Many of us get cervical cancer screenings (often just called your Pap smear, even though it may also include an HPV test) because our doctor recommends them, without much thought into the process. You may groan when you see the appointment on your calendar and probably cringe a bit when it’s time to put your feet in the stirrups. At Teal Health, we are working to make the process of cervical cancer screening less uncomfortable. Let's start by getting a better understanding of the exam itself, and why it’s so important.

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What is a cervical cancer screening? 

The cervical cancer screening experience – conducted in a clinic, using a speculum – has not evolved much in its 80 years in medicine. However, there have been updates to what doctors can test for. Thanks to major advancements in research and technology, we know human papillomavirus (HPV) is linked to nearly all cervical cancer diagnoses. These findings led to the introduction of the HPV test.

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Below are the three tests that can be performed during your cervical cancer screening exam:

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Primary HPV: This screening test looks for a current HPV infection. Detecting HPV is critical because having high-risk HPV is the single most important risk factor in developing cervical cancer, as almost all cervical cancers are caused by HPV.

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Pap Smear: According to Dr. Liz Swenson, Medical Director and OB-GYN at Teal Health, “A Pap smear is a screening method used to sample the cells of the cervix to test for changes which could indicate precancer or cancer of the cervix. Usually, this is due to an infection with a type of high-risk HPV.”   

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Co-test: A co-test includes both a high-risk HPV test and the Pap test. 

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It's good to understand which test you receive because the follow-up timelines can be different and these tests are looking for (slightly) different things. The tests also differ in their sensitivity (the test’s ability to pick up an infection or disease if it is present), with the HPV test being the most sensitive at above 94% overall. Since the Pap has a lower overall sensitivity, it could be a good idea to ask your clinician about getting a primary HPV or co-test.

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Following a normal HPV test, you won’t need to test again for up to five years (abnormal results for any test will result in more immediate follow-up with your doctor). If you have a Pap smear with normal results, you’ll need another one in three years. It is, however, important to review your individual situation with your provider and determine the most appropriate timing for your next screening.

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What does getting a cervical cancer screening entail?

We’ll speak plainly here: The traditional clinic-based cervical cancer screening is in dire need of an upgrade. Teal Health is currently working on an at-home self-collection option for primary HPV testing so that you can collect a cervical sample from the comfort of your own home. While we work towards FDA approval (and you can be the first to know by signing up here), here’s what you can expect when you go into the doctor’s office for a screening. 

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When you arrive at the doctor’s office, you’ll undress from the waist down and likely change into a gown. Your doctor or clinician will have you place your feet in stirrups and spread your legs. From there, they will use a speculum to hold the vaginal walls apart so the clinician can access your cervix. They will insert a cervical brush and you may feel pressure as they collect a sample. It’s not a comfortable process, but it shouldn’t take longer than a couple of minutes. 

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After your exam, your clinician will insert the brush into a preservation solution and send it to a lab with an order from the physician to perform a HPV test and/or Pap smear on the sample (depending on which test you got). Within 1-3 weeks, you’ll get results from your doctor, indicating either “normal” or “abnormal” results and the appropriate follow up. This could include doing additional testing if your results are abnormal.

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What exactly *is* my cervix? 

So, your doctor or clinician will access your cervix via your vagina during a cervical cancer screening (take a look at this diagram to learn more). But what exactly is the cervix?  Dr. Swenson explains, “The cervix is the lowest portion of the uterus which connects the uterus to the vagina. It produces mucus that cleans and hydrates the vagina. Because the cervix responds to hormonal changes, the character of the cervical mucus changes throughout the menstrual cycle.”

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Perhaps if you’ve tracked your menstrual cycles or tried to conceive, you’ve noticed or looked for changes in your cervical mucus. Dr. Swenson says, “Near the time of ovulation, the mucus is thin and slippery, promoting sperm to pass through. During pregnancy, it develops a protective thick mucus plug which helps prevent infections. The cervix is the part of the uterus that opens/dilates during labor, allowing the fetus to move through the birth canal during a vaginal delivery. It can also be a source of sexual stimulation for some women during intercourse.”

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What should I know before I get a cervical cancer screening?

Now that we know more about what to expect and why a cervical cancer screening is important, we asked Dr. Swenson if there’s anything else to know before getting one. 

She says, “Having sex just before your screening can cause some changes to show up on the cells, indicating inflammation or atypical cells of undetermined significance. The presence of HPV is used to determine the significance of these findings. If there is no HPV, it is most likely benign and nothing to worry about.” So while it may be best to avoid sex the day or so before your screening, Dr. Swenson says it’s fine to have sex as soon as you feel comfortable after your test results. 

Lastly, she explains that it’s common to have some spotting after a cervical cancer screening. 

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When and where should I get a cervical cancer screening? 

For now, the U.S. Preventive Services Task Force (USPSTF) and the American Cancer Society (ACS) recommend getting an HPV or co-test (Pap + HPV) every 5 years, or a Pap smear every 3 years if you are between 25-65 years old (no younger than 21 years, according to the USPSTF). The ACS recommends HPV primary testing as the preferred screening method, if it’s available in your clinic. All insurance covers cervical cancer screening tests every three to five years, and most cover it every year.  

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“Cervical cancer screens can be done by a variety of providers, including OB-GYNs, midwives, family practitioners, internists, nurse practitioners, and physician assistants,” says Dr. Swenson. “It's helpful to confirm that your primary care provider [performs a Pap smear] as part of their routine exams, as occasionally some don't include this as part of their care.” 

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The future of cervical cancer screening is bright

If you haven’t had a Pap smear in the past three years or an HPV or co-test in the last five years, don’t wait to get screened. But a better way is on the horizon, and we’re so excited to share with you what we’ve been working on. 

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The Teal Wand^TM will enable people to perform self-collect primary HPV testing at home—no more uncomfortable speculum and stirrups at your doctor’s office. The Teal Wand^TM (think a swab similar to a tampon) will make screening more comfortable and accessible for everyone with a cervix. Sign up below to be the first to know when you can get Teal Health in your state.