Pap Smear Test
Overview
A Pap smear test is a simple medical procedure that checks for changes in cells on the cervix, which can show signs of cervical cancer or early cell changes before cancer develops. During this test, a healthcare provider collects a small sample of cells from the cervix and examines them under a microscope, making it an important tool for women’s health.
Also called a Pap test, it plays a key role in finding and preventing cervical cancer and helps guide future care. Many people feel nervous about getting a Pap smear, but the process is usually quick and doesn’t hurt. Knowing what to expect during the procedure can help ease worries and make the experience smoother.
Purpose of the Pap Smear Test
The main purpose of the Pap smear is to screen for cervical cancer and detect abnormal cell changes in the cervix before they turn into cancer. Cervical cancer often develops slowly, and early changes can be found by testing a small sample of cervical cells.
People with a cervix, usually starting at age 21, should have regular Pap smears. The test can also find signs of other infections or issues, but its main focus is catching abnormal and precancerous cells. If a provider finds something unusual, they may order more tests, such as a colposcopy or repeat Pap smears.
Differences Between Pap Smear and HPV Test
The Pap smear and HPV test both play roles in cervical cancer screening, but they are not the same. A Pap smear examines cervical cells under a microscope to find any that are abnormal or precancerous.
The HPV test checks for the presence of high-risk human papillomavirus (HPV) types, which can cause cervical cancer. Sometimes providers perform both tests together as “co-testing,” which can improve the chances of finding early problems.
| Feature | Pap Smear | HPV Test |
|---|---|---|
| What is checked? | Cell changes | HPV virus |
| How is it done? | Cell sample | Same cell sample |
| Main use | Find abnormal cells | Detect cancer-causing HPV |
Who Should Get a Pap Smear
Pap smears are a common test for checking cell changes in the cervix that could lead to cervical cancer. Healthcare providers determine who should get this test based on age, risk factors, past surgeries, and screening history.
Age Recommendations
Healthcare providers recommend Pap smears for most women ages 21 to 65. Testing usually begins at age 21, even if the person is not sexually active. Women between ages 21 and 29 should have a Pap smear every three years.
From age 30 to 65, women can choose between a Pap smear every three years, a high-risk HPV test every five years, or both tests together every five years. After age 65, most women who have had regular, normal screening results may stop testing, but should discuss this with a healthcare provider.
Risk Factors for Cervical Cancer
Certain risk factors can affect who should get Pap smears and how often they need them. People with the following risk factors may need more frequent testing:
- Having a weakened immune system, such as from HIV infection, organ transplants, or using medicines that lower immunity
- A history of cervical cancer or serious cervical cell changes
- Exposure to a medicine called DES before birth
- Having multiple sexual partners
- Smoking tobacco
A healthcare provider may recommend a special screening plan for anyone with these risk factors.
Special Considerations After Hysterectomy
Not all people need Pap smears after a hysterectomy, which is a surgery to remove the uterus. The type of hysterectomy matters.
- If someone has had a total hysterectomy (removal of the uterus and cervix) for non-cancer reasons, Pap smears are usually not needed.
- If the cervix was not removed, or if the surgery was done because of cervical cancer or serious cell changes, screening may still be needed.
It’s best to talk to a healthcare provider to decide what is right in each situation. Those who have had a partial hysterectomy still need regular screening.
Screening Frequency
How often a person should get a Pap smear depends on age, health history, and certain risk factors. Most people ages 21–29 should get tested every three years. From ages 30–65, options include a Pap smear every three years, a high-risk HPV test every five years, or both tests together every five years.
More frequent testing may be needed for those with immune system problems, a history of cervical cancer, HIV, or abnormal test results. People should always follow the advice of their healthcare provider, who will make recommendations based on individual needs.
Preparation for the Pap Smear Procedure
Getting ready for a Pap smear helps make the screening test as accurate as possible. People should follow a few simple steps before the procedure:
- Do not have vaginal sex for 2 days before the test.
- Avoid douching, and vaginal creams or medicines.
- Do not use tampons or spermicidal products.
- Try to avoid the test during your period.
Waiting until at least 5 days after the end of menstrual bleeding helps improve test accuracy. A Pap smear does not replace a full pelvic exam, but both may be done in the same visit. This allows the healthcare provider to check overall reproductive health. If patients have any questions, they should contact their healthcare provider.
Pap Smear Test Procedure Step-by-Step
Doctors perform Pap smears in an office or clinic using specific tools to reach the cervix, collect cells, and send those cells for testing.
During the Exam
The person lies on an exam table, usually with feet placed in footrests called stirrups. A sheet or gown provides privacy. The healthcare provider explains the steps and checks that the person is comfortable. Next, the provider asks the person to relax their knees apart so the cervix is easier to see.
The exam room remains private, and only necessary staff are present. This part of the procedure usually takes a few minutes. It is normal to feel a bit of pressure, but the Pap smear should not be painful. If discomfort happens, the person should let the provider know right away.
Role of the Speculum and Cytobrush
The provider gently inserts a speculum to open the vagina and see the cervix. The specimen can be plastic or metal. Before using the speculum, the provider may warm it to reduce discomfort. Once the speculum is in place, the provider uses a small brush called a cytobrush or a spatula.
The cytobrush is shaped like a tiny bottle brush and gently collects cells from the surface of the cervix and sometimes from the endocervical canal. Providers avoid using too much lubricant with the speculum, as this can affect the quality of the cell sample. The provider slowly removes the speculum after collecting the sample.
Collecting Cervical Cells
The healthcare provider carefully swabs the cervix and endocervical canal to collect cervical tissue cells. The provider may rotate the cytobrush or spatula to make sure enough cells are gathered from the squamo-columnar junction, an important area where cervical changes can start.
After collection, the provider places the sample either on a glass slide or into a special liquid container and labels it with the patient’s information for accuracy. The provider then sends the collected cervical cells to a lab for examination. The goal is to check for abnormal or precancerous changes. The entire collection process is quick and should not take more than a few minutes.
Results
A Pap smear looks at cells from the cervix under a microscope. The results usually fall into one of three main categories: normal, abnormal, or unsatisfactory.
- Normal Result: A normal result means no signs of abnormal or cancerous cells were found. It may be called negative for intraepithelial lesion or malignancy.
- Abnormal Result: An abnormal Pap smear does not always mean cancer. It means there are changes in the cervical cells that may need closer follow-up. The doctor will explain what the changes mean and what steps to take next.
- Unsatisfactory Result: Not enough cells were collected or the sample wasn’t clear enough to interpret.
Pap smear results are most often described by the Bethesda System:
| Term | What It Means |
|---|---|
| ASC-US | Atypical squamous cells of undetermined significance |
| ASC-H | Atypical squamous cells, cannot rule out high-grade |
| LSIL | Low-grade squamous intraepithelial lesion |
| HSIL | High-grade squamous intraepithelial lesion |
| AGC | Atypical glandular cells |
If results show ASC-US or AGC, more tests may be needed.
What Happens After an Abnormal Pap Smear?
When a Pap smear shows abnormal results, some of the cells collected from the cervix do not look normal under a microscope. These changes can range from mild dysplasia to more serious problems like pre-cancer or even cancerous cells.
Most abnormal Pap tests do not mean there is cancer. Instead, they often show atypical squamous cells or signs of cervical intraepithelial neoplasia (CIN), also known as cervical dysplasia. These are changes that may need more monitoring or treatment.
Next Steps
- Repeating the Pap smear in a few months
- Testing for high-risk HPV
- Scheduling a colposcopy to view the cervix more closely
- Taking a biopsy if abnormal tissue is seen
| Finding | Possible Next Step |
|---|---|
| Low-grade changes | Repeat test or HPV test |
| High-grade changes | Colposcopy and biopsy |
| Severe changes or cancer | More testing or treatment |
Pap Smear Tests and Sexually Transmitted Infections
A Pap smear is a common test for cervical health. It can sometimes show cell changes caused by infections, but it is not meant to diagnose all types of sexually transmitted infections (STIs).
Detecting STIs During Pap Smear
Pap smears mainly check for abnormal cervical cell changes, often linked to HPV. While they may reveal signs of inflammation or infections like bacterial vaginosis, they do not screen for most STIs.
Chlamydia, HIV, and Other Infections
A Pap smear does not directly check for chlamydia, HIV, gonorrhea, or similar infections. These require specific swabs or blood tests. Doctors may recommend additional testing for people with symptoms or risk factors.
Limitations and Considerations
False-Negative Result Risks
A Pap smear can sometimes miss abnormal cells—this is called a false-negative result. Causes include poor sample quality or lab issues. This is why regular screening is important. The false-negative rate ranges from 20% to 70%, depending on factors like technique and lab quality. Good sample collection helps reduce this risk.
Understanding Cancer Screening Limitations
Pap smears are essential for detecting cervical cancer early, but no screening test is perfect. Some cancers or precancerous changes may be missed. Occasionally, the test finds changes that would never cause harm, leading to unnecessary treatment. HPV testing, alone or with Pap smears, offers another screening option. People should work with their provider to decide which plan suits them best.
