Bleeding during pap smear

Why Am I Bleeding After My Pap Smear and How Long Will It Last?

Some bleeding or spotting after a Pap smear is normal. Heavier bleeding may be a sign of another condition or issue.

Cervical scratch

In order to get a sample of cells, your doctor must scrape or scratch the delicate lining of your cervix. This can cause bleeding and sensitivity. However, bleeding from a cervical scratch is typically very light and ends on its own in a matter of hours or a few days.

Cervical sensitivity

Blood will surge to your cervix and other reproductive organs following a Pap smear and pelvic exam. This can increase bleeding from a scratch or irritated spot on your cervix.

Increased cervical blood vessels

If you’re pregnant during a Pap smear, you may see more bleeding following the test. Your cervix develops additional blood vessels during pregnancy. These can bleed following a test, but the bleeding should end within a few hours or no more than two days.

Cervical polyps

Cervical polyps are small, bulblike growths that develop on the opening of your cervix. During a Pap smear, a cervical polyp may bleed, which increases the amount of surface tissue that’s bleeding.

Birth control pills

Birth control pills and other forms of hormonal contraception increase your hormone levels. This can make your cervix more sensitive and may cause more cramping or pain. This may make bleeding more likely after a Pap smear.

Infections

Yeast infections, as well as STIs, can cause cervical bleeding after a Pap smear. These infections may make your cervix more tender, and blood vessels may bleed more following the procedure.

Friable cervix

This condition causes the tissues in your cervix to be overly sensitive and easily irritated. If you have a friable cervix, you may experience heavier spotting and bleeding following a Pap smear. Spotting also isn’t uncommon after other activities, such as sex, with this condition.

Cervical cancer

One of the primary symptoms of cervical cancer is irregular vaginal bleeding. This bleeding is likely coming from your cervix. Anything that irritates the cervical tissues, such as a Pap smear, can cause additional bleeding.

If you attend your cervical screening and notice some blood or spotting during or after the examination, you do not need to be alarmed.

We speak to Rebecca Shoosmith, Deputy Chief Executive and Head of Support Services at Jo’s Cervical Cancer Trust, about what to expect during and after your cervical screening:

Is it normal to bleed after a smear test?

Spotting during or after cervical screening is completely normal. ‘After a smear test, you may have some very light bleeding (spotting) for a day after the test, so it can help to wear a sanitary pad or panty-liner,’ says Shoosmith.

What about vaginal discharge? ‘Discharge is perfectly normal and you will know what amount is typical for you,’ says Shoosmith. ‘However, if you notice an increase in the amount of discharge or any abnormal discharge then it is important to contact a GP as this can be a symptom of cervical cancer. Likewise, if a nurse notices a large amount of discharge she may refer you for a colposcopy.’

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Does cervical screening hurt?

For most people, a five minute smear test may be uncomfortable or embarrassing but usually doesn’t hurt. However, ‘Some women do experience pain,’ says Shoosmith.

There are a number of reasons why a smear test may be painful as outlined by Shoosmith:

  • Vaginismus, which is when the vagina suddenly tightens as you try to put something into it.
  • Endometriosis.
  • Cervical ectropion (cervical erosion).
  • Vaginal dryness and other post-menopausal symptoms.
  • Female genital mutilation (FGM), which is when the genital area is deliberately cut, injured or changed.
  • Clenching, or feeling unable to relax, perhaps due to nerves, anxiety, a previous bad smear test or experiences of sexual violence.
  • Other gynaecological issues.

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I’m nervous about cervical screening

If you are anxious about getting a smear test, remember you are not alone. All women aged 25-64 attend cervical screening and the nurses are used to performing examinations.

‘There are ways to make a smear test more comfortable,’ says Shoosmith. ‘Don’t forget you are in control and can say stop at any time, especially if you experience pain. It’s also important to tell your nurse about any health problems that may cause pain before the test or bring someone you trust with you so that they can speak on your behalf. That way, the nurse can suggest ways to lessen any pain.’

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What happens if you’re on your period?

If your monthly cycle is preventing you from attending your cervical screening and so you keep putting it off, then you should stop worrying.

‘There is no “best time” to attend a smear,’ says Shoosmith. ‘Book your test at a time that is most convenient for you. What is important is that you don’t delay and attend them regularly.’

Remember it’s important that you attend your cervical screening, as it could save your life.

‘You can still attend your smear if you’re on your period but ideally, if you get regular periods, try not to book an appointment when you are bleeding as it can make it harder to get a clear sample of cells,’ she adds.

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How to prepare for cervical screening

Remember it’s important that you attend your cervical screening appointment, as it could save your life. If you’re feeling nervous, read up on what to expect so you feel prepared.

‘The best way to prepare for a smear test is to make sure that you understand what happens during the test and what happens after,’ advises Shoosmith. ‘You don’t need to worry about shaving or waxing, unless you want to, and wear something that you feel comfortable in.’

⚠️ If you are a woman aged between 25 and 64 and you haven’t been invited to attend cervical screening, contact your GP or visit NHS.UK for details.

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Last updated: 19-11-19

Everything that happens during your Cervical Screening Test appointment (hint: it’s very similar to the old Pap smear)

Getting your first Cervical Screening Test, or in years gone past, Pap smear, is something of a rite of passage for women. You may have heard stories from your mum, other relatives or friends about what it’s like, or you might know nothing at all about it except that you need to have one.

If you’re 25 or over and you haven’t had a Cervical Screening Test yet, now is your time. To help you feel prepared, we’ve broken down exactly what you can expect.

What is a Cervical Screening Test for?

Before you know what’s going to happen, it’s good to know why we’re so bent on you getting a Cervical Screening Test in the first place.

A Cervical Screening Test takes cells from your cervix and tests them for a virus called human papillomavirus, or HPV. HPV is a super common virus that’s spread through sexual activity (and that’s any activity, including intercourse, but also sexual activity using the hands, oral sex and anal sex).

The thing about HPV is that it can go on to cause some types of cancer, including cervical cancer. Most people who get HPV don’t get cancer, but the link between the two makes it important to test for HPV, and if it’s there, make sure it doesn’t develop into cancer. You can read more about HPV, how it spreads and how it can cause cancer to develop here.

Having a Cervical Screening Test every five years means you can check if you have been infected with HPV, and if you have been, monitor for any changes that require preventative treatment.

I’ve had the HPV vaccine, does this mean I don’t need to get screened?

Sorry, but this one’s a no. The HPV vaccine protects you from some strains of HPV that cause cancer, but not all of them. So, even if you’ve had the HPV vaccine, you still need to get regular Cervical Screening Tests.

Wait…what and where is my cervix?

We’re glad you asked!

Your cervix is located at the top or ‘end’ of your vagina, inside your body. While some women call all their genitals their vagina, technically the outer parts (you might call them lips) are your labia. Your vagina is the opening and passage that starts from inside your labia and continues up inside your body to end where your uterus starts. It’s where menstrual blood comes out and where a baby travels through in a vaginal birth.

Your cervix is the tissue at the end of your vagina that connects your vagina and your uterus, which is the organ where your menstrual tissue grows and a baby is grown during pregnancy. Your cervix allows your menstrual blood to pass out of the uterus and through the vagina, and for sperm to travel through the vagina and into your uterus during sexual intercourse. At the end of pregnancy, it widens and opens for the baby to pass through.

Now that you know where everything is and why we want you to get it checked out regularly, let’s get into what exactly goes down at a Cervical Screening Test appointment.

Making your appointment

Women need to have a Cervical Screening Test every five years from the age of 25. If your time has come, you’ll need to make an appointment with a GP to get screened.

Your doctor’s surgery might prefer that you book a longer appointment, so tell the receptionist that you’re booking to get your Cervical Screening Test done so they can make the appropriate appointment for you. Or, if you’re booking online, pick the option for ‘other’ when it asks for the reason for your visit and pop in “Cervical Screening Test” so the doc knows what you’re coming in for.

Some women prefer to have their Cervical Screening Test done by a female, and others don’t mind. The most important thing is that you feel comfortable at the appointment, so book in with whoever helps you to feel most relaxed.

The Cervical Screening Test is provided for free under the National Cervical Screening Program, which means you don’t pay for the test or for it to be sent away to the lab to be analysed. You might need to pay for the appointment with the doctor, though, so check what the fees are when you book your appointment.

Bring your Medicare card and Healthcare card if you have one to your appointment.

On the day

Once you’ve made your appointment, it’s important you go! If you’re feeling nervous about it at all, schedule some time to do something nice and relaxing beforehand to take your mind off it.

If they don’t know, tell the doctor it’s your first time having a screen and ask them any questions you have. If you’re feeling a bit nervous or embarrassed when you get to the appointment, let your doctor know so they can make sure you’re comfortable before they get started.

When it’s time to get down to business, your doctor will ask you to take off what you’re wearing on your bottom half and lie down on their bed (and no, we’ve checked, doctors don’t care at all if you’re wearing your nice undies or if you’ve recently had a bikini wax!). They’ll put a sterile sheet under you and give you one to put over you as well.

Your doctor will have you lie back with your knees bent and feet on the bed. They’ll put on some gloves to keep everything hygienic, prep their equipment and do the screen. When they’re ready, the first thing they’ll do is take an instrument called a speculum, which will help them open your vagina so that they can see your cervix. You can see a speculum in picture below. They can be made of plastic or metal and have a rounded tip and sides, to make it easy to insert. Your doctor might put a condom or some lubricant on the speculum to make it more comfortable to be inserted, too. After they’ve put it in, your doctor will squeeze the two handles together to gently open the speculum, which opens your vagina.

You might not know it, but your vagina is a super strong set of muscles. These powerful muscles can help deliver a baby and account for some of the pleasure of sex. But, when you’re nervous, they can also squeeze pretty tight. This can make it difficult for something like a speculum to be inserted.

When your doctor is prepping the speculum, take a few deep breaths to help you relax your muscles. It might help you to think about something happy, like your favourite holiday destination. Your doctor will be able to tell if you’re tense, so they might ask you to take a deep breath out as they first insert the speculum, and remind you to relax as much as possible. Remember to continue taking deep breaths when the speculum is in (holding your breath makes your muscles tense).

Once the speculum is open, your doctor can take a little swab of your cervix. They might pull out a torch or light so they can see (it’s dark down there!) and then they’ll put a small brush up through the speculum and into your vagina until it reaches your cervix. They’ll brush it round a little to get some of your cells, then remove it and put it in a sterile tube to be sent to the pathology lab. Then they’ll take the speculum out and you’re all done! The whole thing usually only takes a few minutes.

What do you mean by ‘uncomfortable’?

You might have had women say to you, “The Cervical Screening Test doesn’t hurt, it’s just uncomfortable.” But what does that really mean?

Well, different women mean different things by this.

Some find the experience uncomfortable because they’re embarrassed about their bottom half being naked in front of the doctor, or because being naked in front of others isn’t something their culture would normally find appropriate.

Some women find the speculum uncomfortable. They can be made of plastic or metal, which can mean they feel cold and a little odd up there.

Some women are talking about the actual brushing part when they say uncomfortable. Having your cervix touched with a brush isn’t an everyday experience, and it might feel like a tickle or a prod.

The most important thing to know is that while your Cervical Screening Test might feel ‘uncomfortable’ for the reasons above or other reasons, it shouldn’t ever hurt. If you feel pain at all during your appointment, whether that’s when the speculum is being inserted or opened, or during the screening procedure, tell your doctor straight away.

What else might be done at my appointment

Your doctor might do a pelvic exam after your Cervical Screening Test. This involves gently pushing on your belly while they feel your vagina and cervix with their hand. This gives them an indication of the health of your other reproductive organs, like your uterus and ovaries.

Your doctor might ask if you want to do a sexual health check at the same appointment as your Cervical Screening Test. If you say yes, they’ll talk through your sexual history and if they think it’s useful, might do some tests to check if you have any sexually transmitted infections (the Cervical Screening Test only checks for HPV, so you need to have other tests done to look for other infections). You can find more information on getting tested at Stop the rise of STIs.

When do I get my results and what happens if they’re positive?

It will take about two weeks for your results to come through. Ask your doctor how they want to deliver the results to you; some doctors will call to tell you whether the results are negative or positive, and some will only call if they need you to come back in. If you haven’t heard anything after a couple of weeks, you can always call the doctor’s surgery and check in.

If HPV isn’t found, all you have to do is come back in five years for your next screen. The National Cancer Screening Register will also send you a reminder when you are next due.

HPV infections usually clear up on their own and very rarely cause abnormal cells or cancer. If HPV is found, your doctor will talk to you about the next steps. They might need to do other tests, or they might just re-test again for HPV after a shorter period of time to see if it’s gone away.

Is a Cervical Screening Test the same thing as a Pap smear?

In December 2017, the National Cervical Screening Program changed. Before this, women were advised to have a Pap smear every two years. Pap smears and Cervical Screening Tests are done in the same way, but the Pap smear tests for changes in cervical cells that might have happened as a result of HPV infection. The new Cervical Screening Test, tests for the HPV infection itself, which can lead to changes in the cervix. This means that your healthcare provider can monitor HPV if it is detected and intervene if there are any changes to cells in your cervix.

You can read more about why the Cervical Screening Test replaced Pap smears here.

More information

Hopefully now you’re feeling comfortable and ready for your first Cervical Screening Test. If you have any questions about the process, you should ask your doctor, or visit the links below for more information.

National Cervical Screening Program – About the test

National Cervical Screening Program – If you’re under 25

Cancer Council – Cervical screening

Paps are “normal” despite bleeding and cervical cancer… and more

Paps are “normal” despite bleeding and cervical cancer

A ROUTINE PAP SMEAR of a 27-year-old woman showed atypical squamous cells of undetermined significance. Over the next 3 years, the same gynecologist obtained annual Pap smears; pathologists and cytotechnologists interpreted these as being within normal limits. Then the patient reported postcoital bleeding to her gynecologist. Assuming the bleeding to be due to low estrogen associated with her oral contraceptive (OC), he switched her to another OC. Over the next 7 months, the patient reported on six occasions that she was still experiencing significant postcoital bleeding, tenderness during intercourse, and abdominal cramping. A Pap smear on one of those visits indicated no evidence of malignancy. Nine months after the change in OC, cervical cancer was diagnosed. Ten months later, the patient began radiation and chemotherapy because she was found to have metastatic cervical cancer of the rectum, pelvis, and colon. She died 9 months later at age 32.

PLAINTIFF’S CLAIM The first Pap smear actually showed evidence of a low-grade squamous intraepithelial lesion, so further testing was needed to rule out cervical cancer. When the patient reported postcoital bleeding, colposcopy and cervical biopsy should have been performed to determine whether she indeed had cervical cancer.

PHYSICIAN’S DEFENSE Not reported.

VERDICT $1.3 million Massachusetts settlement.

Ectopic pregnancy with IUD leads to fallopian tube removal

A FEW WEEKS AFTER IUD PLACEMENT, a 26-year-old woman reported to a hospital complaining of abdominal pain and bleeding. An ObGyn diagnosed an ectopic pregnancy, recommended removal of both fallopian tubes, and then proceeded to remove them.

PATIENT’S CLAIM It was negligent to perform nonemergent surgery when she was unable to consent to it.

PHYSICIAN’S DEFENSE The procedure was proper, as the patient was highly likely to have another ectopic pregnancy. Also, the patient could undergo in vitro fertilization if she wanted to become pregnant.

VERDICT Tennessee defense verdict.

Could retractors have caused right-leg femoral nerve neuropathy?

A 66-YEAR-OLD WOMAN with endometrial cancer underwent hysterectomy and surgical staging. Following the procedure, she suffered complete neuropathy of the femoral nerve in her right leg.

PATIENT’S CLAIM Retractors were used improperly during surgery, causing the injury.

PHYSICIAN’S DEFENSE The neuropathy was not a result of the type of retraction, but was probably due to the patient’s modified lithotomy position during surgery. Such an injury is a known risk of the procedure.

VERDICT $750,000 New York verdict. As the verdict was for all past pain and suffering, the court increased the judgment to $900,000 after the trial to include future pain and suffering.

Was retained clip the reason for kidney failure 12 years later?

BECAUSE OF A TUMOR on her left ovary, a woman’s left ovary and fallopian tube were removed. During surgery, Dr. A found and lysed adhesions around her right ovary. Seventeen months later, the patient underwent laparoscopy and lysis of adhesions as well as biopsy of the right ovary. Dr. B, who performed the procedure, did not note any clip on the left ureter. Three months after that, the patient underwent exploratory laparotomy with lysis of adhesions and right ovarian cystectomy and partial omentectomy—performed by Dr. C. Upon visual inspection, the left kidney appeared to be larger than the right kidney. When the patient complained of left-sided abdominal pain 10 years later, she underwent a CT urogram, which showed a chronically obstructed left kidney—probably related to a surgical clip obstructing the distal third of the left ureter. She was diagnosed with hydronephrosis of the left kidney, which was essentially nonfunctioning. The urologist believed the clip had been left there during the first surgery 12 years earlier.

PATIENT’S CLAIM Dr. A was negligent for placing the clip on the ureter, causing kidney damage.

PHYSICIAN’S DEFENSE Because of the statute of limitation and state of repose, Dr. A moved for dismissal and summary judgment, but the motions were denied. He also claimed that clipping the ureter during the first surgery would have caused immediate excruciating pain. However, he admitted that partial obstruction could occur without pain and in fact lead to total obstruction and death of the kidney years later.

VERDICT $450,000 Massachusetts arbitration award.

Nurses reassure new mother, who then dies from PE

A 25-YEAR-OLD WOMAN GAVE BIRTH to a healthy boy. She did not feel well during the week after hospital discharge. When she called her ObGyn’s office to discuss her complaints, the nurses reassured her. Ten days after delivery, she was taken to the emergency room, where she died from a pulmonary embolism.

PLAINTIFF’S CLAIM The physician and nurses failed to respond properly to the patient’s complaints, which were consistent with a pulmonary embolism.

What Are the Causes of Bleeding After a Pap Smear?

It is natural to have a few drops of blood following a pap smear. The Center for Young Women’s Health states that a woman usually has her first pap smear around 21, unless there is a special risk such as immune problems, HIV disease, early sexual activity or pregnancy. During a pap test, a physician scrapes cells from a woman’s cervix with a scraper in order to identify possible changes in the cervix.

Excess Cervical Blood

Excess cervical blood can cause bleeding after a pap smear, according to the website Baby Center. Many women experience a surge of blood to their cervix and reproductive organs during or shortly after a pap test. A pap smear can cause the cervix to become extremely irritated and sensitive triggering light bleeding or spotting following the test.

Cervical Scratch

A cervical scratch may contribute to bleeding after a pap test. A woman may experience bleeding after a pap smear when the health care provider scratches or scrapes the delicate lining of her cervix in order to get a small sample of cells from the upper cervix or vagina, notes Dr. Lee Shulman of the Feinberg School of Medicine at Northwestern University in “Cosmopolitan” magazine. Bleeding that occurs following a pap smear is usually mostly spotting. This type of bleeding tends to stop fairly quickly. If the bleeding increases or clots form, contact your health care professional.

Cervical Polyps

Cervical polyps contribute to bleeding after a pap smear. Cervical polyps consist of smooth, fingerlike growths that extend from the uterus to the cervix. MedlinePlus states that women over the age of 20 are more likely to have cervical polyps than young girls who have not started menstruating. Cervical polyps usually cause bleeding after a pap smear because of an infection, chronic inflammation, increased levels of estrogen or congested cervical vessels, according to the website MD Guidelines. If the woman’s cervical tissues are already irritated at the time of the pap smear, then she may bleed after the test.

An ectropion is an exposed area of the glandular lining of the inside of the cervix. Normally the outer cervix is covered entirely with a smooth lining that’s quite tough and similar to the skin lining the inside of the vagina. But the glandular lining is a bit rough and more fragile. Its most common to have an ectropion when taking the combined oral contraceptive pill, or during pregnancy, but loads of women just have one for no particular reason. They’re not associated with a higher risk of having abnormal smears, or with any other disease. They can be bloody annoying however…literally. They can bleed on contact, such as during my smear test, or during/after sex due to the fragile nature of the glandular lining. It doesn’t mean anything is wrong, it’s just that lining isn’t really designed to be exposed in such a way. Lots of people have an ectropion and never know because they don’t all bleed. If you do have one it can go away on it’s own. But if the bleeding is really annoying there are things that can be done to treat this, such as burning away that top layer of skin. We generally don’t really recommend doing that unless it’s really problematic.

Having said that, bleeding after sex is abnormal until proven otherwise. Not all bleeding after sex is caused by an ectropion, and other more serious causes include infections and abnormal cells on the cervix. So please go and see your GP if you’re getting problems with bleeding and they can easily check your cervix and decide whether you need to come to the Gynaecology clinic for further assessment.

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