Ladies Well Check
Dr. Cindy Basinksi and Dr. Rupal Juran, Newburgh, IN board-certified gynecologists, perform well-checks for women of all ages and stages of life. Included in this physician exam are a number of varying procedures. Pap smears (or pap tests) are how women are screened for cervical cancer, or cancer of the cervix. The cervix is the mouth of the uterus (or womb). During a pelvic exam, a speculum (small duck-billed instrument, about the size of a tampon) is placed in the vagina, and the cervix can be visualized at the top of the vagina. The pap smear is a painless test performed with a soft brush. The soft brush sweeps cells off the cervix, and those cells are then examined under a microscope in the lab. While we usually recommend yearly gynecologic exams for most women, a pap smear does not necessarily need to be performed every year.
When do I start getting pap smears?
Most women start getting pap smears at age 21, regardless of their sexual history. This is in accordance with the most recent guidelines from the American Congress of Obstetricians and Gynecologists.
How often do I need a pap smear?
It depends on your age and what the results of your previous pap smears have been. Each patient is unique and Dr. Basinski and Dr. Juran will discuss the frequency of pap screening with the patient per their individual needs. In general, the most recent guidelines from the American Congress of Obstetricians and Gynecologists recommend:
- Age 21-29: Pap smear every 3 years, as long as they are all normal
- Age 30-65: Pap smear AND HPV testing every 5 years, as long as the pap is normal and negative for HPV.
Depending on the individual patient, paps may be performed more frequently depending on your medical history, symptoms, or exam.
What is HPV?
HPV stands for Human PapillomaVirus. There are over 100 different types of HPV that we know of so far. About 30 different types of HPV are spread through sexual contact and affect the genitals. Some types of HPV cause genital warts. These are referred to as “low risk” HPV. Other types of HPV can cause the cells of the cervix to become abnormal. These are referred to as “high risk” HPV. If these abnormal cells are not monitored and not treated, the abnormality could worsen into cancer. It usually takes years for cancer to develop. In most women, their immune system will get rid of the virus before it can cause severe abnormalities or cancer, usually within 1-2 years. In some patients, the HPV persists and an abnormality can become more severe. There are some known risk factors for not being able to get rid of HPV, including smoking.
HPV is very common. 60-80% of women will have HPV at some point in their lives. Again, the immune system of most women will be able to get rid of the virus. Further reading about HPV from the American Congress of Obstetricians and Gynecologists is available at:
How can I prevent HPV infection?
There is a vaccine for 4 of the more common types of HPV, called Gardasil. It is a series of three shots, recommended by the CDC for girls and boys between the ages of 10-12. The vaccine is recommended at such a young age because the vaccine works best at mounting an immune response to HPV if it is given prior to any HPV exposure.
Other ways to reduce the risk of contracting HPV include using condoms and limiting the number of sexual partners. These are also ways to reduce the risk of contracting any Sexually Transmitted Disease.
Abnormal Pap Smear
If you receive a phone call from us informing you that your pap smear is abnormal, please do not panic, as an abnormal pap smear DOES NOT mean you have cancer. Abnormal pap tests are very common.
The following will help you understand your abnormality and what we will do to treat you. Below is a basic list of pap smears ranging from normal to more abnormal.
- Normal Pap Smear, negative for HPV
- Atypical Squamous Cells of Undetermined Significance without Human Papilloma Virus (ASCUS, neg HPV) / Variant of Normal Pap
- Normal Pap Smear, positive for HPV
- Atypical Squamous Cells of Undetermined Significance with Human Papilloma Virus (ASCUS, pos HPV)
- Atypical Gladular Cells of Undetermined Significance
- Low Grade Squamous Intraepithelial Lesion (LGSIL)
- High Grade Squamous Intraepithelial Lesion (HGSIL)
- Carcinoma In Situ (CIS)
Every patient’s situation is unique, but in general, any of the above pap smears that are italicized will require a procedure called a colposcopy to evaluate your cervix. A colposcopy will help us determine whether the abnormality requires any further treatment or just continued monitoring with more frequent pap smears.
If you have one of the more severe abnormalities such as HGSIL, we may offer you an excisional procedure (which is meant to remove the area of abnormality) without doing a colposcopy first. This excisional procedure is called a LEEP (see below).
LEEP & Colposcopy
LEEP stands for “Loop Electrosurgical Excisional Procedure.” A LEEP procedure is done in the office after applying some numbing medicine. The LEEP procedure is not the same as colposcopy/biopsy. Whereas the colposcopy and biopsy are meant to evaluate and monitor abnormalities, the LEEP procedure is meant to REMOVE the abnormality. A thin wire loop is used, and electric current is passed through the loop to shave off a part of the cervix. The portion of the cervix that is removed is sent to the lab for evaluation.
You may experience some bleeding and discharge for up to a few weeks after your LEEP, as your cervix heals. Taking some ibuprofen before your LEEP procedure may prevent cramps during the procedure. The results of the LEEP take about 1-2 weeks to come back. After the LEEP procedure, we will usually see you in the office after 6 months for a pap smear, depending on the results.
This is a procedure that is done in the office to evaluate your abnormal pap smear. Dr. Basinski or Dr. Juran will look at your cervix with a special microscope after applying vinegar solution over the cervix. The vinegar solution causes any significant abnormalities to appear white.
If any significant lesions are seen, a biopsy of that area may be taken for evaluation in the lab. DO NOT worry about this biopsy. Most women do not even feel it being done. Your cervix does not have nerve endings like your skin. If needed, medicine will then be use to stop any bleeding at the biopsy site. This can cause some cramping like menstral cramps. If you want to take some Ibuprofen prior to your procedure, this can help with the cramping. The results from the colposcopy will take about 1-2 weeks to receive. Unless the results require that we do any further procedures, we will usually see you in the office for another pap smear in 6 months.