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Pap smear

Definition

The Pap smear is a screening test for cervical cancer. Cells scraped from the opening of the cervix are examined under a microscope. The cervix is the lower part of the uterus (womb) that opens at the top of the vagina.

Alternative Names

Papanicolaou test

How the test is performed

You lie on a table and place your feet in stirrups. The doctor or nurse gently places an instrument called a speculum into the vagina to open it slightly. This allows the doctor or nurse to see inside the vagina and cervix.

Cells are gently scraped from the cervix area. The sample of cells is sent to a lab for examination.

How to prepare for the test

Tell your doctor or nurse about all the medicines you are taking. Some birth control pills that contain estrogen or progestin may interfere with test results.

Also tell your doctor or nurse if you:

  • Have had an abnormal Pap smear
  • Might be pregnant

Do not do the following for 24 hours before the test:

  • Douche (douching should never be done)
  • Have intercourse
  • Take a bath
  • Use tampons

Avoid scheduling your Pap smear while you have your period (are menstruating). Blood may make the Pap smear results less accurate. If you are having unexpected bleeding, do not cancel your exam. Your doctor will determine if the Pap smear can still be done.

Empty your bladder just before the test.

How the test will feel

A Pap smear may cause some discomfort, similar to menstrual cramps. You may also feel some pressure during the exam.

You may bleed a little bit after the test.

Why the test is performed

The Pap smear is a screening test for cervical cancer. Most cervical cancers can be detected early if a woman has routine Pap smears.

Screening should start at age 21. After the first test:

  • You should have a Pap smear ever 3 years to check for cervical cancer.
  • If you are over age 30 and you also have HPV testing done and both the Pap smear and HPV test are normal, you can be tested every 5 years. (HPV is the human papillomavirus, the virus that causes genital warts and cervical cancer.)

After age 65 to 70: Most women can stop having Pap smears as long as they have had three negative tests within the past 10 years.

You may not need to have a Pap smear if you have had a total hysterectomy (uterus and cervix removed) and have not had an abnormal Pap smear, cervical cancer, or other pelvic cancer. Discuss this with your doctor.

Normal Values

A normal result means there are no abnormal cells present.

Talk to your doctor about the meaning of your specific test results.

What abnormal results mean

Abnormal results are grouped as follows:

ASCUS or AGUS

  • This result means there are atypical cells of uncertain significance
  • The changes may be due to HPV
  • They may also mean there are changes that may lead to cancer

LSIL (low-grade dysplasia) or HSIL (high-grade dysplasia):

  • This means precancerous changes are likely to be present
  • The risk of cervical cancer is greater with HSIL

Carcinoma in situ (CIS):

  • This result usually means the abnormal changes are likely to lead to cervical cancer

Atypical squamous cells (ASC):

  • Abnormal changes have been found and may be HSIL

Atypical glandular cells (AGC):

  • Cell changes that may lead to cancer are seen in the upper part of the cervical canal or inside the uterus

When a Pap smear shows abnormal changes, further testing or follow-up is needed. The next step depends on the results of the Pap smear, your previous history of Pap smears, and risk factors you may have for cervical cancer.

Follow-up testing may include:

For minor cell changes, doctors usually recommend having another Pap smear in 6 to 12 months.

Special considerations

The Pap smear test is not 100% accurate. Cervical cancer may be missed in a small number of cases. Most of the time, cervical cancer develops very slowly and follow-up Pap smears should identify changes in time for treatment.

References

American College of Obstetricians and Gynecologists. Practice Bulletin No. 99: Management of abnormal cervical cytology and histology. Obstet Gynecol. 2008;112:1419-1444.

American College of Obstetricians and Gynecologists. Practice Bulletin No. 109: Cervical cytology screening.Obstet Gynecol. 2009;114:1409-1420.

American College of Obstetricians and Gynecologists. Committee Opinion No. 463: Cervical cancer in adolescents: screening, evaluation, and management. Obstet Gynecol. 2010;116:469-472.

Noller KL. Intraepithelial neoplasia of the lower genital tract (cervix, vulva): etiology, screening, diagnostic techniques, management. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 28. 

Saslow D, Solomon D, Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin. 2012;62(3):147-72.


Review Date: 2/8/2013
Reviewed By: Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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