Pap Smear
Also known as: Pap Test
What is it?
The Pap smear is named for Dr.
George N. Papanicolaou, who developed it.
This procedure is usually performed during an
annual gynecological exam to check for any changes
in the cells of the cervix. The
cervix is the lower part of the uterus that opens
into the vagina. By analyzing the cervical
cells on a regular basis, doctors can detect
cervical cancer in its early stages, which
increases the chances of successful treatment.
Regular Pap tests can also detect precancerous
changes in the cervix, vaginitis, infections, and
some sexually transmitted diseases. In some
cases, a Pap smear can reveal cancers of the
uterus and ovaries.
Who needs this procedure?
It is recommended that all women who are sexually
active, or age 18 and older, have a Pap smear
performed each year. A regular Pap smear is
especially important for women who are at risk for
cervical cancer. You are at a greater risk
for cervical cancer if you have had an abnormal
Pap smear in the past; have had vulvar or vaginal
cancer; or if your mother took the hormone
diethylstilbestrol (DES) during her pregnancy.
Your sexual habits can also increase your risk of
cervical cancer. For example, you are at
higher risk if you were sexually active at a very
young age; have had many sexual partners; have a
sexual relationship with someone who has had
cancer of the penis; have a sexual relationship
with someone whose previous partner had cervical
cancer or cervical cells that were precancerous;
or if you or your sexual partner has had a
sexually transmitted disease such as genital
herpes or warts. Increased risk of cervical
cancer is also associated with cigarette smoking,
and having a weak immune system due to AIDS or
taking immunosuppressive drugs after an organ
transplant. Your doctor may not feel annual Pap
smears are necessary if you are older than 65 and
have had a history of normal Pap smears.
However, you should still have an annual
gynecological exam. Having had a
hysterectomy does not mean you no longer need a
Pap smear. In some cases, the cervix is not
removed during this procedure. If you are
pregnant, your doctor will perform a Pap smear
during your first prenatal examination.
Conditions detected by a Pap smear can affect your
unborn child.
How do I prepare for this procedure?
A Pap smear will be more accurate if you do not
douche or use any type of vaginal medications
within 48 hours of the test. Having sexual
intercourse within 24 hours of the Pap smear can
also cause inaccurate test results. The best
time to have a Pap smear is around the middle of
your menstrual cycle. The test cannot be
done while you have your period. It's also a
good idea to empty your bladder right before the
test. This will not affect the results, but will
cause less discomfort for you.
How is this procedure performed?
Before performing the Pap smear, your gynecologist
will ask you about your medical history,
specifically related to your reproductive health.
If he or she does not have a record of previous
Pap smears, the doctor may ask you about the date
and result of your last test. It's also
important that your doctor is aware of any
problems with your menstrual periods; any
medications you are taking, especially birth
control pills or hormones; any family history of
cervical or other gynecological problems; or any
abnormal symptoms you've been experiencing.
The Pap smear is a very quick procedure. You
will lie on your back with your knees bent and
your feet apart. You may feel some pressure
as the doctor inserts a lubricated instrument
called a speculum into your vagina. The speculum
holds open the walls of the vagina so your doctor
can examine the inside of the vagina and the
cervix. Your doctor then uses a special swab
to scrape some cells from the surface and the
inside of the cervix. These cells are then smeared
onto glass slides, sprayed with a preservative to
protect the cells, and then sent to a laboratory
for examination under a microscope.
What can I expect after the procedure?
You will be notified, usually by mail, of the
results of your Pap smear. The results will
be either normal or abnormal. If the test
results are normal, you should still be sure to
schedule another Pap smear and routine
gynecological exam for the following year. If the
test reveals abnormal cells, the results are then
classified according to the types of cells that
were found. Abnormal changes in cells is
called dysplasia. If your test results show
minimal cervical dysplasia, this means the changes
are in the early stages and are not yet cancerous.
This type of result might also be called low grade
squamous intraepithelial lesion (SIL).
Squamous cells are flat cells located in the
outermost, or epithelial, layer of the cervix.
Low grade SIL can be caused by the sexually
transmitted human papillomavirus (HPV), and can
eventually cause cancer. If your test
results show high grade SIL, this means there is
moderate to severe dysplasia. These are more
advanced changes in the cervical cells, but are
still not cancerous. Carcinoma in situ,
however, is cancer in the outermost layer of the
cervix, and is also considered a high grade SIL.
If test results show invasive cancer, the cancer
has spread beyond the outermost layer of the
cervix and may affect other organs. Another
rating system for Pap smear results is called
cervical intraepithelial neoplasia (CIN).
Neoplasia is a term used to describe the abnormal
growth of cells that can lead to a tumor, or
neoplasm. Mild dysplasia would be called CIN
I, moderate dysplasia is CIN II, and severe
dysplasia or carcinoma in situ is CIN III.
Self-care tips
Like many tests, the Pap smear is not 100%
accurate, so it is important to see your doctor
immediately about any abnormal results.
Further testing may reveal a non-cancerous cause,
or even a false result. The Pap smear is
still, however, the best test for cervical cancer.
Many gynecologists send reminder cards to their
patients to schedule their yearly checkups.
If your doctor does not, mark the date on your
calendar each year so you don't forget.
Early detection and treatment increase your
chances of a complete cure.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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