Safety Zone

Personal hygiene is described as the principle of ensuring and maintaining cleanliness and care of the external body.
The benefits of good hygiene:

• Increased self-esteem and confidence;
• Projecting a positive body image;
• Helps reduce unpleasant body odors;
•  Helps reduce the risks of infection and pain.

The Risks of Poor Hygiene:

• Social embarrassment;
• Rejection and isolation;
• Increased risk of getting an infection or an illness

Hand Hygiene:

•  Hand washing is vital. This should be carried out after using the toilet, after handling anything potentially hazardous, after playing with pets, before preparing food, before eating, and before and after having sex.
• When washing your hands try using warm water and a good soap. Wet your hands thoroughly and apply soap and work into a soapy lather. With a repetitive motion continue hand washing (over the back of your hands, across your palms, in between your fingers, around your nails, and even around your wrists) until you are thoroughly satisfied they are clean (which is usually the duration of singing ‘Happy Birthday to you’ in your head). Rinse and dry thoroughly using a clean dry towel.
• Keep your nails clean and make sure your nails don’t have rough edges.
• Treat any cuts or open sores immediately.
• A latex glove is very handy when engaging in any sexual activity (e.g., finger fucking).
• In cases where water is not readily available consider using an anti-bacterial wet wipe.

Oral Hygiene:

• Bad breath (or halitosis) is most commonly caused from poor dental hygiene (e.g. wrong technique used to brush teeth, don’t floss, irregular visits to the dentist etc). Bad breath can also be caused by eating highly aromatic foods such as onions and garlic or in cases where food intake has been severely restricted. Dehydration can cause bad breath, while drinking alcohol can lead to bad breath and body odor. And lastly, smoking, chronic sinus problems and gum disease may also lead to bad breath. Resolving any of these causes is likely to result in a dramatic improvement.
• In general, teeth should be brushed at least twice a day, followed by some flossing. You could also floss after every meal. Remember to also brush your tongue as this will remove any buildup of bacteria and/or dead cells.
• You should avoid brushing your teeth before or after engaging in any oral sexual activity as this may cause the gums to bleed, increasing your risk of infection. Rinse with a mouth wash or chew some gum instead.
• Replace your toothbrush approximately every three months.
• Keep well hydrated, by drinking at least 6 – 8 glasses of water per day, which is actually good for your overall health.
• Go to your oral hygienist/dentist for a check-up and clean-up at least twice a year.

Genital Hygiene:

• Genital care means the way in which women keep their genital area healthy. This part of the body (the vulva) is made up of skin, moist areas and glands. Secretions (moistness) from the vagina keep it clean and healthy and these secretions are normal. These secretions protect the vagina and the skin.
• The skin and moist surfaces of this part of the body are very delicate. It is important not to wash with harsh chemicals that may irritate the area. Washing too often, or rubbing too hard when drying, can irritate this skin. If you have problems in this area, washing with plain, lukewarm (not hot) water is best. Using soap, shower gels and some cleansers can make the problems worse. Your health care provider may be able to suggest a soap substitute.
• Gently separate the outer "lips" and bathe the inner skin with plain water, using your hands only. Gently pat dry the outer skin. Do not use a hair dryer.
• Wear well fitting clothing and avoid thongs and tight jeans. Wash underclothes in a mild detergent and avoid fabric softeners.
• It is not necessary to wash the vulva every day and it should not be washed more than once a day. Do not wash the vagina. Do not use wipes, deodorants, douches or other cosmetic and cleansing products. Women with a problem in this area should use only treatments prescribed by their health care. International Society for the study of Vuvo-vaginal Disease Patient Information Committee, June 2006.

Anal Hygiene:

• The anus should only need proper washing once a day and then appropriate cleaning after every bowel movement.
• Although hygiene is very important, over-cleaning (using harsh internal cleansing products) and over-wiping (using course toilet paper) is not desirable as this may lead to irritation and in some cases bleeding.
• When cleaning use a soft ‘two-ply’ toilet paper, or if possible, use a pre-moistened, non-perfumed adult wipe.
• Anal douching is the practice of introducing water slowly and gently into the anus in order to clean out the rectum. This has been suggested as a possible method but there are associated risks to this practice: it can lead to damage of the rectum and can actually increase the risk of infection.
• When sex toys are used, these should be cleaned in between uses, even if new condoms are used each time. This is especially important if sex toys are shared.

Body Odor:

• Body odor develops from a buildup of perspiration generally in the groin, armpit and feet. Exercising and hot weather can contribute to this. Perspiration is not preventable but body odor can be controlled.
• Frequent washing can help reduce the development of body odor. For most, one wash a day may be adequate. For others, two to three washes a day may be required. Ensure that you dry yourself thoroughly to avoid reservoirs for bacteria to breed in.
• Wearing clean underwear, socks and clothes every day can also help reduce body odor and reduce risks of infection and soreness.
• The moderate use of anti-perspirant deodorants or roll-ons can help reduce odours developing in the armpits.
• The removal of excess hair can help reduce the area on which bacteria can breed and odors developing.
• In cases of severe perspiration, medical treatment may be sought (e.g., trans-thoracic sympathectomy or botox injections into the armpit).

In public health, considerable attention has been placed on establishing a hierarchy of risk associated with STI and HIV transmission (see table below). The hierarchy ranges from minimal risk (abstinence) to highest risk (anal intercourse with internal ejaculation without a condom). This hierarchy is useful for establishing what your risk profile so that you can make informed choices on how to have fun safely and responsibly. Lesbian women and WSW, as any other, could have various different types of sexual practices, including for some anal intercourse with a man, with ejaculation and without a condom, putting herself at no 30, the highest risk possible to contract HIV.

Taking this hierarchy into account, safer sex can be achieved by:

• Using condoms correctly and consistently when having sex and when giving a blow job to a man,
• Using condoms and a water-based lube correctly and consistently when sharing sex toys;
• Using dental dams or latex sheets correctly and consistently for oral sex and rimming. Alternatively, use a flavoured condom cut along the side or non-microwavable cling wrap;
• Using finger cots correctly and consistently for finger-fucking. Alternatively, use a condom over your finger;
•  Using non-powdered latex gloves for fisting or finger-fucking;
• Avoiding an exchange in bodily fluids (e.g., vaginal fluids coming into contact with an open wound)

‘Barrier methods’ is the technical term used for products that are aimed at preventing the exchange of bodily fluids (e.g., semen, vaginal secretions, blood etc) between people. Examples of barrier methods for women include male condoms, female condoms, dental dams and finger cots/latex gloves. These barrier methods have been shown to significantly reduce the risk of transmission of sexually transmitted infections (STIs), including HIV, when used correctly and consistently. Some women feel that using a barrier method ‘ruins the mood’. Many feel that barrier methods decrease pleasure, serve as a barrier for ‘true’ intimacy, convey distrust between partners, and can become a major burden in the bedroom. While this may be true to some extent, the bottom line is that there is no other way to protect yourself and your partner from STIs during sex. So, it is a trade-off but certainly the benefits of using a barrier method greatly outweigh the disadvantages. In order to make barrier methods more appealing, barrier methods are now available in a variety of shapes, colours, flavours, textures and sizes. The use of barrier methods can also be made more fun and sexy by incorporating their use into foreplay. By using barrier methods you are conveying the message that you care enough to protect yourself and your partner.

• The female condom (or femidom) is a great alternative to the male condom, whether sharing a sex toy with another woman or having sex with a man.
• Follow the directions on the package for correct placement. Be sure the inner ring goes as far into the vagina as it can. The outer ring stays outside the vagina.
• Guide the vibrator / dildo / penis into the femidom.
• After sex, remove the femidom before standing up by gently pulling it out.
• For oral sex or rimming, the femidom is also a great alter­native to the dental dam. Simply cut along the side and fold open. Place over the vagina or anus before stimulating with the tongue or lips.
• Use water-based lube to assist with placement and for height­ened pleasure.
• Remember: don’t re-use femidom’s or use in combination with the male condom.

THE MALE CONDOM

• A new male condom is recommended when having penetrative sex (whether sharing a sex toy with another woman or when having sex with a man).
• Ensure that the condoms are stored away from too much heat, cold or friction.
• Check the packaging and the expiry date before using the condom. Open the package carefully. Do not open the packaging with your teeth. Be careful that your fingernails or jewellery do not tear the condom. Ensure that you have enough water-based lube beforehand. If you don’t have water-based lube, you can substitute it with plain white low-fat yoghurt. Oil-based lubricants such as butter, baby oil, Vaseline, Dawn or Aqueous Cream should be avoided as these products can cause condom breakages – condoms will lose 70 percent effectiveness within 30 seconds!
• Gently squeeze the tip of the condom (to get rid of the trapped air) and place onto the tip of the penis or dildo.
• Roll the condom down. If the condom is on the right way, proceed to roll the condom down the shaft of the penis or dildo, all the way to the base.
• Put water-based lube on the outside of the condom and on your vagina. Begin penetration. Check the condom during sex, especially if it feels strange. Make sure it is still in place and unbroken. Add more lube when necessary.
• Only remove the condom after penetration is over. Dispose of it by wrapping it in paper and throwing it in the bin. Don’t try and flush it as it may cause plumbing problems.
• Remember to use a new condom every time you have penetrative sex. Never use the same condom more than once or use a condom that has been used by someone else.
• Do not “double bag” (use two condoms at once) as friction between the condoms increases the chance of breakage.  

 

• A ‘Silk-e’ is a rectangular latex sheet that can be used for oral sex and rimming (annilingus). It can be used to protect against the transmission of sexually transmitted infections. They are available in a variety of flavours for enhanced pleasure.
• Placed over the genital area or anus, it allows for oral-genital/anal stimula­tion without any exchange of bodily fluids.
•  ‘Silk-e’s’ are quite pricey and are not readily available.
•  In the absence of a Silk-e, a great alternative is to use non-microwavable cling wrap (available at most shops) or a cut flavoured condom. The cut condom is achieved by cutting alongside the shaft of the condom. This is then opened and placed flat over the genitals or anus.

• A finger cot is a latex device resembling a condom, but designed specifically to fit over the finger. This is ideal for finger fucking and offers protection against the transmission of most sexually trans­mitted infections, including Herpes and the Human Papilloma Virus (HPV).
• These are not readily available. Non-powdered latex gloves are more commonly used, especially for fisting, and are more readily available.

• You might find it difficult to bring up the subject of barrier methods with your sexual partner(s). You may feel embarrassed or shy or worry about rejection. Or if you are already in a sexual relationship, you may worry that by bringing it up, your partner will assume that you have been unfaithful or cannot be trusted.
• It is definitely easier to raise the issue of barrier method usage before you have sex for the first time. You can stress that this is your policy and that you always have sex with a barrier method to protect yourself and your partner(s). In most cases, if she is as concerned about her health as you are, she will have no problem with it.
• It may be difficult, but it is not impossible, to discuss barrier method use any time during a sexual relationship. Stress that it is not only a question of trust, but precisely that you care for her and that you want to ensure that she is protected. The discussion may be undertaken in a larger context, if you are ready and willing, of negotiated safety. Thus it will include a discussion about going for an HIV test, what the results will mean for the relationship, and also issues about sex outside of your primary relationship.
• In any case, do not wait until you are in bed or about to have sex to have the discussion about the use of barrier methods. It might be helpful to have the conversation at a low-key moment, such as over dinner or over the phone. Tell her that it is not because you do not trust her, but that you are just concerned about health in general – yours and hers.

It is important that you set ground rules for yourself with respect to barrier method use. Make it a practice to use barrier methods, whoever you are having sex with – especially when it is a casual sexual encounter.

Risk reduction is a personal strategy that you can develop and follow in order to your risk profile. This is only possible once you:

• Have gained insight into your own risk behaviour and current health status; and
• Have a clear understanding of the available tools you could draw on to reduce your risks.
• A personalized risk reduction is only effective when:
• You are completely honest with yourself. It is only when you are completely honest with yourself that you are able to identify what you can and cannot do in terms of reducing your risk;
• You do what is possible and realistic first. You are more likely to stick to choices and changes that are possible and realistic; and
• You start small. Smaller changes at first are usually easier and are likely to motivate you to move on to more difficult changes later on.
• You are clear on the steps and goals. By being absolutely clear on the steps involved in each area of change and by allotting a time frame to it, you are less likely to get side-tracked and lose momentum.

Voluntary Counseling and Testing or VCT is a process that is followed when a person wants to find out if they are infected with HIV. Voluntary means that a person decides on their own whether or not to have the test. In making the decision to be tested or not the person will have the chance to discuss the test with a trained counselor. The test is an accurate scientific test to show if a person has been infected with HIV. The test is usually conducted on a person’s blood. Most clinics use a rapid test, which means that the test results are available after about twenty minutes.

• Pre-test counseling where questions about HIV and AIDS and the test are discussed with the counselor
• When a person decides to have an HIV test, they need to sign a consent form
• After the test, the counselor gives the results in a post-test counseling session

The HIV Test

• When you were infected.
• How you were infected, or who the infection was from.
• Whether you have progressed to AIDS or not. Another test will have to be done to test whether the person has AIDS.

A counselor can provide ongoing support and also refer a HIV positive person to other health care professionals or organisations where they can get further help.      

A  list of updated VCT sites in South Africa can be found on National Help Line www.karabo.org.za .

• OUT LGBT Wellbeing’s Clinic, 1081 Pretorius Street, Hatfield , Pretoria. Contact Elmie @ (012) 430 3272
• OUT LGBT Wellbeing’s Hillbrow Clinic, for now Fridays only, Cnr Esselen and Klein,
  Hugh Solomon Building, Office G33, Hillbrow. Contact Trudie @ 082 520 7010
• Triangle Project, Cape Town, Unit 29, Waverley Business Park, Dane St, Mowbray, Contact Heather or Sharon @ (021) 448 3812

HIV Pre- and Post-Test Counseling

Pre-test counseling

• Identifying the person’s reasons for testing
• Assessing the possible risk of HIV infection
• Exploring and correcting beliefs and knowledge about HIV infection and safer sex
• Providing information on how the test is done
• Dealing with the anticipation of the test results
• Guaranteeing confidentiality of the test results
• Obtaining informed consent
• Providing education on the giving of results and ongoing support
• Educating on the waiting period for results

Pre-test counseling is extremely important. It should not only be seen as a preparation for the HIV test, but also as an opportunity to educate people about HIV and AIDS and safer sex. It is important that you feel comfortable with your counselor so you can ask specific and intimate questions with regard to WSW if necessary.

Post-Test Counseling

Post-test counseling happens at the time of getting results. It helps people deal with the result, the implications of a positive or negative diagnosis, and helps to deal with the reality of their situation, and have a clear understanding of what their results mean and the options that are available to them.

Post-test counseling involves:

• Giving the results
•  Listening to the persons concerns about her results
• Focusing on the person’s feelings and how the result may affect their lives
• Helping people make a plan for action for the future: this may include issues of disclosure, referrals to health care providers, finding ongoing support.

We realize that many lesbian women neglect their sexual health due to fear of being ridiculed or discriminated against on the basis of their sexual orientation. WSW and bisexual women often experience the same kind of fear. The chances are that even if these women do go for medical checkups, they tend to keep important personal information to themselves. This can lead to mis-diagnosis and lack of proper health information given, because the health care provider has no proper sexual history of the woman. If you are one of those woman who find it difficult to disclose your sexual orientation or same sex sexual history, we suggest you call.

REGULAR CHECK UPS
BREAST SELF-EXAMINATION (BSE)

Breast self-examination is a procedure performed by oneself to physically examine yourself for any changes in your breasts and underarm areas of your body. BSE should used in addition to clinical breast examination and mammography for early detection of breast cancer.

How to examine your breasts

•  Lie down and place your right arm behind your head. The exam is done while lying down, not standing up. This is because when lying down the breast tissue spreads evenly over the chest wall and is as thin as possible, making it much easier to feel all the breast tissue.
•  Use the finger pads of the 3 middle fingers on your left hand to feel for lumps in the right breast. Use overlapping dime-sized circular motions of the finger pads to feel the breast tissue.
  
  
• Use 3 different levels of pressure to feel all the breast tissue. Light pressure is needed to feel the tissue closest to the skin; medium pressure to feel a little deeper; and firm pressure to feel the tissue closest to the chest and ribs. It is normal to feel a firm ridge in the lower curve of each breast, but you should tell your doctor if you feel anything else out of the ordinary. If you're not sure how hard to press, talk with your doctor or nurse. Use each pressure level to feel the breast tissue before moving on to the next spot.
• Move around the breast in an up and down pattern starting at an imaginary line drawn straight down your side from the underarm and moving across the breast to the middle of the chest bone (sternum or breastbone). Be sure to check the entire breast area going down until you feel only ribs and up to the neck or collar bone (clavicle).
  
  
• There is some evidence to suggest that the up-and-down pattern (sometimes called the vertical pattern) is the most effective pattern for covering the entire breast, without missing any breast tissue.
  Repeat the exam on your left breast, putting your left arm behind your head and using the finger pads of your right hand to do the exam.
• While standing in front of a mirror with your hands pressing firmly down on your hips, look at your breasts for any changes of size, shape, contour, or dimpling, or redness or scaliness of the nipple or breast skin. (The pressing down on the hips position contracts the chest wall muscles and enhances any breast changes.)
• Examine each underarm while sitting up or standing and with your arm only slightly raised so you can easily feel in this area. Raising your arm straight up tightens the tissue in this area and makes it harder to examine.
• www.cancer.org/docroot/cri/content/cri_2_6x_how_to_perform_a_breast_self_exam_5.asp
  
  

A Mammogram is a low-powered x-ray technique that displays an image of the internal structure of your breast.  Additional angles and magnified views are taken of suspicious areas. The function of a mammogram is to assist in early diagnosis of breast diseases, including cancer. A mammogram can detect cancer even before a lump is felt. It is recommended that women have baseline mammogram at age 40, followed by a mammogram every couple of years until age 50. Family history may require that women do mammogram’s earlier and more frequently. After the age of 50 years, women should have a mammogram done yearly.

What to expect during a mammogram

• At the radiology department, they would ask you to undress and only keep your panties on and the examination jacket provided. If you are wearing a neck less, also a remove that.
• The radiologist will ask you to remove the examination jacket and stand next to the X-ray machine.
• The radiologist will assist you to place one of your breasts between two compression plates to flatten the breast to a thickness of about 4-6 cm. It may be a little uncomfortable.
•  Your breast will first be compressed horizontally and then obliquely. An X-ray will be taken of each position. The same procedure will be followed for your other breast.

PELVIC AND VAGINAL EXAMINATION

A pelvic exam is a simple procedure — although for many an embarrassing or uncomfortable one. Your doctor or health care practitioner will examine your vulva, vagina, uterus, rectum and pelvic and your ovaries for masses or growths. Often a pap smear is part of the procedure, but it is not always the case. Understanding what your doctor is looking for during a pelvic exam may put your mind at ease. Learn who the test is for, when you should have it done and what exactly happens during a pelvic exam.

Who needs a pelvic exam?

All women benefit from routine gynecologic screening, including a pelvic exam. Most experts agree that the first pelvic exam should take place within three years of the onset of sexual activity or by age 21, whichever comes first. Your doctor can recommend how frequently you need to be examined, but many women have a pelvic exam once a year.

How do you prepare for a pelvic exam?

No special preparation is required for a pelvic exam, though you may be advised to schedule the test on a day when you don't have your menstrual cycle.

Where is the pelvic examination performed?

A pelvic exam is performed in your doctor or health care practitioner’s office and takes only a few minutes. The exam involves using a specialized technique to feel (palpate) your pelvic organs and maybe a visual inspection of your vagina by means of using a speculum. Your doctor is looking for signs that point to a problem that requires treatment, such as an infection, a sexually transmitted disease or early-stage cancer.

What can you expect during a pelvic exam?

• You'll be asked to change out of your clothes and into an examination gown in privacy. This means that you will need to take of your bra and panties as well.
•  Before performing the pelvic exam, your health care practitioner may listen to your heart and lungs and perform a breast examination.
• During the pelvic examination, you will lie on your back on an examination bed. To allow your health care practitioner to examine you more comfortable, you will have to bend your knees and place your feet on the corners of the bed for support. You'll be asked to slide your body toward the end of the table and let your knees fall apart.
• To assist your health care practitioner, try to keep your legs as far apart as possible. This will allow your health care practitioner to examine you more thoroughly and this will cause less discomfort for you. The procedure is not painful, but may be uncomfortable due to the cold lubrication and the fingers that enter your vagina. 
• First, your health care practitioner will visually inspects your external genitalia, looking for sores, swelling or any other abnormalities. He/She will then inspect your vagina using a speculum — a plastic or metal-hinged instrument shaped like a duck's bill, which spreads open your vaginal canal. Before the speculum is inserted, it is lubricated with a water-base lubricant. Often, the speculum is cold, so this might be uncomfortable.
•  Inserting and opening the speculum can cause pressure or discomfort for some women. Relaxing as much as possible may ease discomfort, but tell your health care practitioner if you experience pain. If your pelvic examination includes a Pap smear, a sample will be taken of your cervix before the speculum is removed. 
• After removal of the speculum, your health care practitioner will examine your other pelvic organs for any signs of abnormalities. Because your pelvic organs, including your uterus and ovaries, can't be seen from outside your body, your health care practitioner needs to feel (palpate) your abdomen for this portion of the exam. To do this your health care practitioner inserts two lubricated, gloved fingers into your vagina with one hand, while the other hand presses gently on the outside of your lower abdomen. This is to check the size and shape of your uterus and ovaries and identify any tenderness or unusual growths. Sometimes after the vaginal examination — especially if you're older than 40 — your doctor also inserts a gloved finger into your rectum to check for tenderness, growths or other irregularities.
• Usually your health care practitioner will tell you exactly what he or she is doing next so that nothing comes as a surprise to you.

Pap Test

During a pelvic exam, your doctor uses a speculum to hold your vaginal walls apart. If your pelvic exam also includes a Pap test, your doctor collects a sample of cells from your cervix, using a small cone-shaped brush and a small plastic spatula (1 and 2). Your doctor then transfers the cells onto a glass slide (3) for examination under a microscope. Or your doctor may rinse the brush in a liquid-filled vial (4) and send the vial to a laboratory for testing.

After the pelvic exam

• When the pelvic examination is completed, you may get dressed.
• Your health care practitioner will inform you if he/she discovered anything unusual during your pelvic examination. If you had a pap smear, the results will be available within a few days.
• Your health care practitioner will discuss any necessary next steps, including your health care practitioner’s recommendation on your follow-up or the timing of your next pelvic examination.

Having regular pelvic examinations can help to ensure that any problems that you might have, are detected at an early and treatable stage.

VAGINAL PAP SMEAR

A pap smear, also called a pap test, is a procedure to test for cervical cancer in women. A pap smear involves collecting cells from your cervix — the lower, narrow end of your uterus.

Detecting cervical cancer early with a pap smear gives you a greater chance for treatment and curing of cervical cancer. A pap smear can also detect changes in your cervical cells that suggest cancer may develop in the future. Early detection of these cells is your first step in stopping the possible development of cervical cancer. Furthermore, a pap smear can also detect any infection that you may or may not have. A pap smear can be done in conjunction with a pelvic examination.

Who should have a pap smear?

Women should have her first pap smear about three years after first having sexual relations or at age 21, whichever comes first. Pap smears are not only for heterosexual women, Lesbian women should also abide by this rule. In general it is safer to have a pap smear annually, although some medical professionals say if you had 3 negative results in a row, then you can do it every 2-3 years. If you have any of the following risk factors then you should go annually for a pap smear, regardless of your age:

• Any previous diagnosis of a cervical cancer or a result showing precancerous cells;
• Family history of cervical cancer;
• HIV infection;
• Weakened immune system due to organ transplant, chemotherapy or chronic corticosteroid use.

Who can consider stopping Pap smears?

Discuss your screening options with your doctor. In certain situations a woman and her doctor may decide to end Pap testing, such as:

• After total hysterectomy. After a total hysterectomy (surgical removal of the uterus including the cervix) ask your doctor if you need to continue having Pap smears. If you had hysterectomy due to noncancerous conditions, you may be able to discontinue routine pap smears. If your hysterectomy was for a precancerous or cancerous condition, you should have an annual vaginal pap smear.
• Older age. There is not enough evidence to determine an age at which it's safe to stop testing. Some health care professionals believe that if you are 70 years of age and had 3 negative results in the last 10 years, you can stop having pap smears. Discuss your options with your health care professional and together you can decide what's best for you based on your risk factors.

Risks

A pap smear is a safe and easy way to screen for cervical cancer. However, a pap smear isn't always foolproof. It's possible to receive false-negative results, meaning that the test indicates no abnormality, even though you do have abnormal cells.

The liquid-based Pap smear test, in which the sample of cells is preserved in liquid rather than smeared on a microscope slide, provides fewer false-negative results. With either test, false-positive results, when the test indicates an abnormality when there really isn't one, are extremely rare. To eliminate the changes of false negative and false positive, 2 microscope slides are examined, to be able to compare.

A false-negative result doesn't mean that a mistake was made. Many factors can cause a false-negative result, including:
 

• An inadequate collection of cells;
• A small number of abnormal cells;
• An inaccessible location of the lesion;
• A small lesion;
• Abnormal cells mimicking benign cells;
• Blood or inflammatory cells obscuring the abnormal cells.

Although it's possible for abnormal cells to go undetected, time is on your side. Cervical cancer takes several years to develop, and if one test doesn't detect the abnormal cells, the next test most likely will. Therefore it is best to go annually for a pap smear.

How to prepare for your pap smear

To ensure that your pap smear is most effective, follow the following guidelines:

• Avoid penetration intercourse, douching or using any vaginal medicines or spermicidal foams, creams or jellies for two days before having a pap smear, as these may wash away or obscure abnormal cells; and
• Try not to schedule a pap smear during your menstrual period. If you recently menstruated, you should at least have stopped for two days. Although the test can be done, it's best to avoid this time of your cycle cause the blood will prevent the cytologist to see the cells clearly under a microscope.

What can you expect during the pap smear?
 

• You'll be asked to change out of your clothes and into an examination gown in privacy. This means that you will need to take of your bra and panties as well. Depending on the procedure, if it is only a pap smear or in combination with pelvic examination, your health care practitioner might even ask you just to take off your clothes from the waist downwards.
• During the pap smear, you will lie on your back on an examination bed. To allow your health care practitioner to examine you more comfortable, you will have to bend your knees and place your feet on the corners of the bed for support. You'll be asked to slide your body toward the end of the bed and let your knees fall apart.
• To assist your health care practitioner, try to keep your legs as far apart as possible. This will allow your health care practitioner to examine you more thoroughly and this will be less uncomfortable for you.
• Your health care practitioner will gently insert an instrument called a speculum into your vagina. The speculum holds the walls of the vagina apart so that your health care practitioner can easily see your cervix. Inserting the speculum may cause sensation of pressure in your pelvic area. The procedure is not painful, but may be uncomfortable due to the cold lubrication and the speculum that is inserted in your vagina.
• Then your health care practitioner will take two samples of your cervical cells using a soft brush and/or a flat scraping device called a spatula. This doesn't hurt and you may not even feel the sample being taken.
• The sample is then spread onto two microscope slides and sprayed with fixation spray to keep the cells in place. He/she might also transfer the cells collected into a container containing a special liquid to preserve the sample and this is called a liquid-bases pap smear test.
• After removal of the speculum, your health care practitioner might perform or continue with a pelvic examination.

After the Pap smear

After your pap smear, you can continue with your day as normal without any restrictions about your day without any restrictions.

The samples are transferred to a laboratory where a cytologist (a person trained to detect abnormal cells) will examine your sample. The cytologist work in cooperation with a pathologist (a doctor who specializes in cellular abnormalities). The pathologist is responsible for the final diagnosis.

Ask your health care practitioner when you can expect the results of your pap smear. In some cases, your health care practitioner will only contact you if something of concern is found or if it's determined that you need further testing.

Results
 

• Normal results
  If only normal cervical cells were discovered during your pap smear, your test will then be negative for presence of cancer cells. You won't need any further treatment or testing until you're due for your next pap smear and pelvic examination.
• Abnormal results
  If abnormal or unusual cells were discovered during your pap smear, this means that you have a positive result or the presence of cancer cells were noted.

Here are some terms your doctor might use and what your next course of action might be:

• Atypical squamous cells of undetermined significance (ASCUS). Squamous cells are thin and flat and grow on the surface of a healthy cervix. In the case of ASCUS, the pap smear reveals slightly abnormal squamous cells, but the changes don't clearly suggest that precancerous cells are present. With the liquid-based test, your health care practitioner can reanalyze the sample to check for the presence of viruses known to promote the development of cancer, such as some types of human papillomavirus (HPV). [see: STI's > Genital Warts) If no high-risk viruses are present, the abnormal cells found as a result of the test aren't of great concern. If worrisome viruses are present, you'll need further testing.
•  Squamous intraepithelial lesion. This term is used to indicate that the cells collected from the pap smear may be precancerous. If the changes are low-grade, the size, shape and other characteristics of the cells suggest that if a precancerous lesion is present, it's likely to be years away from becoming a cancer. If the changes are high-grade, there's a greater chance that the lesion may develop into cancer much sooner. Diagnostic testing is necessary.
• Atypical glandular cells. Glandular cells produce mucus and grow in the opening of your cervix and within your uterus. Atypical glandular cells may appear to be slightly abnormal, but it's unclear whether they're cancerous. Further testing is needed to determine the source of the abnormal cells and their significance.
• Squamous cancer or adenocarcinoma cells. The cells collected from the pap smear appear so abnormal that the pathologist is almost certain a cancer is present in the vagina, cervix or, occasionally, the uterus. Squamous refers to cancers arising in the flat surface cells of the vagina or cervix. Adenocarcinoma refers to cancers arising in glandular cells. If such cells are found, your health care practitioner will recommend additional examinations.

If your pap smear is abnormal, your doctor may perform a procedure called colposcopy using a special magnifying instrument (colposcope) to examine the tissues of the cervix, vagina and vulva. He or she may take a tissue sample (biopsy) from any areas that appear abnormal. The tissue sample is then sent to a laboratory for analysis and for a definitive diagnosis.