As of May 2012 new guidelines for Pap tests were issued by the American Society for Colposcopy and Cervical Pathology (ASCCP), decreasing the number of Pap tests a woman may have to have in her lifetime.  Even though Pap tests are no longer needed yearly, it is still recommended that women schedule pelvic exams, breast exams and STI screening annually.
 

Why Get a Pap Test? Two screening tests, done regularly, can help prevent cervical cancer by finding it early:

• The Pap test screens for abnormal cervical cells. These abnormal cells can then be further evaluated, and if necessary, removed.
• The HPV (Human Papillomavirus) test looks for the virus that can cause cell changes. HPV testing is often done for women who have had an abnormal Pap or who are age 30 or older.

How Is a Pap Test Done?During a pelvic exam, your nurse practitioner or doctor will use an instrument called a speculum, to examine the vagina and the cervix. A few cells will be collected directly from the cervix and the surrounding area, and sent to a lab for evaluation.

When to Get Screened?Women age 21 should start getting regular Pap tests. Screening before age 21 is not recommended because it may lead to unnecessary evaluation and treatment in women at very low risk of cancer.

• Women age 30 or older who have never had an abnormal Pap test should get Pap and HPV typing every 3-5 years. The charge for these tests at Student Health is $175. If you are on the Penn Student Insurance Plan (PSIP), there is no out-of-pocket fee.
• Women under the age of 30 with no history of abnormal Pap tests should have Pap tests every three years. The charge at Student Health is $50. Additionally, HPV testing is indicated at times; the charge for this test is an additional $125. If you are on the PSIP, there is no out-of-pocket fee.
• Women who have had an abnormal Pap test may be advised to have additional testing which may incur additional fees.

Annual pelvic and breast exams are still recommended, even if a Pap test is not indicated.

How to Prepare for Your Pap TestTwo days before your Pap test, you should not have intercourse, use tampons, creams, lubricants or douches. Schedule your Pap test for a time when you are not having your period.

Pap Test ResultsYou will be notified of your Pap test result in 1-2 weeks by secure message. If the results are abnormal, follow-up testing is recommended. There are many reasons for abnormal results. Most Pap test abnormalities show mild changes due to HPV infection. In the majority of women, this virus resolves without treatment within 1-3 years. A colposcopy may be recommended. This is a simple office procedure which allows for a magnified view of the cervix.

Management of Abnormal Pap TestsIn the event that a student has an abnormal Pap test, follow-up is provided by either the nurse practitioners or by the gynecologist. This follow-up may include repeat Pap tests, colposcopy, biopsy, or referral.

Besides routine check-ups or to obtain contraception, you are welcome to schedule an appointment if you have any of the following symptoms:• Abnormal or heavy vaginal discharge that itches, burns, has an odor, or causes you discomfort
• Heavy vaginal bleeding, missed periods or irregular menstrual cycles
• Bleeding between periods, also known as spotting or break through bleeding
• Painful intercourse
• Menstrual cramps that cause you to miss school or work
• Any signs of pregnancy
• Side effects or problems from your birth control method
• Breast pain, lump, or discharge from the nipple

Preparation for the Well Woman ExamThe well woman visit, which typically includes a pelvic exam, can be a unnerving experience for many women, especially when it is the first exam. However, preparation for the exam and an understanding of the underlying health reasons behind the exam may help to lessen the anxiety. Important: In order to ensure accurate results, we ask all women who are scheduled for a well woman exam to have nothing in the vagina at least 48 hours prior to the examination. This includes abstaining from intercourse, tampon use, creams, douching, etc. If you are actively bleeding or are on your menstrual period at the time of a scheduled well woman exam, we will ask that you reschedule your appointment.

If it is your first visit to Women's Health, the provider will start by taking a routine health history. Questions she will ask will include information about your health as well as any pertinent family medical history. She will ask about your menstrual cycles, if you are sexually active, and if your sexual relationships place you at any risk for pregnancy or sexually transmitted infections. Additionally, she will ask about any dietary, social, and violence related concerns which may place your health at risk. If you have any questions for her about your health, please do not hesitate to ask!

In preparation for the exam, you will be given a gown to wear and a drape for your lap. You will be asked to undress for an annual exam. If you prefer, you may keep on your top/shirt during the exam ( if so, you will also be asked to unhook your bra in order to facilitate the breast examination).

The Breast ExamThe Women's Health Division of Student Health Services at the University of Pennsylvania currently follows the National Comprehensive Cancer Network (NCCN)'s recommendations regarding women's self breast exam. We no-longer suggest a monthly self breast exam for women. At this time, we recommend that women be familiar with their breasts and report any changes or problems to their health care provider as soon as possible. The NCCN's term for women's familiarity with their breasts is called "breast awareness." Breast awareness includes consistent periodic self breast exams and being aware of what your breast tissue normally looks and feels like.

When performing a self breast exam women should be aware of "red flags," which warrant prompt attention from a women's healthcare provider. These red flags include:

§ A lump that has not been evaluated
§ A change in a breast lump, such as size
§ Red, swollen, or flaky skin on any area of the breast
§ A nipple that is painful or becomes inverted
§ Any fluid that is leaking from the nipples (if not breastfeeding)
§ Any skin dimpling
§ A lump or changes in skin under the arm.

The Pelvic ExamThe pelvic exam, in most cases, is actually a very short and simple procedure. In fact, it will probably take more time to read the following information than it will take to do the exam! At any rate, many women feel needlessly embarrassed and self conscious during the pelvic exam. Please try to remember that the provider performs routine pelvic examinations every day and understands your feelings. Additionally, she also goes regularly for her own examinations! However, if you have had negative experiences in the past or have particular concerns, use this opportunity to discuss this with your provider before the exam. She may be able to help make the exam a more pleasant experience.

Before the exam, you should empty your bladder. You will be asked to bend your knees and place your feet in footrests during the actual exam. The first part of the exam consists of a brief examination of the external area. The provider will look for any external signs of problems, including abnormal bumps or rashes. If you have noticed any bumps or rashes yourself, please alert the provider.

The Speculum ExamA speculum will be used during the second part of the pelvic exam. A speculum is a metal or plastic instrument that is used to gently separate the vaginal walls allowing for better visualization of the cervix (the opening of the uterus). The speculum comes in several sizes, accommodating even virginal women. A warmed speculum will be inserted into the vagina. Most women describe the feeling as "having pressure". After inserting the speculum, the provider will visually examine the cervix and take a few cells for a Pap test. To do this, she will use small flexible plastic broom and a small cervical brush, which looks like a mascara brush. The Pap test is a screening test for abnormal cells that may become pre-cancerous cervical cells. Follow-up and treatment for abnormal Pap tests is done at Women's Health. Most results are back within two to three weeks.

Screening for Sexually Transmitted InfectionsThe provider will examine the cervix and vaginal tissue for any abnormal discharge or bumps. Screening for sexually transmitted infections (STI), including gonorrhea and chlamydia, can be done. We encourage all sexually active women to be screened for STI if they have had a new sexual partner since their last exam or are not in a monogamous sexual relationship. Screening for STI is simple and consists of taking a small amount of cervical discharge with a swab at the time of the exam. It can also be done through urine testing or by a self-administered vaginal swab. Like the Pap test, this will also be sent to the laboratory for evaluation. Most results are back within 2-3 weeks. Women's Health will contact you if your results are normal or abnormal. Please contact your provider if you do not hear from Women's Health within 3 weeks of your testing. Testing is confidential and done with minimal charges.


The Bimanual ExamAfter the speculum is removed from the vagina, a bimanual (two-hands) examination of the uterus and ovaries will conclude the exam. The provider will insert one or two gloved fingers into the vagina and will locate the cervix with the tip of her finger. With her other hand, she will press firmly on the abdomen, right above the pubic bone. During this procedure, the provider is evaluating the size, shape, and consistency of the cervix, uterus, and ovaries. This can often feel like pressure to the woman. Any pain should be discussed with the provider.

Rectal ExamRectal exams are not a routine part of a well woman exam in women under the age of 50. Evaluation of certain pelvic problems, such as endometriosis, may require a rectal exam in addition to a bimanual exam. The provider will tell you if she needs to do a rectal exam. During the rectal exam, the provider will insert one lubricated, gloved finger into the rectum.


What happens after the exam?After the exam, the provider will leave the room and ask you to get dressed. When she returns to the exam room, you will be given time to ask any additional questions about the exam findings. If any abnormalities were noted during your exam, the provider will use this time to discuss them with you. If any treatments are needed, the provider will provide them at this time and will instruct you on their use. Contraceptive options and medication refills may be discussed at this time as indicated.

You also will be given a handout about the Pap test and how to get your results as well as general information about the results.