Cervix exam and Pap test

Pap test - What is it, where and how is it taken, cell changes, test results, and the cervical screening program (2022)

The doctor or gynecologist performs a regular gynecological examination of the genitals and uses a small brush to collect cells from the cervix. It can be a little uncomfortable and can bleed a little afterward, this is completely normal. It takes a few minutes and is an important factor in detecting cancer or pre-stages of cancer at an early stage. You can prepare yourself by not taking the test when you are menstruating, preferably avoiding intercourse in the last 2 days before the test, and do not use tampons or vaginal medication/cream in the last two days before the test.

Read more about HPV and the vaccine hereWhy you should take the pap test? Read here

Pap test at Dr.Dropin

You can have the cell sample or HPV test taken either by our general practitioners (695 NOK) or by our gynecologists (1195 NOK). General practitioners only execute the test, while gynecologists provide a complete gynecological examination.

It's important to note that in accordance with new guidelines for cell samples and HPV testing, these are only conducted when symptoms indicating genital issues are present or as part of the cervical screening program. If you wish to have the HPV test taken without the presence of such symptoms or outside of the cervical screening program, an additional fee of 1400 NOK will be charged by the laboratory.

Meet our gynecologists here
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Skummelt med gynekologisk undersøkelse?

Det er smertefritt å ta HPV-testen. Legen eller gynekologen bruker en liten børste som føres inn i skjeden. Denne roteres rundt, før den tas ut.

Alle våre leger og gynekologer har full forståelse for at en gynekologisk undersøkelse kan oppleves ubehagelig for deg. For å gjøre det mindre skummelt kan du se på filmen av Iselin Guttormsen som utfører en celleprøve hos en av våre gynekologer.

Livmorhalsprogrammet

Livmorhalsprogrammet er et tilbud til alle kvinner mellom 25 og 69 år om å regelmessig sjekke seg for HPV-virus og celleforandringer i livmorhalsen. Kreftregisteret sender ut påminnelsesbrev til alle kvinner hvert 5. år til og med det året de fyller 69. Fra fylte 70 år må man selv ta initiativ til testen. Dette er et screeningprogram utarbeidet for å oppdage forstadier til kreft på et tidlig stadium slik at man får behandlet det tidlig og forebygge alvorlig sykdom. Det er frivillig om man vil undersøkes eller ikke, men det anbefales på det sterkeste.

Visste du at HPV-viruset er den mest vanlige kjønnsykdommen i Norge? Les mer her!

Cell changes and cervical cancer

A long-term HPV infection in the genitals can cause something called "cell changes" which in the course of 10-20 years can develop into cancer. Cell changes are an altered structure in the cells of the cervix from normal. These changes are divided into three stages (described in the section "Test results") and are not necessarily the same as the pre-stage of cancer. A change in the cells can return to normal, or they can change further to the precursor to cancer. Precisely because HPV infection often goes away on its own without leading to serious illness, and the fact that it takes a long time before a cell change eventually develops into cancer means that there is little point in testing for an HPV infection in women under 34. year.

Every year, about 300 Norwegian women are diagnosed with cervical cancer. Cervical cancer develops slowly through several stages from benign precursors to cancer to malignant cancer, and it takes time before you get symptoms. It is important to follow the cervical program even if the virus or cell changes are not detected, as it may occur at a later time.

It is recommended that all women of all ages, regardless of whether they have had zero or more sexual partners, be vaccinated against HPV, and follow the cervical program from the year they turn 25 years old.

Read more about the HPV-vaccine here

Symptoms you should watch out for

  • Genital warts
  • Changed discharge with a brownish-pink colour, changed smell
  • Light bleeding between two periods
  • Bleeding / brownish discharge after intercourse and physical activity
  • Bleeding after menopause
  • Pain / discomfort from the lower abdomen or lower back

Test results

The test results can often be a bit confusing, as many people believe that cell change is the same as the precursor to cancer. This is not true, as a cell change can also be a sign of mucosal irritation.
The test answer is divided as follows:

  • HPV negative: no virus found, you can wait 5 years for the next test
  • HPV-positive: virus has been found, and the sample will also be examined for cell changes
  • Mild cell changes (stage 1) detected: this is usually a sign that you have an HPV infection, and the sample is also tested for HPV. If it is HPV-positive, a new test is recommended within 6 months. The reason for waiting a while is that the body then usually has got rid of the infection in the meantime and the cells are normal again. It is not dangerous to wait this time, as it takes at least 10-15 years before a cell change can develop into cancer.
  • Severe cell changes (stages 2 and 3) detected: then you will be referred directly to a gynecologist for a thorough examination of the genitals and several tests. If these tests also show serious changes, you will be offered prompt treatment and follow-up.
  • Cervical cancer detected: if the cell sample shows cancer, you will be quickly referred in a cancer package to your local hospital where you will be examined thoroughly to find out how far the disease has come, and the doctors there will find the right treatment for you.

Expected response time

Regardless of where you perform the HPV-test it usually takes up to three to four weeks to get an answer to the sample, but can sometimes take up to 8 weeks. If the doctor suspects that it may be cancer, the test will be given priority at the laboratory. The doctors at Dr.Dropin give answers in Pasientsky regardless of whether the answer is positive or negative. If the sample shows severe cell changes or detected cervical cancer, the doctor will call you and refer you directly to a gynecologist for further examination and treatment.

Can I say no to an examination by the gynaecologist?

Ja, det er du selv som bestemmer om du skal undersøkes. Noen ønsker å møte gynekologen først for å bli trygg og ha en samtale rundt hvordan en undersøkelse foregår, før de kommer tilbake på en ny time for selve undersøkelsen.

Can I just come for a chat?

You can. You decide for yourself what you want to spend your time with the gynecologist on. Our gynecologists are knowledgeable and confident professionals who are happy to help you with advice and recommendations.

What does a gynecologist do?

Gynecologists are doctors who specialize in diseases of the female reproductive system. They perform ultrasound of the uterus and ovaries, take a pap smear and other samples from the pelvis and check you for infections. They can diagnose and treat diseases such as endometriosis, infertility, cysts and abdominal pain.

Can I go to the gynecologist if I have my period?

In most cases, yes. If it's for cervical cancer screening, the Pap test can sometimes be inconclusive if you're bleeding profusely, but if it's one of the lighter days of your period, you should be fine. It's perfectly fine to bleed when you have a gynecology appointment.

Can I use a tampon when I go to the gynecologist?

You can leave the tampon or menstrual cup in until just before the examination. If you come for a pap smear, it is recommended to use pads for two days before. Other than that, there are no special procedures or things you need to do before going to the consultation, and you don't need to shave or wash in a special way.

Can you go to a gynecologist without a referral?

With a private gynecologist, such as with Dr. Dropin, you can book an appointment directly yourself, without a referral.

Is a gynecologist expensive?

How much it costs to see a gynecologist will vary somewhat depending on the type of examination to be had and how long it takes. With us, the vast majority pay a fixed price of NOK 1,395. We do not charge extra for regular tests, but for surgery.

How much does an consultation at a gynecologist cost?

A 20-minute gynecological consultation costs NOK 1,195. You can see the complete price list here: https://drdropin.no/en/gynecologist/prices

Should I book a single or double consultation?

How long the class should be depends on you and your needs. We have an offer of a double appointment (40 min) for those who want extra time with the gynecologist or have several problems they want solved in one visit. The vast majority manage well with individual lessons of 20 minutes. Examples of problems that require 40 minutes are the first pregnancy check and fertility assessment for couples.

How often should you have a gynecological examination?

At the age of 25-69, it is recommended that you go to a doctor or gynecologist at least every 3 years to have a pap smear. You will receive a summons in Digipost from the Cancer Registry if it is time for a new screening test. You should also see a gynecologist if you have symptoms from the pelvic area.

When should I go to the gynecologist?

Some examples are pain during intercourse or pain from the lower abdomen that you cannot explain. Annoying menstrual cramps are another example. If you get breakthrough bleeding or bleeding after menopause, you should also see a doctor.

Can a gynecologist see if you have cancer?

At Dr. Dropin, the gynecologist has a special microscope called a colposcope. The gynecologist can use this to study your cervix and look for changes that may indicate cell changes or cancer. The gynecologist also has an ultrasound, which in some cases can produce fillings or abnormal findings that should be examined in more detail by, for example, a biopsy.

Is it free to take a pap smear?

If you take a pap smear at your GP, you pay a deductible. If you have indications of cell changes, suspect cervical cancer or have received a reminder from the cervical program and book an appointment with a gynecologist with a pap smear/HPV test at Dr. Dropin, the pap smear or HPV test is free. With us, you pay for the consultation itself (NOK 1,395).

What does the gynecologist ask?

The gynecologist will ask you if you have any diseases and if you use any regular medicines. The gynecologist will also ask you if you have had an vaginal examination with a doctor before or if this is the first time. You will also be asked if you are afraid, so the gynecologist can pay extra attention to your concerns.

What happens during a gynecological examination?

First, the gynecologist will get to know you, make you feel at ease and understand your problem. If an examination is required to help you further, you will be offered to undress behind a curtain. We offer free disposable skirts that many people accept to feel less undressed.

What should you preferably not do before an appointment with a gynecologist?

Avoid washing inside the vagina, the gynecologist will like to check if the discharge is normal, which is easier if it has not been washed away. You don't have to worry about the smell and the appearance underneath. You don't have to shave. The gynecologist has seen thousands of abdomens and all are different - as different as our faces. This is the everyday life of the gynecologist, even if it is not for you :)

Can you ask for a female gynecologist?

When it comes to treatment in the public sector, you have the right to necessary and proper health care, but you are not entitled to a therapist of a specific gender and cannot demand this. There are many male gynecologists and you cannot reserve yourself against this. At Dr. Dropin, you choose which gynecologist you want to see.

How much does it cost to have a cervical pap smear?

A cervical smear on indication (screening or as part of an investigation) costs NOK 1195, it is included in the consultation price. Dr.Dropin has fixed and predictable prices, with no hidden additional costs.

Can cervical cancer be seen on ultrasound?

Cancer in the cervix cannot usually be seen with ultrasound, but with the help of a speculum and light, possibly also a colposcope, the gynecologist can look for changes on the cervix.

How often should I have a cervical pap smear?

Women between the ages of 25 and 69 are recommended to have a cervical pap smear every five years. The sample is analyzed for HPV (Human Papillomavirus). If HPV has not been detected, the next test is recommended in 5 years. Always follow the recommendations of the cervical program and/or your gynaecologist. Sometimes it happens that you have to take samples more often than the standard program.

Can you have cervical cell changes without HPV?

Cell changes do not only have to be caused by HPV infection or precursors to cervical cancer. Fungal infections, herpes viruses and other microorganisms can also cause cell changes, for example. It takes several years before a cell change caused by the HPV virus turns into cervical cancer. HPV is transmitted through sexual contact.

How do you notice cancer in the pelvic area?

Gynecological examination, cervical pap smear (cell sample and HPV test) is important for early detection of cervical cancer or cell changes. The cervical sample is obtained through a gynecological examination, where a small brush is used to collect cells from the surface of the cervix.

Can you get cervical cancer without being sexually active?

If you have never had any kind of sex, the risk of developing cervical cancer is very low. HPV (Human papillomavirus) is the cause of the vast majority of cases of cervical cancer, and the virus can be transmitted through all forms of sexual contact.

How do you notice cancer in the uterus?

The first symptoms of uterine cancer are usually abnormal vaginal bleeding. Pain or pressure in the abdomen are other symptoms.

What does it mean to be HPV positive?

A positive HPV test means that you have an HPV infection in the cervix. In the case of a persistent infection over many years, there is a higher risk of developing cell changes. Cell changes usually go back on their own as the body manages to fight the viral infection.

Is it painful to take a biopsy of the cervix?

It is recommended that you take paracetamol 1 gram 1-2 hours before the operation. You receive a local anesthetic in the area where the sample is taken, but it can be uncomfortable after the biopsy. It is normal to bleed a little from the wound after the examination, it is advisable to use a sanitary towel.

Is it painful to have an examination with a gynaecologist?

If you relax and don't tense up, it's usually painless. If you are very tense, you can ask for breaks or say that it is uncomfortable. It is important to try your best to relax, the gynecologist will help you with this. For the vast majority, it goes perfectly well and is without discomfort.

Can you book an appointment directly with a gynecologist?

If you want to book an appointment with a gynecologist yourself, you must go to a gynecologist who works privately. The public gynecologist requires a referral from a doctor. Appointments can be booked easily here : https://booking.drdropin.no/

How do you take a cervical pap smear?

During a cervical test, cells are scraped from the cervix with a swab/brush, and these cells are examined for HPV/human papilloma virus or examined under a microscope.

Can you have intercourse before going to the gynecologist?

You should avoid intercourse for two days before the pap smear. Other tips to get the most correct test possible are to avoid tampons, use of vaginal creams, gels or medicines that are intended for application in the vagina for two days before the Pap test.

Can a gynecologist see if you have ovulated?

The gynecologist assesses the uterus and the shape of the uterine cavity. With the help of contrast liquid, you can see if the fallopian tubes are open. Egg reserves are also assessed. You cannot see all the eggs, but you can see the eggs that have begun to mature for ovulation

Can a gynecologist take a blood test?

Yes, the gynecologist takes a blood test for NIPT. For other blood tests, you will receive a requisition which can be taken to Furst's sampling stations or another laboratory (e.g. GP).

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Author: Dr. Anne Marte Ladim
Last updated: 23.06.2022

Sources

Helsenorge, (2019), Undersøkelse av livmorhalsen (celleprøve og kolposkopi), (online), tilgjengelig fra: https://helsenorge.no/undersokelse-og-behandling/celleprove-av-livmorhalsen-og-kolposkopi (hentet 21.05.2020)
Kreftforeningen, https://kreftforeningen.no/om-kreft/undersokelse-ved-kreft/kolposkopi/ (hentet 21.05.2020)
Norsk elektronisk legehåndbok, https://legehandboka.no/handboken/kliniske-kapitler/gynekologi/tilstander-og-sykdommer/svulster-og-dysplasi/livmorhalskreft/ (hentet 21.05.2020)
Norsk helseinfromatikk, https://nhi.no/sykdommer/kvinne/celleforandringer/celleprove/?page=5 (hentet 21.05.2020)