What is the difference between a Pap and a pelvic exam?
How can I blame anyone on this, it is so easy to confuse! Both of these have some obvious similarities (think: speculum. I know, everyones’ favorite.) But, it also has some key differences that are important to appreciate. Let’s walk through it:
A female pelvic exam is a physical exam that a medical provider (a Primary Care Doctor, Gynecologist, E.R doc, Nurse Practitioner or Physician’s Assistant) may perform to focus on the structures of - you guessed it - the pelvis. It is typically performed annually as part of a physical exam, but can also be indicated for many other reasons, including experiencing pelvic or abdominal pain, changes in urination, pain during intercourse, experiencing symptoms of itching, discharge or lesions, just to name a few. Note that a “pelvic exam” can be an exam for either males or females - but, given that the anatomical structures are different, the methods are different. The female exam will involve observation and examination of the external structures, as well as the internal structures. In order to view the internal structures, a speculum is passed into the vaginal canal, where the cervix can be visualized. Aside from visualization, a bimanual exam may also be a part of the exam, where the medical provider examines internal structures with a gloved hand, noting any pain or palpable structural abnormalities.
A Pap (also known as a Pap smear), is a test that can be obtained during a female pelvic exam. While the speculum is in place with the cervix in view, the medical provider can gently take cells from the cervix using a little brush and spatula. The sample is then placed in a liquid that can preserve it so it may be sent to the lab for analysis. The lab can then test to see if the cells are a normal shape, size, and whether or not there is a presence of Human Papillomavirus (also known as HPV, which is a virus that is very easily transmitted, with hundreds of strains - some of them being more aggressive than others, and may lead to cervical cancer.) As it is relatively simple procedure that can be done in an outpatient setting, a Pap is a very important screening tool for cervical cancer. Typically, a Pap is recommended every 3-5 years after the age of 21, but those recommendations change depending on a patients’ history and whether or not they have had a previous abnormal Pap. Although conventionally, a Pap is used to screen for cervical cancer, it can also be used to detect oral and rectal cancers, which are also very commonly caused by high-risk HPV strains.
It might seem a bit prickly to differentiate between these two things, but the reason for knowing the difference can sometimes change what your provider recommends as a part of your treatment plan. Despite so much being electronic, for reasons often frustratingly beyond our control, we may not have access to our patients’ records to see when their last screening Pap was. Sometimes, our patients will think, if they had a pelvic exam, then they had a Pap, but that’s not always necessarily true. It’s important to know the difference because, if a Pap was not done during a pelvic exam, then the provider unknowingly may delay obtaining a Pap from the patient, possibly missing an opportunity to screen them for cervical cancer. Of course, knowing this, if someone’s history is fuzzy or unknown, they may opt to just obtain a Pap regardless, but any female who has had a speculum placed knows it’s not exactly the most comfortable of procedures. As with anything, it’s a discussion to have between you and your doctor or medical provider so that you can make the best choice for your health.