Frequently asked questions

No screening test is 100% accurate, but scientific evidence tells us that Pap tests can decrease mortality from cervical cancer.

But Pap tests aren’t perfect. Like almost every other test or procedure, they have both benefits and risks. It’s important to be aware of them so that you can make an informed decision that’s right for you. Risks include:

• false-positive results. This means that test results suggest precancerous conditions when there aren’t any. False positives can cause anxiety, stress and possibly painful and unnecessary tests to make sure you don’t have cancer.
• false-negative results. This means that the test results show no cervical cell abnormalities even though they are present. False-negative results can cause you or your healthcare provider to be unaware of cervical abnormalities that could lead to cancer, or to ignore symptoms that suggest the presence of cancer. False-negative results can lead to delays in diagnosis and treatment.
• unnecessary follow-up procedures or treatment. Some people with cervical abnormalities may have follow-up procedures or treatment for a condition that may never have developed into cancer. Low-risk cervical abnormalities in young people often go away on their own without treatment.

No. Pap tests do not test for sexually transmitted infections, including HPV. Pap tests check only for cervical cancer or precancerous cervical cell changes caused by HPV. Often, a Pap test will be done at the same time as an STI test because some STI tests involve swabbing the cervix or vagina.

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 common. But cervical cancer isn't! Cervical cells change often, and often change right back on their own.
• if cervical cell changes don't change back to normal, there are many ways to treat them and to prevent cervical cancer.
• if you have cervical cancer, there are many effective ways to treat it, particularly if it's caught early.

Next steps after a positive test can include the following:

• retest in three to six 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
• taking testosterone, which can cause changes to cervical cells that can mimic cervical dysplasia
• precancerous cell changes, which will need to be treated.

Many trans men prefer natural and holistic ways of taking proactive care of our health. It’s important to take care of your health in the ways that work for you. That said, a Pap test is still the only proven test we have to detect cervical cell abnormalities.

A pelvic exam is a physical examination of the organs in the pelvis. A pelvic exam 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. He or she 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.

A pelvic exam takes only a minute or less to perform. If you find the idea of a pelvic exam uncomfortable or upsetting, you may want to use some of the strategies discussed here for making the test more comfortable.

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

Yes. Healthcare providers should be able to use a water-based lubricant to make a Pap test more comfortable. Until recently, it was thought that using lubricant can alter lab results, but it's now known that a water-based lubricant will be fine. If your healthcare provider isn't accustomed to using lubricant for a Pap test, you can ask why and ask them to investigate the possibility. Talk to your healthcare provider about how to make a Pap test more comfortable for you.

In 2012, The Canadian Cancer Society changed its cervical screening guidelines to better reflect evidence-based research on cervical cancer. The research showed that screening people under age 21, regardless of the age they first became sexually active, doesn’t reduce their risk for cervical cancer. Changes to screening guidelines are not the result of financial cutbacks but of advances in our knowledge about appropriate screening ages and intervals.

HPV, the leading cause of cervical cancer, comes and goes quickly in people under 21, meaning that cervical cells change frequently between normal and abnormal on their own, without medical intervention. Evidence shows that screening people under age 21 has more negative outcomes — such as follow-up exams and treatment procedures — than benefits. Cervical cancer is very rare in people under age 21.

In 2012, the Canadian Cancer Society's Ontario division changed its cervical screening guidelines, following policy directives from the Ministry of Health and Long-term Care. These new guidelines better reflect evidence-based research on cervical cancer. The research showed that screening every three years is as effective as screening every year. Changes to screening guidelines are not the result of financial cutbacks but of advances in our knowledge about appropriate screening ages and intervals.

It usually takes a long time for an initial HPV infection to develop into cervical cancer. Evidence shows that having a Pap test every three years is just as effective as getting a test every year. As well, doing a Pap test every three years rather than every year reduces the amount of false-positive tests — and the unnecessary stress and follow-up procedures that can go with them.

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, or other reasons. If your healthcare provider has recommended that you get Pap tests more frequently than once every three years, your tests will be covered by OHIP.

You can still get annual Pap tests even if your healthcare provider has not recommended that you do so. In this case, the tests are not covered by OHIP. As of January 1, 2013, annual Pap tests that are not recommended by healthcare providers must be paid out of pocket by the patient. The test itself is $20 plus a healthcare provider fee for performing the service.

No. The earliest you can begin screening is age 21. So, if you started having genital sex at the age of 16, you would wait until you are 21 to get screened. That’s because evidence shows that screening people under the age of 21, regardless of the age they first became sexually active, doesn’t reduce the risk for cervical cancer.

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 begin to get screened three years later, at age 26.

Yes. Even if you don’t have OHIP, you can get screened for cervical cancer by paying out of pocket for a Pap test with a healthcare provider who accepts uninsured clients. Some community health centres and public health department sexual health clinics offer Pap tests to uninsured clients. Click here for resources.

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

• If you had a hysterectomy that left your cervix intact or partially intact, then yes, you will need regular Pap tests.
• If you had a complete hysterectomy that included removing your cervix, AND you have no history of cancerous or precancerous cervical cells, then you will likely not need regular Pap tests.
• If you had a complete hysterectomy and you had a prior history of cervical cancer or precancerous condition, you may need to have vaginal vault or cuff smears until you have three documented normal tests in a row.

Discuss your screening needs and schedule with your healthcare provider.

If you have had colpectomy (removal of the vagina) or colpocleisis (closure of the vagina) as part of bottom surgery such as metoidioplasty, you cannot have a Pap test. These procedures occur after (or as part of) a full hysterectomy, during which your cervix would have been removed.

If you have a history of cervical dysplasia or cervical cancer, you should discuss this with your surgeon and other healthcare providers before surgery.

Yes. If you're 21 or older, have a cervix and are sexually active, you need to be screened for cervical cancer whether or not you're taking testosterone (T). Being on T doesn’t affect your risk of developing cervical cancer. It can, however, cause changes in the cells of your cervix that may mimic cervical dysplasia. For this reason, it’s important that your healthcare provider and the lab analyzing your Pap test know that you are taking T.

Yes. HPV vaccines protect against only the most common strains of the virus that causes cervical cancer. Some cervical cancers are not prevented by HPV vaccines, so screening is still important even if you have been vaccinated.

People living with HIV need to be screened more frequently than people of average risk. Talk to your healthcare provider for more information.

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

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

Yes. HPV reflex testing is one of many follow-up test options after a positive Pap test. HPV testing, however, is not covered by OHIP. If you want the test, you must pay for it out of pocket.

HPV testing is usually only recommended for people aged 30 years and older. This is because as we age, it’s more likely that HPV infections will last longer and therefore be more likely to cause cancer. For younger people, HPV testing isn’t as useful because HPV is much more likely to clear up on its own.

If you’re over age 29, and your Pap test or vault/cuff smear detects cell changes that are hard to read, then your healthcare provider may choose to test your cells for HPV. Testing is usually done on the same sample of cells that were taken during the Pap test or vault smear. 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.

No. That said, most strains of the virus usually clear up within two years without you ever knowing that you had them. High-risk strains of HPV — like the ones that cause cervical cancer — tend to stick around for longer periods of time.

Unfortunately, there is no cure for HPV. It can’t be treated with antibiotics. While you can’t cure or treat HPV, you can get a Pap test to prevent cancer or find it early, when it is easiest to treat.

There are many different strains of HPV. The strains that cause cancer are called “high-risk.” 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 at the same time. 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.

Good question. HPV infection plays a major role in cervical cancer. But it’s also a cause of many other types of cancer, including anal, vaginal, vulvar, penile and some oral cavity and oropharyngeal cancers (cancers of the throat and mouth areas).

Part of the answer to this question is that we don’t have screening tests for all cancers. Another part of the answer is that cervical cancer is much more common than other genital-area cancers related to HPV, and so it makes sense to screen large numbers of people for cervical cancer. While screening is important, it also has risks associated with it, such as false positives or false negatives. This is why screening is typically reserved for more common conditions, such as cervical cancer.

Finally, doctors and scientists don’t have evidence that it makes sense to screen entire segments of the population for certain cancers. In other words, evidence shows that anyone 21 and older with a cervix who has been sexually active should get regular Pap tests. But we don’t have the same kinds of information for other types of cancers. For example, we can’t say that everyone over a certain age should be screened for anal cancer, or that all non-trans women or trans men should be screened for vaginal cancer. This information may change as we get more scientific evidence.

In the meantime, it’s important to get screened for colon, breast and cervical cancer according to the guidelines. Talk to your doctor about your personal risk for cancer. And then reduce the risk factors for many cancers by doing things like staying active, maintaining a healthy weight, quitting smoking or staying tobacco free and limiting alcohol consumption. If you notice any symptoms or changes in your health, ask your doctor about them.

A colposcopy is a follow-up test that is done if your Pap test comes back abnormal. A healthcare 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. In a colposcopy, however, a liquid is applied to the cervix to highlight any abnormal cells. If abnormal cells are found, then a biopsy may be taken. A biopsy is a small sample of tissue that will be taken to a lab for analysis, and to determine whether treatment is needed.

A biopsy involves removing a sample of tissue or tumour 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.