Pap Test (Cervical Smear)

What is a Pap test?

A Pap test is a screening test done during a pelvic exam to check for abnormal changes in the cells of the cervix. The cervix is the lower part of the uterus that opens into the vagina. Abnormal cells can develop into cancer if not detected and treated. There are no signs or symptoms related to early cervical cancer so a pelvic exam of the female sex organs and a Pap test are needed. Cervical cancer is preventable and curable if abnormal cells are detected and treated early. Pap tests have reduced deaths from cancer of the cervix in the US by 70% over the past 50 years. The Pap test does not detect problems or cancer in other female organs.

Other terms for Pap test are Papanicolaou smear, Pap smear, and cervical smear.

What does it test for?

The Pap test checks for abnormal cells on the cervix. Cervical intraepithelial neoplasia (CIN), a precancerous change in the cells, can be detected by a Pap test. Some abnormal cells may develop into cervical cancer if CIN is not caught early and treated. The Pap test can also find cancer early.

The Pap test may detect viral infections of the cervix, such as human papillomavirus (HPV) and herpes. It may detect vaginal infections such as yeast infections, bacterial vaginosis, or trichomonas. Sometimes the Pap test can give information about your hormones, especially progesterone and estrogen.

How often should I have a Pap test?

You should have your first Pap test about 3 years after you first become sexually active but no later than age 21. You should have a Pap test every year until you are at least 30 years old. If you have had 3 negative Pap tests by 30 years of age and do not have certain risks, then you may have a Pap test every 2 to 3 years. Your provider will recommend how often you should be tested based on previous Pap test results and your risk factors for cervical cancer. Some examples of risk factors are:

• You have had an abnormal Pap test.
• You have a family history of cervical cancer.
• You or your sexual partner have had an HPV infection or genital warts.
• You or your sexual partner have a history of many sexual partners.
• You smoke.
• Your immune system is not working well because of cancer treatment (chemotherapy), immune-suppressing drugs (for transplants or autoimmune diseases), or an immune-suppressing infection, such as HIV.
• You have had a sexually transmitted disease.

If you are age 65 or older, talk with your healthcare provider about whether you still need to get Pap tests. You and your provider can decide what testing schedule is right for you based on your past test results. However, an annual physical exam continues to be important for other health reasons, including early detection of possible breast cancer, other cancers, and other illnesses or problems.

If you have had a hysterectomy, but did not have problems with the cervix, you may not need to have Pap tests. If you had a hysterectomy with CIN 2 or CIN 3, you will need to continue having Pap tests as recommended by your healthcare provider.

How do I prepare for a Pap test?

• Do not schedule your Pap test during your menstrual period. The best time to schedule the test is 10 to 20 days after the start of your last period.
• Do not douche for at least 2 days before the test.
• Do not use any creams or medicine in your vagina for at least 2 days before the test unless your healthcare provider tells you to do so.
• Do not have intercourse for 1 or 2 days before the Pap test because it can cause unclear results.

What happens during the procedure?

A Pap test is not painful, takes only a few seconds, and is performed as part of a routine pelvic exam. You lie on your back with your knees bent and your feet apart. Your healthcare provider inserts a speculum into the vagina. The speculum is a tool that holds open the walls of the vagina so your provider can see the cervix. Your provider uses a small, soft brush and a small, plastic spatula to take a few cells from the cervix. The cells are sent to a lab for testing.

What happens after the procedure?

If the cells look normal, no treatment is necessary.

The Pap test may show that you have an infection. Your healthcare provider may treat you for the infection and suggest that you have another Pap test in several months.

If the cells look abnormal, you may need more tests. Discuss with your provider when you should return for any tests or a follow-up exam.

A Pap test is not 100% accurate. You may want to talk to your healthcare provider about the results. There are newer methods used now for Pap testing, including computer-assisted testing, which have been approved by the FDA and are more accurate. Most healthcare providers use these newer tests.

Ask your healthcare provider when you should come back for another Pap test or pelvic exam.

What are the benefits of this procedure?

Pap tests can detect precancerous and cancerous conditions. If these conditions are discovered, there is a good chance that simple treatment will prevent the development or spread of cancer. Pap tests are also useful for detecting some types of cervical or vaginal infections and hormonal problems.

What are the risks or disadvantages?

The Pap smear is a screening test. If abnormal cells are found, your healthcare provider will do more tests to make a diagnosis. Also, sometimes the results may be inaccurate (false positive or false negative) and you may need more tests to check the results.