A Pap smear is an examination under the microscope of cells scraped from the tip of the cervix. The cervix is the lower part of the uterus (womb) that opens at the top of the vagina.

How the Test is Performed

The Pap smear is done as part of a gynecological exam. You will lie on a table and place your feet in stirrups to position your pelvis for examination. The health care provider will insert an instrument (speculum) into your vagina and open it slightly to see inside the vaginal canal.

The health care provider will take a sample of cells from the outside and just inside the opening of the cervix (cervical canal) by gently scraping the outside of the cervix with a wooden or plastic spatula, then inserting a small brush that looks like a pipe cleaner into the canal.

The cells are placed on a glass slide, or put in a bottle containing a preservative, and then sent to the lab for examination.

How to Prepare for the Test

Tell your health care provider if you:

• Are taking any medications or birth control pills
• Have had an abnormal Pap smear
• Might be pregnant

Within 24 hours of the test, avoid:

• Douching
• Having intercourse
• Taking a tub bath
• Using tampons

Avoid scheduling your Pap smear while you have your period (are menstruating), because blood and cells from the uterus may affect the accuracy of the Pap smear. Empty your bladder just before the test.

How the Test Will Feel

You may have some discomfort, similar to menstrual cramps, and a feeling of pressure during the procedure. You may bleed a little bit after the test.

Why the Test is Performed

The Pap smear can detect cancerous or precancerous conditions of the cervix. Most invasive cancers of the cervix can be detected early if women have Pap tests and pelvic examinations.

Screening should start within 3 years after first having vaginal intercourse or by age 21. After the first test:

• Woman should have a Pap smear ever 2 years to check for cervical cancer.
• If you are over age 30 or your Pap smears have been negative for 3 times in a row, your doctor may tell you that you only need a Pap smear every 3 years.
• If you or your sexual partner have other new partners, then you should have a Pap smear every 2 years.
• After age 65-70, most women can stop having Pap smears as long as they have had three negative tests within the past 10 years.
• If you have a new sexual partner after age 65, you should begin having Pap smear screening again.

Women who have had a total hysterectomy (uterus and cervix removed) and have not had any previous history of cervical dysplasia (abnormal cells), cervical cancer, or any other kind of pelvic cancer, may not need to have Pap smears.

Normal Results

A normal value is negative, meaning there are no abnormal cells present.

Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

What does an abnormal pap smear mean?

Being alarmed or worried is a completely normal reaction when told your Pap smear is abnormal. An abnormal Pap smear may indicate that you have an infection or abnormal cells called dysplasia. It’s important to remember that abnormal Pap smear results do not mean you have cancer. These results just show that further testing should be done to verify whether or not there is a problem.

What could cause an abnormal pap smear result?

An abnormal Pap smear may indicate any of the following:

• An infection or an inflammation
• Herpes
• Trichomoniasis
• Recent sexual activity
• HPV (Human Papilloma Virus) This is also called genital warts (up to 60% of women may carry this virus on their cervix, genital area, or skin and are completely unaware of it).
• Dysplasia (abnormal cells that can be pre-cancerous)

What is the treatment for an abnormal Pap smear?

A positive result indicates the presence of abnormal cells, also called an abnormal Pap. Remember that this is a test, not a diagnosis. A positive result does not prove that you have cancer or even dysplasia (a pre-cancerous condition). However, it usually means you should have further evaluation, such as another Pap smear, a colposcopy (using a microscope to look into the cervix) or a biopsy (removing a small amount of tissue from the cervix). Your doctor will discuss the results with you.

One in ten Pap smears indicate some abnormality, though most are not serious. Further testing will be required to determine if you have infection, inflammation, a yeast infection, trichomoniasis, herpes or the Human Papilloma Virus (HPV).

HPV is the main risk factor for cervical cancer, but most women who receive treatment for abnormal cells caused by HPV, do not develop cervical cancer.

In 2003, the FDA approved a screening test that can be done in conjunction with a Pap smear to determine if you have the HPV virus.The HPV DNA test can detect high risk types of HPV before any abnormal cells can be detected on the cervix. This screening is recommended for women over the age of 30, who are at an increased risk of an HPV infection turning into pre-cancerous cells.

Some Pap smears indicate an unsatisfactory sample because of recent sexual activity or use of vaginal creams and douches. Regardless of the reason, an abnormal Pap will require another Pap smear in a few months.

If the abnormal cells are persisting, you may need further treatment, which may include the following:

A colposcopy is an examination in which a speculum is inserted into the vagina, and the cervix is painted with a vinegar solution which makes any abnormal areas stand out. When an abnormal area is located, a sample (biopsy) of the area may be taken for accurate diagnosis by a pathologist.

Cryosurgery, or a freezing of the abnormal cells, is usually performed next. Cone biopsy is a procedure in which a triangle of cervical tissue is removed including the abnormal cells; this is either performed in a doctor’s office or as an outpatient procedure. Bleeding and watery discharge are common after this treatment.

The LEEP procedure is similar to a cone biopsy, but a loop-shaped instrument is used to remove the abnormal area. Bleeding and discharge may also occur.

What check-ups are necessary after treatment?

Check-ups following treatment are necessary to make sure all the abnormal cells are gone and the cervix has healed. Early detection is the key to minimize the risk of cancer developing. After treatment, women will be advised by their health care providers as to how often they will need to have routine Pap smears.

What if I have an abnormal pap smear during pregnancy?

It is safe to have a Pap smear during pregnancy. If your Pap smear results are abnormal, a colposcopy could be performed during your pregnancy. However, further treatment will probably be delayed until after your baby is born. Frequently, the birth of your baby will wash away any abnormal cervical cells. Having an abnormal Pap smear does not pose a risk to your baby.