January is Cervical Cancer Awareness Month. Before the introduction of the Papanicolau test (aka Pap smear) 50 years ago, cervical cancer was the leading cause of cancer deaths in women in the United States.

Since the introduction of the Pap, cervical cancer deaths have decreased significantly. It is now the 14th most common cause of cancer death for women in the United States. Sadly, due to lower screening rates, cervical cancer is more likely to afflict black and Hispanic women more than Caucasian and Asian women.

What I have noticed, as a practicing gynecologist, is that many of my patients actually do not know why I am conducting the Pap smear. Many patients are surprised when I tell them that the Pap smear is for cervical cancer screening.

Other times, patients confuse a simple pelvic exam with a Pap smear. All too often, patients tell me, “They did a Pap smear in the emergency room,” because someone placed a speculum (the instrument that looks like a duck’s beak) during a pelvic exam.

Ladies: listen loud and clear. Just because someone checks “down there” does not mean you are getting a Pap smear for cervical cancer screening. And, doctors in the Emergency Room hardly ever screen for cervical cancer.

So, what is going on “down there”? When are you getting a speculum exam versus a Pap smear for cervical cancer screening? Let us consider different scenarios to determine what your healthcare provider will likely do when he or she checks you “down there.”

Yearly Woman Check-up

BINGO! This is the time that you most likely will have a Pap smear for cervical cancer screening. This visit is focused on preventative care, which usually also includes a breast exam. During this visit, women are offered the Human Papilloma Virus (HPV) vaccine if they are 26 years and under, a mammogram if they are 40 years and over, or a bone scan for osteoporosis if they are 65 and over.

To perform the Pap smear, the doctor will place a speculum into the vagina so your cervix can be seen, then gently scrape some cells from your cervix. The cells will be looked at under the microscope in a laboratory, where they will label the cells normal or abnormal. Sometimes during the Pap smear, the cells will be checked for HPV, the virus that causes cervical cancer. If your Pap smear is abnormal, you should return to your doctor for further testing.

Vaginal Bleeding

If you are being examined “down there” for vaginal bleeding, it is less likely that you will have a Pap smear done (with a few exceptions). If you go to the ER because your period is very heavy or abnormal, or if you are bleeding during pregnancy, you will most likely have a speculum exam without a Pap smear.

The ER doctor will place a speculum into the vagina to determine from where you are bleeding. They may clean the area so that they are better able to see your cervix, but they will likely not scrape the cervix for cervical cancer screening. Since this is the emergency room, they deal with emergencies only. They want to know why you are bleeding and how to stop it, not if you have cervical cancer.

So, hardly any woman should ever say, “They did a Pap smear in the ER.”

Vaginal Discharge or Abdominal Pain

This is a common complaint among women of all ages. Vaginal discharge usually indicates some type of infection, which may or may not be sexually transmitted. Discharge is sometimes accompanied by abdominal pain. If you are going to a doctor for vaginal discharge, you might get a speculum exam, but not necessarily a Pap smear for cervical cancer screening.

Your doctor will, as usual, place the speculum so that he or she can see inside the vagina. The doctor might take a swab sample of the discharge so that the laboratory can determine what kind of infection you have. This is not a Pap smear.

Usually, the swab will determine if you have non-sexually transmitted infections like yeast or bacterial vaginosis, or sexually transmitted infections (STIs) like chlamydia, gonorrhea, or trichomonas. STIs usually happen as a result of having sex without a condom.

In the Know

Now, you know the difference between a speculum exam and a Pap smear for cervical cancer screening. A speculum is just an instrument used to look inside the vagina; it is not by itself the Pap smear.

So, the next time you get checked out “down there,” you’ll know what’s going on and be sure to ask your doctor about cervical cancer screening.