Gynacological pap test/cell specimens
Gynekologisk cellprovtagning

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Summary

Summary

Regular testing of gynaecological cell specimens may help protect you against cervical cancer. The cell specimen is taken from the mouth of the uterus, and may indicate early indications of cellular changes that could lead to cervical cancer.

Most cell changes detected are minor changes that heal by themselves, but a number of them need to be removed. In very rare cases, the cell specimen may indicate a cancerous presence. At that point, the cancer is usually in the early stages and treatment may be simpler, with fewer adverse effects.

Women in Sweden are regularly summoned to have gynaecological cell specimens taken, a process known as “screening”. Women between the ages of 23 and 50 are summoned every three years. Thereafter this usually occurs every five years until the age of 60. The routines for women over 50 may differ slightly depending on where they live in Sweden.

creening may also be performed by a midwife or gynaecologist during a gynaecological examination for other reasons 

Svensk text

Regular testing of gynaecological cell specimens may help protect you against cervical cancer. The cell specimen is taken from the mouth of the uterus, and may indicate early indications of cellular changes that could lead to cervical cancer.

Most cell changes detected are minor changes that heal by themselves, but a number of them need to be removed. In very rare cases, the cell specimen may indicate a cancerous presence. At that point, the cancer is usually in the early stages and treatment may be simpler, with fewer adverse effects.

Women in Sweden are regularly summoned to have gynaecological cell specimens taken, a process known as “screening”. Women between the ages of 23 and 50 are summoned every three years. Thereafter this usually occurs every five years until the age of 60. The routines for women over 50 may differ slightly depending on where they live in Sweden.

creening may also be performed by a midwife or gynaecologist during a gynaecological examination for other reasons

Preparations

You do not need to make any special preparations, but it is good if you abstain from sex or using any kind of ointment or salve on your genital area for twenty-four hours before the examination. Otherwise the specimen may be difficult to interpret. You should not be screened if you are menstruating.

What happens during the examination?

When the specimen is to be taken, you are to undress from the waist down and recline on a gynaecological examination table. The doctor or midwife may take the specimen in different ways. Most often they use a small spatula, which is scraped against the exterior orifice, and then a small soft brush in the lower part of the cervical canal.

You may frequently need to answer a few questions in connection with taking the specimen. The answers are important to the test being analysed correctly.

The examination is not painful and only takes a few minutes to perform. The results of the screening usually come back within six weeks.

How does it feel afterwards?

The screening is entirely risk-free. There may be some slight bleeding afterwards, but this is not dangerous.

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What is a pap test/gynaecological cell specimen?

What is a pap test/gynaecological cell specimen?

A gynaecological cell specimen is a sample taken from the lower part of the cervix, called the mouth of the cervix and protrudes into the vagina. The specimen may provide early indications whether there are cell changes that may lead to cervical cancer. Most cell changes detected are minor changes that heal by themselves, but a number of them need to be removed. The specimen could also indicate malignancy, though that is very rare.

Having regular screenings is strong protection against cervical cancer, as cell changes may be detected before they develop into cancer.

 

 

 

The cell specimen is a sample taken from the lower part of the cervix, called the outer orifice, which protrudes out into the vagina.

Livmoder = Uterus

Äggstock: Ovary  

Livmoderhals=Cervix

Livmodertapp= Mouth of cervix

Slida= Vagina

Regular tests 

A gynaecological sample is included in the health check-ups – called “screening” – that women in Sweden are regularly summoned for. Detection and treating of cell changes early has led to cervical cancer becoming significantly rarer over the last 40 years.

Screening on other occasions

A gynaecological cell specimen may also be taken if you are visiting a midwife or gynaecologist to undergo a gynaecological examination for other reasons. Sometimes the cell specimen may be a part of the gynaecologist’s investigation if for example, you have bleeding disorders, but it may also be a good occasion to provide a screening sample. It may be appropriate if it is nearly time to take another specimen anyway, or if you had missed an earlier check-up.

Cell changes and cancer 

Cell changes may be due to irritation in the mucus membranes caused by bacteria, or a temporary viral infection. These are the most common types of cell changes that can heal by themselves. Other cell changes that could lead to cervical cancer can be removed in a minor operation.

Abnormal cell specimens are investigated, and often you will be called in for a medical examination. You may then be recommended to have the cell changes removed, or wait and see if they heal themselves.

It usually takes a long time before cell changes develop into cervical cancer, usually ten to fifteen years. It’s quite unusual that advanced cancer is detected in screenings, but it does happen occasionally. At that point it is usually in the early stages, and treatment may be simpler and with fewer side effects.

Every year almost 450 Swedish women get cervical cancer, while many more – 30 000 – are notified that they have undergone cell changes.

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Women are called in regularly

Women are called in regularly

Women summoned every three years

All women between the ages of 23 and 50 are summoned to have a cell sample taken every three years. They are summoned every five years between the age of 50 and 60. For women over 50, the time between calls may differ slightly depending on where they live in Sweden. Women who had previously been treated for cell changes may also need cell specimen check-ups after the age of 60.

The notice will be sent to the address where you are registered; participation is always voluntary.

Which clinics perform screenings?

When you have received a notice, the specimen is taken by a midwife at the nearest midwives clinic, which is also known as a maternity clinic. In most cases you will be given an appointment time which may be changed. In certain towns, you may even change the appointment to another clinic.

If a specimen is taken in connection with a gynaecological examination, for example at a gynaecologist’s, or in connection with birth control advice, the samples are usually also registered so that you receive your next notification about specimen screening check-up after three or five years hence.

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Many people don’t need specimens taken

Many people don’t need specimens taken

Those under 23 or over 60 are not notified

If you are under the age of 23, you will not be summoned for cell specimen check-ups. Cell changes are in and of themselves quite common before the age of 23, but most disappear by themselves in women that young. It is extremely unusual for cervical cancer to develop that early.

If you have had cervical screening checkups and had several normal cell specimens by the time you have turned 60, the risk of developing cervical cancer later in life is very low.

If you have not had sex, you don’t need specimens taken

If you have never had sex, you won’t need to have specimens taken. Cervical cancer appears only in women who have had sex and then been infected by a certain type of human papillomavirus (HPV).

If you are homosexual

If you are homosexual, it is beneficial to have cervical screening check-ups regularly, since the virus that can cause cell changes may likely be transmitted from woman to woman.

If you have had a hysterectomy

If you have had a total hysterectomy – that is, your entire uterus has been removed – you will not need to go to cervical screening check-ups, since the mouth of the cervix had also been completely removed during the operation. But if the surgery had been performed due to cervical cancer or cell changes in the cervix, you should continue to have check-ups. Samples from the upper part of the vagina will then be taken.

If you are unsure of what kind of surgery you’ve had or what had been removed, you may ask at the clinic where the operation had been performed. Your midwife at the midwives clinic or maternity clinic may often also help in obtaining this information. If you are unsure, it is better to have a sample taken for safety’s sake.

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What happens during the examination

What happens during the examination

Getting ready

You do not need to make any special preparations before taking the specimen, but you should abstain from sex or using any kind of cream or salve on your vagina for twenty-four hours before the examination. It may otherwise be difficult to analyse the cell specimen. You should not have a specimen taken if you are menstruating.

Samples from the  cervical mouth

Prior to the examination, you will need to undress from the waist down and recline on a gynaecological examination table. The person taking the sample – a midwife or doctor – will carefully separate the vaginal walls with normal gynaecological instruments which must be at body temperature.

The process of taking the sample varies from clinic to clinic. Most frequently a small spatula made of wood or plastic is scraped against the mouth of the cervix, and then a small soft brush is used in the lower part of the cervical canal.

Taking the specimen proceeds rapidly and normally takes only a few minutes. It usually does not hurt. Some people may feel discomfort but that quickly passes.

Questions to answer

Often you may need to answer a few questions in connection with the taking of the specimen, for example

  • the last day of your most recent menstruation, or when menses stopped
  • whether you use birth control, and if so, which forms
  • if you are receiving hormone treatments for difficulties with menopause
  • whether you are pregnant or have had children in the last year.

The information is sent along with the sample, which will make it easier for the laboratory to make an assessment.

There may be a little harmless bleeding afterwards

The mucus membranes of the cervix bleed easily, and it is normal to get a small amount of harmless bleeding after an examination. The bleeding will disappear after a few days.

Pregnant women may have samples taken

Taking samples is completely risk-free and may even be done if you are pregnant. It’s usually recommended that samples be taken by week 15 at the latest, as investigating an abnormal sample may be more difficult if the pregnancy has proceeded further.

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When do the results come in?

When do the results come in?

Most results show no changes

You should get a letter with the specimen results within six weeks, but sometimes it can take longer. Approximately 95 out of 100 specimens have no cell changes and are judged to be normal. The results are sent directly to your home from the laboratory.

If the specimen had been taken at a gynaecological clinic or birth control clinic, the person who had taken the sample is most often the one responsible for providing you with the results.

In unusual cases the specimen cannot be analysed – for example, if there is too much menstrual blood in it. You will then be summoned to have a new specimen taken.

If the specimen contains cell changes

If the specimen shows cell changes of any type, it is investigated further. If you have minor cell changes and are between the ages of 30 and 35 (depending on where you live in Sweden), the specimen is usually analysed immediately with a virus test. It checks whether you have a type of HPV – human papillomavirus – that is a risk for cervical cancer. Only those who have this type of HPV at this time need to come in for an examination. If you have minor cell changes that do not involve this virus, you will only need to have a new specimen taken one year later.

As far as all cell changes in women under 30 - 35 are concerned, nowadays an examination by a gynaecologist is recommended, but it may also be the case that you will be summoned to have a new sample taken by a midwife. It is also recommended that women over 30 - 35 who have other cell changes other than the most minor should be examined by a gynaecologist.

Taking cell specimens is not complete protection against cancer

Regular cell specimen check-ups provide strong protection against cervical cancer, but it is not exhaustive. You may get cervical cancer despite having normal cell samples, but it is highly unusual. Apart from having regular screenings, you should always seek medical care if you experience bleeding during sex, if you bleed repeatedly between menstrual periods, or if you experience bleeding after menopause.

You can always phone the healthcare helpline for advice on where to go.

Taking samples and getting results can be worrying

Taking a cell specimen can feel stressful. For example, you could feel worried while waiting for the results; it may be a good idea to think that undergoing a screening is a way of protecting yourself against cancer. Detected may to a large extent be removed through a simple procedure, so you may avoid cancer in the future.

It’s very rare for a specimen to indicate that cancer has developed. The rare occasions where cancer has been detected through cell specimen check-ups, they have been at such an early stage that treatment was simpler, with fewer side effects. The disorder had been detected through a screening and the risk of serious illness was thereby reduced.

You decide whether samples are saved

Specimens that are taken are usually saved. For example, new specimens may be compared to older ones, and various follow-ups can be performed. Additionally, the specimens may be used for research or other purposes approved by a research ethics committee. If you don’t want the specimens saved for the future, you may inform the person taking the sample, and it will be destroyed later.

Information about taking samples is also saved in a quality register which is used for improving health care. If you don’t want your information to be used for this, you may demand that it be deleted.

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Publicerad:
2012-11-07
Skribent:

Written by: Björn Strander, gynaecologist, Gynekologiska mottagningen, Kungshöjd and Regionalt Cancercentrum Väst, Göteborg

Redaktör:

Editor: 

Monica Wallenius, 1177 Vårdguiden

Granskare:

Reviewed by: Inga Sjöberg, gynaecologist and obstetrician, Ersboda hälsocentral, Umeå

Illustratör:

Illustrator: Kari C Toverud, certified medical illustrator, Oslo, Norway