Author: Dr. Sakhan Leakhena, Obstetrics and Gynaecology, Intercare Hospital
Many women ask me a simple question: “Doctor, do I need to worry about cervical cancer if I feel completely well?”
My answer is that cervical cancer is one of the cancers we can often prevent. It usually develops slowly, often over many years. This gives us a valuable opportunity to protect women through HPV vaccination, regular cervical screening, and timely follow-up when a result is abnormal.
Let me explain what HPV means, when to come for screening, what symptoms should not be ignored, and what happens during a cervical screening visit at Intercare.
| Key message Cervical cancer often has no early symptoms. Screening is important even when you feel completely healthy. |
What is HPV, and why does it matter?
HPV stands for human papillomavirus. It is a very common virus that can be passed through intimate sexual contact. Many people will have HPV at some point in life and never know it, because it often causes no symptoms and the body usually clears it naturally.
Does HPV always mean cancer? No. This is very important. Most HPV infections do not become cancer.
The concern is persistent infection with high-risk HPV. When high-risk HPV stays in the cervix for many years, it can cause changes in the cervical cells. These changes may first become “precancer,” which means abnormal cells that are not yet cancer. If precancer is not detected and treated, it can sometimes develop into cervical cancer over time.
Two high-risk HPV types, HPV 16 and HPV 18, cause a large proportion of cervical cancers worldwide. This is why HPV vaccination and HPV-based screening have become so important.
| Key message HPV is common and is not a sign of shame. The goal is to find persistent high-risk HPV or abnormal cervical cells early, before cancer develops. |
What do women usually notice first?
Here is the difficult part: early cervical cell changes usually do not cause symptoms. A woman may feel well, have no pain, and still have changes that can only be detected by screening.
In daily practice, I often hear questions like these:
- “I have never had cervical screening. Should I start now?”
- “I had bleeding after sex. Could it be serious?”
- “My HPV test is positive. Does that mean I have cancer?”
- “My daughter is only nine. Why is HPV vaccination recommended so early?”
- “I received the HPV vaccine. Do I still need screening later?”
These are good questions. Let me answer them one by one.
When should you come for medical review?
Many gynaecological symptoms are caused by conditions that are not cancer, such as infection, cervical inflammation, hormonal changes, polyps, fibroids, or pregnancy-related causes. So please do not panic. But please also do not ignore symptoms that are unusual for you.
Please arrange a medical review if you notice:
- Vaginal bleeding after sex
- Bleeding between periods
- Any bleeding after menopause
- Periods that become much heavier or last longer than usual
- Watery, bloody, or unusual vaginal discharge, especially if it has a strong smell
- Pelvic pain, lower abdominal pain, lower back pain, or pain during sex
- An abnormal Pap test, HPV test, co-test, or biopsy result that needs follow-up
If bleeding is heavy, you feel faint or dizzy, you have severe pelvic pain or fever, or you are pregnant and bleeding, please seek urgent care the same day.
| Key message Symptoms do not automatically mean cancer. But unusual bleeding or discharge should be checked, especially bleeding after sex or after menopause. |
Pap test, HPV test, and co-testing: what is the difference?
Many women grew up hearing that a Pap smear was the main test for cervical cancer prevention. That was true for many years, and Pap testing has saved many lives.
Today, cervical screening has moved forward. International guidance like from the WHO (World Health Organization) places HPV DNA testing at the centre of screening where it is available. Why? Because HPV testing looks for the high-risk virus that can cause cervical cell changes, often before those changes are visible.
The Pap test, or modern liquid-based cytology such as ThinPrep, looks at cervical cells under a microscope. It checks whether the cells already show abnormal changes. The HPV test looks for high-risk HPV infection. In simple language:
- The HPV test asks: “Is the high-risk virus present?”
- The Pap or ThinPrep test asks: “Are the cervical cells already changing?”
- Co-testing combines both pieces of information in one screening pathway.
At Intercare, a combined cervical screening test is available as a routine service. In plain language, this means that during one gynaecology visit, the doctor can take a careful cervical sample and the laboratory can check for both high-risk HPV and cervical cell changes. This gives a more complete picture of your current risk and helps guide the safest follow-up plan.
| Key message Pap testing looks for abnormal cells. HPV testing looks for the virus that can cause those changes. Co-testing brings both views together. |
When should screening start, and how often is it needed?
Screening is for women who feel well and do not have symptoms. If you have symptoms, you should come for medical assessment regardless of your age or screening schedule.
Guidelines vary slightly between countries, but the practical message is consistent: regular screening prevents cervical cancer.
- For most women, WHO public-health guidance recommends cervical screening from age 30.
- Women living with HIV, or women with significant immune suppression, should start earlier, from around age 25, and usually need closer follow-up.
- Some international specialist guidelines, such as the American Cancer Society guideline, start routine screening at age 25. This is why individual advice matters.
- If HPV testing or co-testing is normal, a common interval is every 5 years. If Pap testing alone is used, a common interval is every 3 years.
- Screening may stop after age 65 only if previous screening has been regular and normal, and if there is no high-risk history.
What if you are 35, 45, or older and have never been screened? Please do not feel embarrassed. It is never too late to ask. We can help you start safely and explain each step before we do anything.
| Key message For many women, screening starts around age 30, or earlier in some guidelines and higher-risk groups. With a normal HPV-based test or co-test, repeat screening is commonly done every 5 years. |
Why is HPV vaccination recommended for nine-year-old girls?
This is one of the most important questions parents ask. The HPV vaccine works best before a person is exposed to HPV. That is why vaccination is recommended before the teenage years, not because we expect a child to be sexually active, but because prevention works best before risk begins.
The immune response to HPV vaccination is also very strong in young adolescents. WHO recommends HPV vaccination primarily for girls aged 9 to 14 years. In Cambodia, the Ministry of Health introduced one-dose HPV vaccination for nine-year-old girls into the national immunisation schedule in October 2023.
A helpful way to think about it is this: we vaccinate early for protection later. It is like teaching road safety before a child drives a car. It is prevention, not permission.
Does vaccination remove the need for screening later in life? No. HPV vaccination greatly reduces risk, but it does not remove all risk. Women should still follow cervical screening recommendations when they reach the recommended age.
| Key message HPV vaccination is recommended early because it works best before exposure to HPV. Vaccinated women still need cervical screening later in life. |
What happens during the screening visit at Intercare?
The medical part is usually simple and quick. First, we talk. I will ask about your age, last period, pregnancy possibility, symptoms, previous screening results, HPV vaccination, medical conditions and any concerns you have.
Then I explain the examination and ask for your consent. You may ask questions at any time. If you prefer a female staff member or chaperone to be present, please let us know.
For the sample, you lie on the examination couch. A small instrument called a speculum is gently inserted into the vagina so the cervix can be seen. A soft brush is then used to collect cells from the cervix. You may feel pressure or mild discomfort, but it should not be painful. The sample collection usually takes only a short time.
Afterwards, you can usually return to normal activity. Mild spotting can happen. If you have heavy bleeding, strong pain, fever, or feel unwell after the procedure, contact the clinic.
How do we interpret the results?
Results are not just “normal” or “cancer.” There are several possibilities, and most abnormal screening results are not cancer.
- HPV negative and cells normal: this is reassuring, and routine repeat screening is usually advised at the recommended interval.
- HPV positive but cells normal: this does not mean cancer. It means high-risk HPV is present and follow-up depends on the HPV type, your age, and your history.
- Abnormal cells: this means cell changes have been seen. The next step may be closer follow-up, colposcopy, or a biopsy.
- Suspicion of cancer: this requires urgent specialist assessment and tissue diagnosis by biopsy. Colposcopy is a closer examination of the cervix using magnification. If needed, a very small tissue sample can be taken. This helps us confirm whether changes are mild, more serious, or cancerous.
| Key message A positive HPV test or abnormal cell result is not the same as cancer. It is a signal that follow-up is needed. |
What treatment might be needed?
There is no medicine that simply “kills” HPV in the cervix. In many women, the immune system clears the infection naturally. The most important treatment is correct follow-up, because persistent HPV or abnormal cells need monitoring or treatment.
If precancerous changes are found, treatment can often remove or destroy the abnormal area before cancer develops. Depending on the case, this may include procedures such as thermal ablation, LEEP, or cone biopsy. Your doctor will explain the safest option in clear language before any decision is made.
If cervical cancer is suspected or confirmed, treatment depends on the stage and may include surgery, radiotherapy, chemotherapy, or a combination. Early diagnosis matters because treatment is usually more effective when disease is found early.
What can you do at home?
The most important home-care advice is simple: do not lose follow-up. If you receive an abnormal result, please come back as advised, even if you feel perfectly well.
You can also reduce your risk by:
- Choosing HPV vaccination for eligible girls and young women according to national and medical guidance
- Attending regular cervical screening at the recommended age and interval
- Using condoms, which reduce but do not completely remove HPV risk
- Avoiding smoking, because smoking increases the risk that HPV-related cell changes progress
- Seeking care early for unusual bleeding, discharge, or pelvic pain
Closing message from the doctor
Cervical cancer prevention should not be frightening. It should be empowering. HPV vaccination, HPV-based screening, Pap or ThinPrep cell testing, and careful follow-up give us a strong pathway to protect women’s health.
If you are unsure whether you need screening, if you have never been screened, or if you have received an abnormal result, please come and talk with us. We will explain what the result means, what it does not mean, and what the next safe step should be.
At Intercare, our aim is to provide care that is clinically sound, respectful, and centred on the person in front of us. You should feel informed, heard, and supported at every step.
