Frequently Asked Questions

Almost every test or procedure has benefits and risks. It’s important to be aware of them so that you can make an informed decision that’s right for you. No screening test is 100% accurate, but scientific evidence tells us that Pap tests can decrease death rates from cervical cancer.

• False-positive results: This happens when test results suggest cervical abnormalities such as precancerous cervical changes even though cancer is not present. False positives can cause anxiety, stress and possibly painful and unnecessary tests to rule out cancer (that is, to make sure you don’t have cancer when the screening test has suggested you might).
• False-negative results: This happens when cervical cell abnormalities are not detected by the test even though they are present. False-negative results can cause you or your doctor to be unaware of cervical abnormalities that could lead to cancer or to ignore symptoms that suggest the presence of cancer, causing a delay in diagnosis and treatment.
• Unnecessary follow-up procedures or treatment: Some women with cervical abnormalities may have follow-up procedures or treatment for a condition that may never have developed into cancer. Cervical abnormalities in many young women often go away on their own without treatment (if they are the low-risk kind).

Pap tests do not test for sexually transmitted infections, including HPV. Pap tests only check for cervical cancer or precancerous cervical cells that are caused by HPV, but cannot test for HPV itself. Often times a Pap test will be done at the same time as an STI test because some STI tests involve swabbing the cervix or vagina. Talk to your healthcare provider to ensure that you are getting screened for cervical cancer.

If your test results came back positive, your healthcare provider will talk to you about next steps. While this might feel scary, it’s important to remember that abnormal Pap tests are very rarely cancer. Cervical cells change often, and often change right back on their own. If they don’t, there are many ways to treat it and prevent cervical cancer.

Next steps can include the following:

• retest in 3-6 months
• further testing to check for HPV infection
• a colposcopy to further examine cell changes

Follow up tests may show that cell changes are not because of cervical cancer. Changes to the cervix may also be caused by:

• other types of infections, such as yeast infections
• inflammation
• an intrauterine device (IUD), which is a form of birth control
• precancerous cell changes, which will need to be treated

Many lesbian, gay, bisexual and queer women prefer natural and holistic ways of taking proactive care of our health. It’s wonderful to take care of your health in the ways that work for you. While there may be many natural ways that we can take care of our cervical health, a Pap test is still the only proven test we have to detect cervical cell abnormalities.

A pelvic examination is a physical examination of the organs in the pelvis that is often a part of a regular checkup, often after a Pap test. The purpose of the exam is to check the size, shape and position of the ovaries, uterus and Fallopian tubes, and to check for pain, bleeding, and infections. The healthcare provider will check the outer appearance of the vulva and opening of the vagina. The healthcare provider will then put a gloved finger or two inside the vagina to check the cervix and pelvic organs while gently pressing on the lower abdomen with their other hand. Lubrication is usually used. You may feel pressure, but it is usually not painful. If it is, you can tell your healthcare provider and you can stop at any time.

Yes. Speculums come in different sizes and shapes depending on the shape of your vagina. Talk to your healthcare provider about using a size that works for you.

It is widely believed that the use of lubrication can alter lab results. Recommendations on the use of lubrication for Pap tests vary. Talk to your healthcare provider about how to make a Pap more comfortable for you.

In 2012, The Canadian Cancer Society changed its cervical screening guidelines to better reflect evidence-based research that indicates that screening women under age 21, regardless of the age they first became sexually active, doesn’t reduce their risk for cervical cancer.

HPV, the leading cause of cervical cancer, comes and goes much quicker in women under 21, meaning that cervical cells change between normal and abnormal frequently. The evidence shows that the negative outcomes of getting cervical screening for young people under 21, such as follow up exams and treatment procedures, outweigh the benefits of getting screened. Cervical cancer is slow growing, and very rare in women younger than 21 years of age.

If you are at average risk, the Canadian Cancer Society does not recommend that you have a Pap test annually. Sometimes healthcare providers will assess that some people need Pap tests more frequently, possibly because of a suppressed immune system, a history of abnormal cervical cells, etc. If your healthcare provider has not recommended that you have annual Pap tests, you can still get annual Pap tests but they are not covered by OHIP.

As of January 1, 2013, annual Pap tests that are not recommended by health care providers must be paid out of pocket by the patient. The test itself is $20 plus a healthcare provider fee for performing the service. If your doctor has recommended that you get Pap tests more frequently than once every three years, your tests will be covered by OHIP.

The earliest you can begin screening is 21 years of age. So, if you started having genital sex at the age of 16, you would wait until you are 21 to get screened. If you are older than 21 but haven’t had genital skin-to-skin contact with someone else, then you can wait to get screened until three years after your first sexual experience. For example, if you are 23 years old at the time of your first genital skin-to-skin sexual experience, then you would get screened three years later, at 26.

Yes, even though you don’t have OHIP, you can get screened for cervical cancer by paying out of pocket with a healthcare provider who accepts uninsured clients. Some community health centres offer Pap tests to uninsured clients.  Click here for resources.

It depends on the type of hysterectomy. If you don’t know what type you had, you will need to talk to your healthcare provider.

If you had a hysterectomy:

• to treat a cancerous or precancerous condition of the cervix, then Pap tests or vaginal vault smears are usually continued annually until three documented vaginal smears come back normal in a row.
• to treat a non-cancerous condition, and you don’t have a history of precancerous cells, then you will likely not need a Pap test.
• if no previous Pap test record is available and you were not given a hysterectomy because of cancerous or precancerous cells, then you will need two negative Pap tests one year apart and then you will be able to stop screening.
• that was partial, then you will likely need to continue screening.
• that was sub-total (uterine corpus removed, cervix in place) should continue screening every three years.

Yes. Thirty percent of cervical cancers are not caused by HPV, so screening is still important even if you have been vaccinated.

You will need to get screened every year. Talk to your health care provider for more information.

Yes, you can get a Pap test while pregnant. Make sure that your provider knows that you are pregnant.

Yes. If you have ever had genital skin-to-skin contact with anyone of any gender, then you need to get a Pap test.

Yes. HPV reflex testing is one of many follow-up test options after a Pap, if results come back positive. If you’re 30 years old or older and there are cell changes in your Pap test that are hard to read, then your healthcare provider may choose to test your cells for HPV. The test is only for women 30 years and older because as women age, the chances increase that HPV infections become longer lasting and therefore cancer-causing. For younger women, because HPV clears up on its own very often, HPV testing is not helpful in determining who may need more follow up tests.

Testing is usually done on the same sample of cells that were taken during the Pap. The cells are then examined to determine what type of HPV is present.

HPV testing is not a screening tool, but a follow up test. HPV testing does not replace a Pap test.

Most people can fight most strains of HPV infections on their own. The virus usually clears up within two years without you even knowing that you had it in the first place. For high risk strains of HPV like the ones that cause cervical cancer, they have a tendency to stick around for longer periods of time. Unfortunately, there is no cure for HPV and it can’t be treated with antibiotics. While you can’t cure or treat HPV, you can get a Pap test to find cancer early, or even before it starts, when it is most effective to treat.

There are many different strains of HPV. The strains that cause cancer are called high-risk and all other strains are called low-risk. Some low-risk strains of HPV can cause genital warts. If you have the strain of HPV that causes genital warts, that doesn’t necessarily mean that you have the strain that causes cervical cancer, although it is possible to have multiple strains simultaneously. Having genital warts does not increase your chances of getting cervical cancer.

The biggest risk factor for anal cancer is HPV. Click here for more information on anal cancer.

A colposcopy is a follow-up test to a Pap test that is done if your Pap test comes back abnormal. A health care provider, usually a gynecologist, performs the procedure. Using a colposcope, which is an instrument that magnifies the cells of the cervix, the provider will look more closely at the cervical cells. The test is done in a very similar way to a Pap test, with a speculum, however this time a liquid is applied to the cervix to highlight any abnormal cells. If abnormal cells are found, then a biopsy will be taken. This is a small sample of tissue that will be taken to a lab for analysis, and to determine if treatment is needed or not.

A biopsy involves removing a sample of tissue or tumor from the cervix and examining it under a microscope for cancer cells. Biopsies are used to diagnose a cancer and to determine the extent of disease during the staging process.