How Does Your Doctor Know You... Health Article

If you’re having symptoms that are like those of cervical cancer, your doctor will want to know why. Your doctor will ask some questions. You’ll probably talk about these issues.

• Medical history

• Smoking history

• Family history of cancer

• How old you were when you first had sexual intercourse

• If you have had unprotected sex

• Other risk factors such as a history of genital warts or human papillomas virus (HPV) infection

And to learn more about your symptoms, your doctor will do a pelvic exam and tests.

Many women don’t have symptoms of cervical cancer. Sometimes your doctor may first see signs of cancer during a pelvic exam or a Pap test.

What A Doctor Learns from a Pelvic Exam

Your doctor or healthcare provider does a pelvic exam in the office. This exam is recommended as a regular screening for women. For it, you’ll remove your clothes from the waist down and put on a medical gown. You lie on your back on an exam table and bend your knees. You place your feet in supports called stirrups at the end of the table. This position allows the doctor to look at or feel your uterus, vagina, ovaries, fallopian tubes, bladder, and rectum. The doctor places a plastic or metal tool called a speculum inside your vagina to widen it. This lets the doctor see the upper portion of your vagina and your cervix. After removing the speculum, the doctor inserts 2 or 3 gloved fingers into your vagina and uses his or her other hand to press on your abdomen. This is to feel for lumps or anything unusual.

You may also have a Pap test and human papillomavirus (HPV) test during a pelvic exam.

Some cervical cancers may be found during a pelvic exam. While your doctor cannot see precancerous changes such as dysplasia, he or she can see some invasive cancers during an exam. If the doctor or nurse notices something suspicious during the pelvic exam, additional tests can help determine whether you have cervical cancer.

What Your Doctor Learns from a Pap Test

A Pap test is the standard way to see if there are any cell changes that cause concern. You should see your doctor once a year for a regular screening Pap test if you are sexually active or over the age of 18. This test can help find cervical cancer or problems before they become cancer. The Pap test is simple and relatively painless. You can have it right in the doctor’s office. You should not have this test done during your period. The best time to have a Pap test is 10 to 20 days after the first day of your last period.

A Pap test may feel uncomfortable, but it should not hurt, and it takes just seconds. The doctor uses a tool called a speculum to widen your vagina and examine the upper part of your vagina and cervix, which is the area that connects your vagina to your uterus. The doctor then uses a small, soft brush to collect cells from the cervix and vagina. A specialized doctor called a pathologist looks at the cells under a microscope to check for cancer.

There are 2 types of Pap tests. The difference between them has to do with how the cells are checked after they are taken from your cervix. There is not a difference in how the cells are removed from you.

• With the regular method, the cell sample gets put on a slide and checked in a lab.

• With the newer liquid-based test, the doctor mixes a special liquid with the cells. This helps to preserve the cells for testing so that they can be seen and checked more clearly in the lab.

Studies show that the newer test is more successful in finding precancerous cells. The newer method is also usually more expensive.

You should avoid these things before your Pap test.

• Do not douche for at least 2 days (48 hours).

• Do not have sex for 2 days (48 hours).

• Do not use a tampon for 2 days (48 hours).

• Do not use any kind of vaginal products or medicines for 2 days (48 hours).

Ask when you can expect results and how you will receive them. For instance, will you receive results by telephone or in the mail? Knowing how long you will have to wait for results may help you feel less anxious.

Why Your Doctor Does an HPV Test

If your Pap test shows that abnormal cells may be present, your doctor may do a human papillomavirus (HPV) test. This test looks at the abnormal cells to see if HPV is present. Some types of HPV increase the risk of cervical cancer. The Food and Drug Administration (FDA) has approved the use of the HPV test along with the Pap test for women 30 years of age and older, the age group most likely to develop cervical cancer. This simply means that rather than doing the HPV as a follow-up test, your provider may do the Pap test and the HPV test at the same time. Some doctors now do an HPV test even when a Pap test is normal.

The preparation for the HPV test is the same as for a Pap test. Avoid sex, douching, tampon use, or any kind of vaginal products or medicines for 2 days before the test. 

How Your Doctor Uses a Colposcopy

If your doctor finds something suspicious during the pelvic exam or Pap test, he or she may decide to do a colposcopy. This test helps pinpoint abnormal areas in the cervix. This procedure can be done in a doctor’s office. You lie in the same position as for a pelvic exam, on your back with your knees up and feet in stirrups. The doctor inserts a tool called a speculum to widen your vagina. The doctor or nurse puts a vinegar-like solution (3% to 5% acetic acid) on your cervix. This helps highlight abnormal areas. Next, the doctor places a special microscope called a colposcope at the opening of your vagina to magnify the surface of the cervix up to 40 times its normal size. You may have a biopsy during a colposcopy. This involves removing tissue to be examined under a microscope. It may pinch some.

Depending on the results of these tests, your doctor may need to do a biopsy.