baby to leave the uterus through childbirth. 

How can I make my cervix healthy?

There are numerous things that are good for your cervical health; these are also ways to protect your cervix and maintain good reproductive health. 

Ways to keep your cervix healthy include the following:

• HPV vaccine: HPV, or human papillomavirus for short, is a virus with many subtypes, of which the high-risk types are associated with cervical, vaginal, and vulvar cancer in women. The HPV vaccine protects against some of the high-risk subtypes and affords some protection against HPV infection. The HPV vaccine is best taken between 9 and 26 years of age (before one’s sexual debut) and usually consists of a 2-dose or 3-dose regimen (depending on age). Depending on the HPV vaccination taken, it can provide 70-90% protection, and there is no current need for booster jabs. 
• Practice safe sex: HPV infection is very common amongst sexually active men and women, and it is typically transmitted through sexual activity involving skin-to-skin contact or through sex toys. As such, it is good to use barrier protection consistently, i.e. condoms, as condoms can significantly reduce the risk of getting infected with HPV. 
• Healthy lifestyle: It is important to avoid smoking as that can increase one’s risk of getting cervical cancer; people who are immunocompromised, such as those with coexisting HIV infection or transplant patients, are also at higher risk of developing persistent HPV infections and progression to cervical cancer. 
• Get tested at regular intervals: as early-stage cervical cancers may not have symptoms, it is important to go for screening regularly as pre-cancerous changes of the cervix, if caught early, can be treated to prevent disease progression to cancer. 

When these steps are performed together, you can rest assured that your cervix is well-protected. However, it is important to be aware of any changes that may occur in your cervical health and consult with a gynaecologist if you notice any changes, no matter how mild.

What are the symptoms of cervical cancer?

One of the abnormalities of the cervix is cervical cancer. It is the 5th most common cancer in women between the ages of 15 and 44 and the 10th most common cancer in women of all ages. Women with early-stage cervical cancer typically do not have any symptoms at all, which makes regular screening all the more important. Cervical cancer symptoms can include:

• Vaginal bleeding: this can occur in between periods, after sexual intercourse, or manifest as postmenopausal bleeding. 
• Vaginal discharge: the discharge from cervical cancer can sometimes be heavier, watery, blood-tinged, or have a foul smell. 
• Pain: some women may experience lower abdominal discomfort or pain. 

If you notice any of the symptoms stated above, make an appointment with your gynaecologist for a proper diagnosis and effective treatment. 

What are pap smears and HPV tests? How do they work, and how often must they be done?

Pap smears and HPV tests make up cervical cancer screening tests – during these tests, a vaginal speculum is inserted gently into the vaginal canal, and a brush is used to gently collect some cells from the cervix to be sent to the laboratory for further evaluation.  

Women between 25-29 years old should go for regular pap smears once every 3 years, and women 30 years old and above should go for HPV tests once every 5 years. This applies as long as one has ever had sex before (even if you are no longer sexually active). Women who have completed their HPV vaccination should also go for regular cervical cancer screening as the vaccination does not provide 100% protection. 

Schedule your next cervical cancer screening with your gynaecologist to help maintain your cervical health.

What is the difference between a pap smear/HPV test and cervical cancer screening? 

Pap smears/HPV tests and cervical cancer screening are terms often used interchangeably, but there are some differences between the two. The primary purpose of a pap smear is to detect abnormal cells on the cervix, which may indicate the presence of pre-cancerous or cancerous change of the cervical cells, whilst the purpose of an HPV test is to detect the presence of any high-risk HPV subtypes. The most dangerous high-risk HPV subtypes are types 16 and 18, which are known to cause 70% of all cervical cancers; other high-risk HPV subtypes (non-16/18) cause the remaining 30% of all cervical cancers. 

Cervical cancer screening is a broader term encompassing the aforementioned methods.

Do you need a pap smear/HPV test if you are not sexually active?

It is a misconception that you do not require pap smears if you are not sexually active – as long as you have had sex once before, you will need to continue with regular cervical cancer screening as HPV infections can persist over a long time and slowly cause pre-cancerous changes (or cancer) of the cervix. It is important to note that cervical cancer is a slow-evolving condition that can develop over the course of years and may not manifest in any symptoms in the interim.  

What is the maximum age for undergoing cervical cancer screening?

In Singapore, a woman can be discharged from cervical cancer screening at 69 years old if she has had 3 consecutive negative pap smear results prior or 2 consecutive negative HPV tests in the last 10 years (with the latest done within the past 5 years), or 2 consecutive co-testing (i.e. pap smear and HPV test) in the last 10 years (with the latest done within the past 5 years). 

However, if you have a history of pre-cancerous changes of the cervix, you will need to continue regular cervical cancer screening for at least 20 years following the diagnosis, and your gynaecologist will advise you on this accordingly. 

What do the results of a pap smear/HPV test mean?

A pap smear/HPV test result will usually be ready within 1-2 weeks. The results can be interpreted in the following ways:

• HPV test: negative or positive (only positivity for high-risk subtypes will need to be acted upon, and you will need to see a gynaecologist for further discussion). 
• Normal smear: no pre-cancerous cell changes of the cervix detected – this is usually reported as NILM (negative for intraepithelial lesion or malignancy).
• Abnormal smear: these can range from low grade to high grade, and you will need to see a gynaecologist for further discussion.  

A co-testing usually involves doing a pap smear and HPV test simultaneously; this can be performed using the same specimen and does not require additional examination time. 

Is cervical cancer screening painful?

Pap smears may feel uncomfortable but are not painful; as long as you are relaxed during the examination, the whole testing process usually takes less than a minute. 

What are the risks of a pap smear/HPV test?

Pap smears are generally safe but have potential (minor) risks. Some women may experience discomfort or pain during the procedure, and there might be light spotting/bleeding afterwards. False positives or negatives can occur, leading to the need for follow-up tests or missed abnormalities.

Can cervical cancer screening affect your next period?

A pap smear/HPV test typically does not affect the menstrual cycle or disrupt the regularity of periods. However, you should aim to schedule your cervical cancer screening at least a week after your period finishes to avoid blood obscuring the accuracy of your cervical cancer screening results. 

Conclusion

Cervical cancer screening is an important preventative measure in women’s health – it aims to detect precancerous changes of the cervix in women who typically remain asymptomatic until it is too late. Early detection, in turn, allows for prompt treatment before progression to invasive cancer. 

Regular screening is highly effective in reducing the incidence and mortality of cervical cancer. Coupled with appropriate HPV vaccination and timely follow-up of abnormal results, it is anticipated that the global burden of cervical cancer will drop in the coming decades, which is excellent news for the advancement of women’s health.