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Definition

What is a Pap smear?

A Pap smear is a test that is done to look for changes in cervical cells that can indicate the presence of cervical cancer or cervical cancer. During a Pap test, a small sample of cells on the surface of the cervix is collected by your doctor. The sample is then either spread on a slide (Pap smear) or mixed in a liquid fixative (liquid-based cytology) and sent to a laboratory for examination under a microscope. Cells are checked for abnormalities that may indicate abnormal cell changes, such as dysplasia or cervical cancer.

When should I have a Pap smear?

Pap smear is used for early detection of cervical cancer. Pap smears are usually done at the same time as a pelvic exam. All women are advised to have a Pap test at the age of 21. This Pap test is done to detect early cervical cancer. Women 21-29 years of age are encouraged to have a Pap test every 3 years without testing Human papillomavirus (HPV)

Women aged 30-65 years are recommended to have a Pap test combined with an HPV test every 5 years. If the HPV test is not done, just do a pap test every 3 years. Talk to your doctor about a pap test schedule that is appropriate for your condition.

If you have certain risk factors, your doctor may recommend a Pap smear more often, regardless of your age. These risk factors include:

diagnosis of cervical cancer or Pap smear which shows precancerous cells
Diethylstilbestrol (DES) exposure before birth
HIV infection
weakening of the immune system due to organ transplantation, chemotherapy, or chronic corticosteroid use

You and your doctor can discuss the benefits and risks of a Pap smear and decide what is best for you based on your risk factors.

Precautions & warnings

What should I know before having a Pap smear?

A normal Pap smear test result does not completely rule out the presence of abnormal cells (dysplasia) or cervical cancer. Tests may fail to find the presence of abnormal cells (false negatives). Having 3 normal Pap tests in a row reduces the chance of a false negative result. Or the test can show the absence of abnormal cells (false positives). However, the Pap test has a fairly good accuracy for early detection purposes. Talk to your doctor about what your Pap test results mean.

Some women with an abnormal Pap test or women who are older than age 30 may be tested for human Papillomavirus (HPV), a sexually transmitted infection that causes genital warts. Several types of high-risk HPV can cause cervical cancer. The HPV test may be done at the same time as the Pap test. The results of the HPV test can help the doctor decide whether further tests or specific treatments are needed.

Pap smears alone cannot be used to diagnose dysplasia or cervical cancer. Other tests are needed, such as a colposcopy.

The Pap test is not used to detect sexually transmitted infections or cancers other than cervical cancer. If a sexual infection is suspected, other special tests may be needed to confirm the diagnosis.

A vaginal self-examination (VSE) can help you better understand your body, find out what is normal for you, and spot early signs of infection or other abnormal conditions that may mean you should see a doctor. VSE should be used in conjunction with (but not replace) routine pelvic exams and Pap tests performed by doctors.

Process

What should I do before having a Pap smear?

To make sure that your Pap smear is the most effective, follow these tips before your test:

avoid sexual intercourse, douching (using vaginal cleansing) or using vaginal medicines or spermicides for two days before having the Pap smear, as these can wash away or cloud the abnormal cells
try not to schedule Pap smears during your menstrual period. Although the test can be done, it is best to avoid it while you are menstruating

How is the Pap smear process?

The Pap test is a simple and quick procedure that is performed by a doctor, Pap test nurse, or gynecologist. During the test, the doctor or nurse gently inserts an instrument called a speculum into the vagina, so they can clearly see the cervix. They then insert a small spatula or small brush to collect cells from the cervix. They smear these cells onto a glass slide and send them to a laboratory for analysis. Results are usually available within a week.

What should I do after having a Pap smear?

The Pap smear can be uncomfortable, but it doesn't always hurt. If you feel sick, tell your doctor, nurse or obstetrician immediately. Occasionally, the laboratory will report that the sample is unsatisfactory and another Pap test will need to be taken. This doesn't mean your original Pap test shows abnormalities. Perhaps too few cells have been collected, or the cells may have been hidden by blood or mucus.

Explanation of the Test Results

What do my test results mean?

Results are usually available within 1 to 2 weeks. Ask your doctor when you can find out the results immediately.

Normal

The sample contains sufficient cells and no abnormal cells are found.

Abnormal

The sample does not contain enough cells, or abnormal cells are found. Most often there are minor problems with the cervix. If the Pap test results are not clear or show small changes in cervical cells, your doctor can repeat the Pap test immediately, in 6 months, or one year, or he can run the test again.

Some abnormal cells can turn into cancer. Treating abnormal cells that do not go away on their own can prevent almost all cases of cervical cancer. If you have abnormal results, talk to your doctor about what they mean. Your doctor should answer any questions you have and explain anything you don't understand. Treatment for abnormal cells is often done in the doctor's office during routine visits.

If more serious changes are found in the cells of the cervix, the doctor may recommend retesting. The results of these tests will help your doctor determine the best treatment.

Pap tests aren't always perfect. False positive and false negative results can occur. This can be distracting and confusing.

False positives

A false positive Pap test occurs when a woman is said to have cervical cells that are abnormal, but they mean cells that are not completely normal, and not cancer cells. If your doctor says your Pap result is a false positive, this means there is no problem.

False negatives

A false negative Pap test is when a woman is said to have normal cells, but there is actually a problem with missed cervical cells. False negative results delay the discovery and treatment of healthy cells from the cervix. But having regular Pap smears increases your chances of finding a problem. Cervical cancer usually takes years to develop. If these abnormal cells are missed at one time, they may be found on your next Pap test.