Archived Questions

Please see our latest questions and answers here.

Q: I don't understand the difference between PAP tests and HPV tests. Don't they look for the same things? My Paps have ALWAYS been normal, but at my clinic they say they're starting to use HPV tests for "older" women (as if! I'm 32). Wouldn't just my regular PAP be good enough?

A: After all these years of telling women they need a yearly PAP test, we've gone and changed the rules—no wonder you're confused! Let me start with a review of these screening tests.

The PAP test (also called PAP smear) was developed about 60 years ago. A gentle scraping of the cervix accumulates cells that are sent to the lab for review under a microscope. There, the cells are examined for any characteristics that might indicate abnormal cell growth. The results are then reported in a category that corresponds to the degree of abnormality seen. This cellular test has been the cornerstone of cervical cancer screening in the United States.

The HPV test has only been available for less than 10 years. It is considered a molecular test since it tests for the presence or absence of HPV DNA. Only the “high risk” strains should be tested for since they are the ones that cause pre-cancers and cancer. It can be tested from the residual of the liquid- based PAP test, or by itself with a small collection brush. The results are reported as positive (meaning high risk DNA has been detected) or negative (meaning high risk DNA has not been detected).

New guidelines for screening now have an option for women age 30 and older by screening with both a PAPtest and an HPV test. Rates of HPV are lower in this age group, but the incidence of cervical cancer begins to go up. This may be because some women do not clear the HPV infection they acquired years before. By using a “specific” test (the PAP test) and a “sensitive” test (HPV DNA) together, you get the benefit of a highly effective screen for pre-cancers and cancer.

If both of these tests are negative, you are at the lowest risk category for developing cervical cancer and can safely lengthen the interval that you are screened to every 3 years.
Beth Colvin Huff, MSN, FNP-BC Vanderbilt University Medical Center

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Q: I'm the parent of a pre-teen. I want to know how to broach the subject of sex and STIs with my child. How do I start? What are the main topics I should cover?

Talking to your children about sex is something that almost every parent thinks about. Especially when their child (or their child's friends) start showing signs of puberty.

Here are some points to consider in getting yourself ready.

1. It's not just one “talk.”
You want your teen to understand that sex isn't simple so you shouldn't expect to cover everything in one “talk.” Relationships, love, the mechanics of sex, the feelings of sex, the good parts of sex, the dangerous parts of sex…these are all things that require attention, probably more than once.

There are two other important things to remember. First, the fact that you are talking at all is the most important part of helping your child grow up. Exactly what is said, and when, may be less important than talking itself.

Second, listening to your child may be as important as talking. Paying attention to what your child is talking about in other conversations, or watching on television, may give you useful opportunities to engage the issues around sex. As you do this, don't mistake apparent lack of attention for lack of interest.

2. Prepare yourself
It's probably a good idea to prepare yourself to talk to your child about sex. You have your own values and experiences that have shaped you: it may be useful to review those before talking to your child. That process may also be helpful in clarifying your hopes and expectations for your child as a sexual person.

It may help to think about the type of language you want to use. Very few people use formal anatomic language in discussions about sex with others. On the other hand, much of our informal language about sex is considered vulgar. Thinking through the words you can be comfortable with helps express your comfort with the topic to your child.

Finally, do some homework. There are lots of inexpensive resources for parents. For example, Beyond the Big Talk: Every Parent's Guide to Raising Sexually Healthy Teens – From Middle School to High School and Beyond by Debra W. Haffner.

The National Campaign to Prevent Teen Pregnancy has guides in both English and Spanish for parents wanting to help their teen delay sex and be sexually healthy.

3. Look for opportunities to talk
Parents are sometimes so uncomfortable in talking about sex that they attempt to “schedule” a talk. There are lots of circumstances – watching television, listening to news, reviewing homework, riding to practices – when some talk about sex would be appropriate to the context.
J. Dennis Fortenberry, MD, MS
Indiana University School of Medicine

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Q: I am a male and have been married for more than 20 years. Recently, my relationship with my wife has deteriorated to an extent where there is no physical contact (and no sex!) whatsoever!

I am not the type who looks for different partners. I am currently celibate, as I'm earnestly trying to work on this marriage. I am becoming depressed, though, and do feel the need to have a sexual partner, but my conscience won't allow me to be disloyal! I'm worried that all of this will have an effect on my health.

A: The World Association for Sexual Health defines sexual health as the “…state of physical, emotional, mental and social well-being related to sexuality; it is not merely the absence of disease, dysfunction or infirmity.” This definition applies through the lifespan and encompasses the changes in individuals as well as changes in relationships with their partners. By definition, when these changes are associated with distress, they are unhealthy.

As briefly described, the changes in your marriage as well as in your sexual relationship are causing great distress, at least for you. And, many people find seeking professional help for these types of problems to be overwhelmingly embarrassing. However, this type of help can be effective for both relationship problems and accompanying sexual problems.

Physicians, psychologists, licensed social workers and marriage/family counselors all might be helpful. One resource for locating sexual health professionals in your area is available on the website of the American Association of Sexuality Educators, Counselors, and Therapists .

J. Dennis Fortenberry, MD, MS
Indiana University School of Medicine