Cervical cancer is one of the few cancers that can be prevented almost entirely, because it develops slowly and from a known cause. Nearly all cases are driven by persistent infection with high-risk types of human papillomavirus, or HPV. The virus is passed through sexual contact and is so common that most sexually active people acquire it at some point. In the great majority, the immune system clears it within a year or two and nothing further happens.
The problem arises when a high-risk type persists. Over years, it can cause the cells at the opening of the cervix to change in ways that, if left alone, may eventually become cancer. Those early changes are what screening is designed to catch. The Pap test looks at the cells themselves; the HPV test looks for the virus that causes the changes. Used together, they identify who needs a closer look long before anything dangerous develops.
At NYMD Center our gynecologists provide routine screening, HPV vaccination, and the follow-up that abnormal results require, including colposcopy with biopsy and LEEP treatment, all in the office. We explain what each result means in plain terms, because an abnormal Pap causes far more anxiety than the findings usually warrant.
Who it affects and the symptoms that bring people in
Screening is for every woman with a cervix, starting at age 21 and continuing to 65 in most cases, regardless of whether you have received the HPV vaccine, have had the same partner for years, or are past menopause. Women whose hysterectomy removed the cervix for benign reasons generally no longer need it; those whose hysterectomy was for precancerous changes still do.
Early cervical changes cause no symptoms, which is why routine screening rather than symptoms drives most visits. Some women come in because a Pap done elsewhere came back abnormal and they want it explained. Others come in with bleeding after intercourse, bleeding between periods, or an unusual discharge, all of which deserve an exam even when the last Pap was normal. Women with a weakened immune system, including those living with HIV, and women who were exposed to DES before birth need more frequent screening.
How we evaluate it at NYMD Center
Screening follows current US guidance. From 21 to 29, a Pap test every three years. From 30 to 65, we prefer co-testing with a Pap and an HPV test every five years, since a negative HPV test provides strong reassurance. Screening more often than the guidelines call for does not improve protection and leads to unnecessary procedures. We adjust the schedule for women with prior abnormal results or immune conditions.
The test itself takes a minute during a pelvic exam: a small brush collects cells from the surface and canal of the cervix. Results return within one to two weeks. When we test for HPV, the lab also identifies whether the two highest-risk types are present, which changes what we recommend next.
When a result is abnormal, the next step depends on the combination of Pap and HPV findings, your age, and your history. Many mildly abnormal results simply need a repeat test in a year. Others call for colposcopy. In the same visit we can screen for other sexually transmitted infections if that is relevant, and we review your overall cancer screening status.
Treatment options
Most abnormal results do not lead to treatment at all. The path is observation, then closer examination, then treatment only when precancerous changes are confirmed and significant. Each step is chosen to avoid the next one when it is safe to do so.
HPV vaccination
The vaccine prevents infection with the HPV types responsible for most cervical cancers and genital warts. It is most effective before any exposure, which is why it is recommended in early adolescence, but it is routinely offered through age 26 and approved through 45. For adults in that older range, we discuss the likely benefit given your history. The vaccine does not treat an existing infection or reverse cell changes, and it does not replace screening. We give it in the office.
Repeat testing and observation
For low-grade changes, especially in younger women, the most likely outcome is that the immune system clears the virus and the cells return to normal. Repeating the Pap and HPV test in a year confirms this without any procedure. This is not doing nothing; it is the correct treatment for changes that usually resolve on their own, and it avoids removing cervical tissue that would have healed itself.
Colposcopy with biopsy
When results suggest higher-grade changes, or when a positive HPV test persists, we look at the cervix directly with a colposcope, a magnifying instrument that stays outside the body. A dilute vinegar solution is applied, which turns abnormal areas white and makes them visible. If we see an area of concern, we take a small biopsy, usually one to three samples, and sometimes a scraping from the cervical canal. The procedure takes about ten to fifteen minutes in the office and requires no anesthesia beyond, in some cases, a topical numbing agent. Biopsy results tell us whether the changes are low-grade, which we follow, or high-grade, which we treat.
LEEP
When biopsy confirms high-grade precancerous changes, the loop electrosurgical excision procedure removes the affected portion of the cervix with a thin wire loop. It is done in the office under local anesthetic and takes a few minutes. The removed tissue goes to pathology, which both confirms the diagnosis and shows whether the edges are clear. Recovery involves a few days of cramping and several weeks of discharge; we advise avoiding intercourse and tampons for about a month while the cervix heals. The trade-off we discuss is that removing cervical tissue slightly raises the risk of preterm birth in a future pregnancy, which is why we treat only confirmed high-grade changes and remove the least tissue needed.
After treatment
A LEEP cures the precancerous changes in most women, but the underlying HPV infection may persist, so follow-up testing continues. An HPV test about a year after treatment tells us whether the virus has cleared. Women who have been treated need ongoing screening for many years afterward, longer than the general population.
What to expect at your visit
For a routine screening visit, try to schedule when you are not on your period, and avoid intercourse, douching, or vaginal medications for two days beforehand, since these can affect the sample. The visit is a standard pelvic exam, and you can return to normal activities immediately.
For colposcopy, an over-the-counter anti-inflammatory an hour beforehand reduces cramping. Bring a pad; the solution used to stop bleeding after a biopsy causes a dark discharge for a few days. Avoid intercourse and tampons for several days afterward. We call you with biopsy results, usually within one to two weeks, and explain the next step.
For LEEP, plan a quiet day. We schedule a follow-up to review pathology and set your screening plan.
Dr. Guichard and our women's health team provide cervical screening and colposcopy at both our Midtown Manhattan and Forest Hills offices. Dr. Guichard conducts visits in French, Haitian Creole, American Sign Language, and medical Spanish.
Questions patients ask
I tested positive for HPV. Does that mean I have cancer?
No. HPV is extremely common, and most infections are cleared by the immune system within a year or two without ever causing a problem. A positive test means the virus is present now, not that cells have changed. Depending on the type and your Pap result, the next step is either a repeat test in a year or a colposcopy to look more closely. Cervical cancer takes many years to develop, which is exactly why screening works.
How often do I need a Pap smear?
Less often than most people think. Screening starts at 21. Between 21 and 29, a Pap every three years is standard. From 30 to 65, co-testing with Pap and HPV every five years, or HPV testing alone every five years, is preferred, though a Pap alone every three years is acceptable. Women with abnormal results, a weakened immune system, or certain past treatments need more frequent testing, and we set that schedule individually.
Does colposcopy hurt?
The exam itself feels like a slightly longer Pap smear. If a biopsy is taken, you feel a brief pinch or cramp for each sample, usually one to three. Most women describe it as uncomfortable rather than painful. Expect mild cramping and some dark discharge for a few days from the solution used to stop bleeding. An over-the-counter anti-inflammatory beforehand helps.
Can I get the HPV vaccine as an adult?
Yes. The vaccine is routinely recommended through age 26 and is approved through age 45. For adults 27 to 45 the benefit is smaller, because many have already been exposed to some HPV types, but the vaccine still protects against types you have not encountered. It does not treat an existing infection. We discuss whether it makes sense for you based on your history, and we administer it in the office.
Will a LEEP affect a future pregnancy?
A single LEEP that removes a small amount of tissue has little effect on fertility and only a small effect on pregnancy outcomes. Removing a larger amount of cervical tissue, or having more than one procedure, modestly raises the risk of preterm birth. We weigh this when deciding between treatment and observation, especially in younger women, and we remove the least tissue needed. Tell your obstetrician about any prior LEEP.
Make an appointment
Manhattan (212) 991-9991 · Forest Hills (718) 360-9550 · same-week visits, most major insurance accepted.