A woman is positioned on her back with legs spread apart while the doctor inserts a speculum.   A pap smear is done relatively quick and is often times painless.   However, you may experience a menstrual type cramp while the doctor gets the sample.   The doctor may use a small, soft brush to obtain the sample from your cervix.   The sample is then sent to a laboratory for close examination.

Another part of an annual exam is the bimanual pelvic exam.   This exam usually follows the collection of the samples for the pap smear.   The doctor will insert two fingers, usually with lubrication, into your vagina.   One hand will be inside the vaginal canal to feel for the ovaries and uterus while the other hand is on top of the stomach to feel from the outside.

Results from a pap smear generally take 2-3 weeks to receive.   Depending on the office you go to, the doctor or nurse may or may not contact you.   Some offices policy is “No news is Good news.”   So if you don’t hear from them, you pap smear came back normal.   If you have not heard back from the office in over a month and are still curious of the results, you can call and request the results.

When to get a Pap Smear:

It is suggested that you have a pap smear done within a few years of becoming sexually active.   After the age of 21 is when you should have a pap done regardless of sexually activity.   If your results came back negative, yearly pap smears should be done.   Some doctors will do every other year or every 2-3 years in the tests came back normal several years in a row.   Check with your doctor as to what age you should stop having pap smears done.   Most doctors say you can stop after a Total Hysterectomy or after the age of 70 with no history of abnormal pap smears in the last ten years.   Double check with your provider as to what they recommend.

One of the most common causes of abnormal pap smears is HPV (Human Papilloma virus). HPV is a sexually transmitted disease but can go undetected for a long time without any symptoms. HPV can cause abnormal cells on your cervix and sometimes even genital warts. Please contact your gynecologist if you need an appointment to be checked for HPV.

If your pap smear came back abnormal don’t be scared.   Early detection of abnormalities of your cervix can help you out a lot if treated properly.   Cervical cancer tends to progress at a slow rate and can be treated.   Yearly pap tests are crucial in detecting abnormal cell changes before they turn into cancer.   Minor cell changes may only require a repeat pap smear in 6 months to 1 year.   Sometimes abnormal cells will clear on their own over time.   It is important to follow-up with repeat pap smears as recommended by your doctor in case the abnormalities do not become normal.

If an abnormal pap smear has more significant cell changes, other procedures may need to be done. A colposcopy and possible cervical biopsy may be recommended. These procedures may be necessary in order to get a sample of the cell abnormality and evaluate. Based on those results, your doctor will determine the treatment needed. After treatment, repeat paps are very important.

Abnormal Pap Smear Results:

ASCUS (Atypical Squamous Cells of Undetermined Significance)

LGSIL (Low-grade Squamous Intraepithelial Lesion)

ASC-H (Atypical Squamous Cells: Cannot Exclude High-Grade SIL

HGSIL (High-grade Squamous Intraepithelial Lesion)

AGC (Atypical Glandular Cells)

Cervical Dysplasia (link)

Note: Check with your doctor for specific type of abnormality and recommended treatment.

A colposcopy is a method of examining the cervix and tissue surrounding it. An instrument similar to binoculars magnifies the cervix about 15 times. The colposcope allows the doctor to carefully examine the cervix to check for abnormalities.

One of the main reasons a colposcopy is done is an abnormal pap smear. Your need for a colposcopy means that your cervix needs a special examination based on what abnormality you have. Not all abnormal pap smears require a colposcopy. If you do need this procedure done, don’t be too worried.

The Procedure:

This exam is usually done in between your menstrual periods and generally only takes 10-15 minutes to complete.   The colposcopy is done in the same position as a pap smear with the patient lying back on a medical table while a speculum is inserted into your vagina to give the doctor a better view of your cervix.   The doctor will explain the procedure and will then cleanse the cervix with a solution.   The colposcope is used from outside the vagina at a short distance.   The time spent on the colposcopy is used looking through the colposcope for abnormalities.   The doctor will then decide if a biopsy of the cervix is needed.

Biopsy of the Cervix:

If a biopsy is necessary, the doctor will remove a small piece of tissue from the cervix.   More than one biopsy may be needed if there are several areas that look abnormal.   The tissue that is collected is then sent to a laboratory where it is closely examined.   The doctor or a medical assistant/nurse will contact you will the results.   The biopsy may feel like a pinch or cramp.   There may be some light bleeding following the procedure.   Contact your doctor if the bleeding persists, you have fever or chills, heavy and foul smelling vaginal discharge, or sever pain in your lower abdomen.

After the Colposcopy:

There are a few instructions to follow if you had a biopsy taken from your colposcopy procedure.   You may want to avoid intercourse for a few days while your cervix heals.   You may use a tampon, unless otherwise instructed by your doctor.   Continue taking medications as usual.

The Results:

Based on your results from the cervical biopsy, further treatment may be necessary.   You results may come back showing the same results as your abnormal pap smear.   In this case, you may be asked to repeat a pap smear every 6 months to monitor your improvement.    Check with your doctor for your specific treatment plan.

fungus.  These fungi are usually present in the vagina in small amounts anyway.  However, when

the yeast in the vagina starts to overgrow, it causes itching and irritation and usually discharge.

The main symptoms of a yeast infection are thick, cheesy, white, vaginal discharge along with

vaginal itching and burning. There is usually not an odor associated with vaginal yeast.  If you notice a foul odor it may be something else, such as bacteria vaginosis.

There are many common causes of a vaginal yeast infection.  One of the most common is recent use of antibiotics.  Antibiotics kill bacteria and may destroy the acid-producing bacteria in the vagina, making it easier for yeast to grow there.

Other Causes of a Yeast Infection include:

• Pregnancy
• Post-Menopause
• Lupus
• Low-dose estrogen birth control
• Diabetes

Yeast also likes to grow in moist places.  So if the skin of the genitals is not thoroughly

dried, this may promote yeast development.  Examples of this include staying in damp, sweaty gym clothes, staying in wet bathing suit, and also wearing clothes that retain moisture.

Vaginal yeast can be easily treated with a cream, suppository, or oral pill.  You may try over the counter prescriptions or talk to your gynecologist.  Some medications that may be offered to you if you have a yeast infection include Terazol Cream or Monistat.  If you are not pregnant or breast feeding, you may be able to take Diflucan which is an oral medication.  Often times Diflucan is taken only once in order to clear the yeast.  However, another one-dose pill may be offered.  Please talk to your gynecologist to find out what the best treatment is for you.