Pap Smears: Everything You Need to Know

If you are a woman, there's a good chance that you will need to get a pap smear at some point in your life. Short for Papanicolaou smear, a pap smear is a simple cervical cancer screening test that helps your doctor detect abnormal cells on the cervix. In this article, we will answer all of your questions about pap smears and discuss what they are, why they are performed, and who needs them. We'll also talk about the preparation involved and how the test is performed and even explain how to interpret the results of your pap smear.

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If you are a woman, there’s a good chance that you will need to get a pap smear at some point in your life.

Short for Papanicolaou smear, a pap smear is a simple cervical cancer screening test that helps your doctor detect abnormal cells on the cervix.

In this article, we will answer all of your questions about pap smears and discuss what they are, why they are performed, and who needs them.

We’ll also talk about the preparation involved and how the test is performed and even explain how to interpret the results of your pap smear.

What is a pap smear?

A pap smear, also referred to as a pap test, is a screening test used to detect changes in the cervical cells which can be a sign of cervical cancer.

The cervix is the lower, narrow end of the uterus that opens into the vagina and there will be an estimated 14,100 new cases of cervical cancer detected this year alone according to the American Cancer Society.

It used to be a leading cause of cancer in women; however, the earlier you detect cervical cancer the higher your chances are of beating it.

The cervical cancer rate has dropped precipitously due to women receiving more regular screenings in the United States.

pap smear image

Why do doctors perform a pap smear?

A pap smear can help to detect early signs of cervical cancer, as well as other conditions that may cause changes in the cells of your cervix.

These precancerous cells and cancerous cells usually do not cause any symptoms, which is why pap smears are important in the early detection and treatment of cervical cancer.

The test is usually performed during your routine gynecological exam with your doctor by collecting a sample of cells from your cervix using a small brush or swab.

The cervical cells sample is then sent to a laboratory where it is examined for any abnormal cells.

Who needs to get a pap smear?

Most women ages 25 to 65 need to have a pap smear as part of their routine gynecological care.

The test needs to be performed every five years together with human papillomavirus (HPV) screening or every three years with just a pap smear.

The human papillomavirus is a sexually transmitted infection (STI) that can cause genital warts and changes in the cells of your cervix and is thought to be responsible for most cervical cancers.

If you are over the age of 65 or had a total hysterectomy, you may no longer need pap smears if you have had regular screenings and have had normal results for 10 years.

Recent sexual activity does not factor into whether you get a pap smear as the human papillomavirus can lie dormant in your body for years.

If you have had the human papillomavirus vaccine, screening is still necessary according to the same standards as those without it.

Your doctor may recommend more or less frequent screenings based on your individual health history and risk factors.

Other risk factors that may cause your doctor to screen you more frequently include:

  • Medical history of precancerous changes in the cells of your cervix
  • Medical history of cervical cancer
  • Being diagnosed with the human immunodeficiency virus (HIV)
  • Weakened immune system due to a previous history of chemotherapy, organ transplant, or chronic corticosteroid use
  • Exposure to diethylstilbestrol (DES), a synthetic estrogen used from 1940 to 1971 to prevent pregnancy complications, before you were born
  • Smoking

Do I need to prepare for a pap smear?

Before arriving for your pap smear, avoid sexual activity, douching, spermicides, or using vaginal sprays, powders, and lubricants for a day before your pap smear as these products can influence test results.

If you are menstruating, reschedule your pap smear for another time as menstrual blood can also affect test results.

How is the pap smear test performed?

During the pap smear, you will be asked to remove your clothing from the waist down and lie on your back on an examination table with your feet in stirrups.

Your doctor will likely also perform a pelvic exam in conjunction with your pap smear since it also takes place on the same exam table.

Your doctor or nurse will then insert a speculum, a tool used to open your vagina so that they can see your cervix.

They will then use a small brush or spatula, and sometimes both, to collect cells from your cervix which will be sent to the laboratory for testing.

The entire pap smear procedure usually takes less than five minutes.

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You may feel some slight discomfort during the pap smear as the speculum is inserted into your vagina and when the brush or spatula is used to collect cells from your cervix.

Some women also feel a sense of pressure in their lower abdomen or pelvic region.

If you experience any pain during the pap smear, let your doctor or nurse know so that they can stop the procedure.

After the pap smear, you may experience some light bleeding or spotting for a day after your test, but inform your doctor if it lasts longer.

You can use a sanitary pad but avoid using tampons, douching, or having sexual intercourse until the vaginal bleeding has stopped.

How do I interpret the results of a pap smear?

It can take anywhere from a few days to three weeks for your results to come back from the laboratory.

Your pap smear results will be reported as either normal or abnormal, which will indicate your cervical cancer risk.

Normal result

A normal pap smear result means that the cells collected from your cervix during the pap smear appear to be healthy and there are no signs of cancer or precancerous changes.

Abnormal result

An abnormal pap smear result means that the cells collected from your cervix during the pap smear appear to be abnormal.

If you have an abnormal result, it doesn’t necessarily mean that you have cancer, but it may be a sign of precancerous changes in the cells of your cervix.

Precancerous changes in the cells of your cervix are usually caused by HPV. There are varying degrees of abnormal cells which include:

  • Atypical squamous cells of undetermined significance (ASCUS) which means these cells appear abnormal, but without any virus present they are not of much concern
  • Atypical glandular cells are another type of cell that produces mucus in your cervix and this result may mean nothing but additional testing may be needed
  • Mild dysplasia, also called low-grade squamous intraepithelial lesions, means there are some mild changes to your cells but they may disappear on their own and the cells turning cancerous are likely years away
  • Moderate dysplasia or severe dysplasia, also called high-grade squamous intraepithelial lesions or high-grade dysplasia, these cells are precancerous lesions and could turn cancerous and follow-up tests are needed
  • Squamous cell carcinoma or adenocarcinoma cells, also called adenocarcinoma in situ, are two types of cancers and this result means your doctor has convincing evidence your cells are cancerous and your doctor will evaluate your situation

If you have an abnormal pap smear, your doctor will likely recommend follow-up testing, which may include:

  • Another pap smear for more cell samples
  • HPV test
  • Colposcopy, which is another test with a lighted instrument so your doctor can get a closer look at your cervix
  • Biopsy, which is when your doctor takes more tissue samples for a closer examination which will be sent to a lab for testing under a microscope for signs of precancerous or cancerous cells

Please note that it is also possible for a pap smear to return a “false negative” meaning it misses any abnormal cells in your cervix although the test is considered very accurate.

Can pap smears detect sexually transmitted infections (STIs)?

As noted above, pap smears can sometimes test for human papillomavirus but not any other sexually transmitted infections.

However, if you have symptoms of another STI or are at risk for an STI, your doctor may also recommend that you get tested for other STIs.

Are there any risks involved with a pap smear?

Pap smears are generally considered to be safe with very few risks.

The most common risk is a false negative which we detailed above.

Summary

A pap smear is a test that is used to find precancerous and cancerous cells in your cervix.

The test is performed by your doctor or nurse using a speculum to open your vagina and a soft brush or spatula to collect cells from your cervix with the results taking anywhere from three days to three weeks.

Your results will either be normal or abnormal; however, abnormal results do not necessarily mean you have cancer.

The pap smear test is considered to be very accurate but there is a rare possibility for the test to miss abnormal cells.

Pap smears can also sometimes test for human papillomavirus but not any other sexually transmitted infections.

If you have any concerns or questions about pap smears, be sure to talk to your doctor or health care provider.

References and Sources:

American Cancer Society

The American College of Obstetricians and Gynecologists

NIH

JAMA

OASH

Mayo Clinic

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