When you think of cancers associated with women, breast cancer is likely the first one that comes to mind. But the truth is that, among Indian women, cervical cancer is the most common cancer and the second most fatal. Sadly, many of those deaths are preventable: There’s a simple test that can identify pre-cancerous cells in the cervix and alert women to a the possibility of a major health risk. It’s called a Pap smear, and here’s what you need to know.

WHAT IS A PAP SMEAR?

Briefly, a Pap smear, or Pap test, is a quick and simple test, in which cells from the cervix are taken and tested for abnormalities that may lead to cervical cancer.

WHAT CAN YOU EXPECT?

A Pap smear is not painful—but we’re not going to lie, it’s not super comfortable. The good news is that it takes only a minute. Once you change into an exam gown in private, your family doctor or gynecologist will ask you to lie on your back with knees bent and feet resting in stirrups. The doctor will then insert into your vagina a lubricated device called a speculum, which is used to widen the opening and allow the doctor to view the cervix and vagina. The sound of the speculum expanding can be as disconcerting as the device is uncomfortable. But, again, it shouldn’t be painful; if it is, alert your doctor and ask him or her to stop!

With the speculum expanded, the doctor will quickly take a small sample of cervix cells using a tiny spatula or brush; you may feel a scraping or pinching sensation. After that, the speculum is closed and removed; your Pap smear is complete.

At the same time as your Pap smear, however, your doctor is likely to also conduct a pelvic exam checking the health of all your pelvic organs: your vulva, uterus, cervix, Fallopian tubes, ovaries, bladder, and rectum. This includes inserting two, gloved fingers into your vagina while pressing on various parts of your lower stomach with the other hand to check the size and shape of your organs. Also, the doctor may insert a gloved finger into your rectum to check for abnormalities or tumors. You can ask your doctor to narrate his or her actions as he or she performs them, so you are not uncomfortably surprised.

After the full exam, it is not unusual to experience spotting.

WHY IS A PAP SMEAR IMPORTANT?

The Pap test identifies pre-cancerous cells in your cervix, if there are any, which means that you can actually prevent cervical cancer from ever developing. But note that there are no symptoms or warning signs if your normal cells become pre-cancerous, which is why it’s important to take a regular Pap smear. Without the test, such cells may go undetected and untreated and develop into cervical cancer.

WHO SHOULD GET A PAP SMEAR?

Women who are sexually active. Cervical cancer can be caused by certain types of the human papillomavirus (HPV), which is a sexually transmitted disease with few or no symptoms. Most sexually active men and women will contract HPV at some point in their life, often without ever knowing it and often with only one partner. Pap smears enable women to know if they’ve contracted HPV and act proactively against any cells that may lead to cancer.

Women who are pregnant. Your doctor will likely conduct a pelvic exam during your first prenatal appointment, in order to confirm the pregnancy. A Pap smear may also be performed, if you’ve not recently had one.

Women experiencing symptoms of vaginal infection. During a Pap smear, a sample of vaginal fluid can be taken and tested for common infections like vaginosis, chlamydia, and trichomoniasis.

Women experiencing pain in the pelvic area or lower back. Pelvic and lower back pain can be a sign of many different ailments of varying degrees of seriousness, from sexually transmitted diseases, to kidney stones, to ectopic pregnancy, to endometriosis, and more. The pelvic exam that usually accompanies a Pap test can help identify the cause.

While doctors have different stances on the frequency of testing, most agree that women between the ages of 21 to 65 should get tested annually. Women older than 65 should discuss with their doctors if and how often they need testing, based on their medical history.

WHO DOESN’T NEED A PAP SMEAR?

If you’ve had a hysterectomy for reasons other than cancer, you don’t need to get Pap smears. However, if you’ve had a hysterectomy because of abnormal cervical cells or cervical cancer, you should take Pap smears regularly until your doctor says they’re no longer required. This may seem confusing, since you’ll no longer have a cervix to test, but your doctor will examine cells from the area where your cervix was, in order to make sure your cancer doesn’t come back.

HOW OFTEN SHOULD YOU TAKE A PAP SMEAR?

Pap tests are generally done every one to three years, depending on your age and medical history. Tell your doctor about any special circumstances in your medical history, such as chemotherapy, organ transplant, exposure to DES (a synthetic form of estrogen) before birth, infection with HIV, or previous treatment for pre-cancerous cells or cervical cancer. You may need to be tested more often in such situations.

HOW DO YOU PREPARE FOR A PAP SMEAR?

You don’t have to do anything to prepare for a Pap test. Simply schedule your appointment when you’re not on your period and for 48 hours before the test don’t have sex, use a tampon, use vaginal creams or medicines (unless prescribed by a doctor), use vaginal deodorants, douche, or use birth control foam, cream or jelly.

Pap tests are not scary or painful, and a few moments of discomfort are worth ensuring you catch any pre-cancerous cells early.

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