Pap Smear. Pelvic Exam. STD Test. What's the Difference?

by Alisha Bridges Patient Advocate
*Credit: Thinkstock*

When I was younger I assumed any vaginal examination would automatically include a Pap smear and testing for sexually transmitted diseases (STDs). As I got older, I came to realize that my assumptions were false. Although the three tests discussed below can be completed during the same visit to the gynecologist, they're designed to detect different things.

Which exam tests for the most abnormalities?

If you are interested in a board range of testing, the best option is a pelvic exam. A pelvic exam can help detect sexually transmitted diseases, uterine fibroids, vaginal infections, and other reproductive abnormalities. The doctor will examine the vaginal area for irregularities like bumps/sores and also swab the inside of the vagina for vaginal fluids, with which she can also test for vaginal infections and some STDs.

What is a Pap smear designed to detect?

A Pap smear's main objective is to detect cervical cancers. According to “virtually all cervical cancers are caused by HPV.” When a woman is given a pap smear, the doctor will insert a tool designed to go inside the vagina, scrape the cervix, and then send the samples off for testing. The sample will be tested for abnormal cells, which will ultimately determine if there is a potential cancer present. If abnormal cells are found, a test for HPV also may be conducted. Because this exam requires the physician to examine the vagina this test could also aid in detecting bumps/sores associated with herpes, genital warts, or syphilis. But a woman could still have those STDs without bumps being present, so it’s important to specifically receive STD testing. The Centers for Disease Control and Prevention (CDC) reports that most people who contract herpes show no visible symptoms.

The CDC suggests women between the ages of 21-65 should receive testing, but 2014 guidelines from the American College of Physicians suggested that for women who are not pregnant, a yearly examination is not required. The guidelines recommend that women ages 21 to 29 should receive the test once every three years and women ages 30-65 should have this test every three years or a combination of a Pap smear and HPV test every 5 years. Women over 65 don’t need routine screening if recent tests were normal.

“Keep in mind that these are guidelines. For personal reasons, you and your doctor may wish to choose HPV testing first or have more frequent Pap smears than recommended,” says Howard LeWine, M.D., chief medical editor, internet publishing, Harvard Health Publications, in a Harvard Health Blog post on the topic.“If during a routine appointment your doctor wants to perform a pelvic exam, and you aren’t keen on the idea, feel free to ask why you need it and what he or she is looking for,” he says in the blog post. “That’s not a challenge. Based on current evidence, there should be a reason for doing a routine pelvic exam.”

Testing for sexually transmitted diseases

Although a woman may decide to receive pap smears on the schedule suggested above, if she is sexually active it’s important that she be tested annually for sexually transmitted diseases. STD testing can be done apart from a Pap smear and pelvic exam through a urine, blood, or swab test. But for the most adequate testing, one should do both a urine, blood, or swab test and a pelvic exam. It’s also important to remember that some STDs like herpes or genital warts are sometimes first detected by sight through a pelvic exam, but can be missed through a urine test.

Alisha Bridges has battled with severe psoriasis for over 20 years and is the face behind Being Me in My Own Skin, a blog which highlights her life with psoriasis. Her goals are to create empathy and compassion for those who are least understood, through transparency of self, patient advocacy, and healthcare. She is currently a post-bach student at Georgia State University pursuing a career as a Physician's Assistance—her passions are dermatology and sexual health. Alisha also shares her passion as a Social Ambassador of the Psoriasis HealthCentral Facebook page where she shares timely tips, stories and insights on living with psoriasis. You can also find Alisha on Twitter.

Alisha Bridges
Meet Our Writer
Alisha Bridges

Alisha Bridges has dealt with psoriasis since 7 years old after a bad case of chicken pox triggered her disease to spread on over 90% of her body. For years she hid in shame afraid of what people would think of such a visible disease. She has suffered from depression, anxiety, and panic attacks due to psoriasis. Years ago Alisha wrote a letter entitled “My Suicide Letter.” The letter was not about actually killing herself but killing parts of her like low self-esteem, fear, and shame so she could truly live to her fullest potential. This proclamation catapulted her into psoriasis and patient advocacy. Following this letter she created a blog entitled Being Me In My Own Skin where she gives intimate details of what it’s like to live with psoriasis. Alisha is a community ambassador for the National Psoriasis Foundation and has served her community in countless ways to help give a better understanding of what’s it’s like to live with psoriasis. Her life motto is the following: “My purpose is to change the hearts of people by creating empathy and compassion for those the least understood through transparency of self, patient advocacy, and dermatology.” Alisha is also a Social Ambassador for the HealthCentral Skin Health Facebook page.