The smear has only one function, but it is essential. This cervical examination allows to detect precancerous or cancerous cells. After placing a speculum, an instrument that spreads the walls of the vagina, the sample is taken directly on the cervix using a swab, a kind of cotton swab.
When an anomaly is detectedcells are classified as high or low grade, depending on their degree of transformation. Their presence does not mean the presence of cancer, but we will have to monitor them. “These cells can regress spontaneously, thanks to the immune system, especially in young women,” explains Dr. Pia de Reilhac, president of the National Federation of Colleges of Medical Gynecology.
Sometimes the nature of the cells remain indeterminate. In this case, the analysis report indicates “asc-us”. A HPV test is then proposed. It allows to highlight the presence of papillomavirus (HPV), responsible for the vast majority of cervical cancers. “If the typing is positive, we realize a colposcopy ” explains Dr. de Reilhac.
This examination, carried out in the gynecologist’s office, pushes the investigations further. A large magnifying glass makes it possible to examine the cervix more precisely. A biopsy is performed. It is the analysis of these cells that will determine their exact nature.
Currently, women aged 25 to 65 are recommended to make a smear every three years, after two normal exams spaced one year apart. The course seems well marked, yet 40% of French women do not follow these recommendations. Apprehension, forgetfulness, lack of information? The brakes are multiple. All you need to know about the smear.
1- The smear is taken care of by Social Security
At present, the examination and consultation are reimbursed by the Social Security and the complementary part is supported by the mutuals. Gradually, a systematic systematic screening gets ready. In this context, everything is 100% refund without charge. In this device, women who have never smeared, or not regularly enough, have priority.
2- It is not painful
Thegynecological examination must be explained to the patient before being practiced. “Putting the speculum can be uncomfortable if the woman is not relaxed enough, but not the smear itself. Abdominal breathing helps a lot, assures Dr. de Reilhac.
3- Your modesty must be respected
“To make a smear, I do not see the interest that the woman is naked from top to bottom,” believes Dr. de Reilhac. The classic gynecological position, legs apart, feet in stirrups, remains the most commonly practiced. For Dr. de Reilhac, it is the one that is most suitable for performing the smear. “The examination must be reliable and effective,” She recalls.
4- Self-collection is sometimes possible
Some pilot regions are proposing that women self-test themselves. But this remains experimental for the moment. The woman introduces the swab into her vagina, then places it in a tube and sends it for analysis to a laboratory. This self-collection allows perform the HPV test, looking for papillomavirus. A test that is not yet supported by social security. “In all cases, if the HPV test is positive, it will be necessary to carry out then a classic smear”, emphasizes Dr. de Reilhac.
5- Avoid making a smear during the menses
“Ideally, it is better to make a smear without any bleeding, except at the end of menses or if they are very scanty”, emphasizes Dr. de Reilhac. The presence of blood cells can, in fact, hinder the interpretation of the result.
6- It is not useful in case of virginity
In a woman who does not have sex, the smear is not a priori not useful. Papillomaviruses, which are largely responsible for cervical cancer, are transmitted sexually, more rarely by touching.
7- The gynecologist is not the only one to practice it
A midwife or one general practitioner, can practice a smear. On the other hand, colposcopy can only be done by a gynecologist. Some have also engaged in a quality approach, under the auspices of the French Society of colposcopy and cervico-vaginal pathology (the list here).
8- No worries in case of inflammatory smear
If the test report indicates an “inflammatory smear”, there is no reason to panic. Multiple causes may explain this result. “For example, the smear was performed just after menstruation, or as a result of a small, common infection,” explains Dr. de Reilhac. If the inflammation is too great, the smear can not be interpreted and it will have to be redone.
9- Metaplastic cells do not mean cancer
The word “metaplastic” written on the report can be scary. However, “It does not indicate any anomaly,” reassures Dr. de Reilhac. The cervix is composed of two tissues, whose cells are renewed. These metaplastic cells situate on the border between the exocervix and the endocervix. Their presence is normal.
10- An atrophic smear is linked to menopause
Nothing disturbing. After menopause, cervical cells tend to “stunt”, as Dr. de Reilhac put it. A local estrogen-based treatment, one to two weeks before the smear, is sometimes necessary to analyze them properly.