Pap Test (Pap Smear)
What is a Pap test (Pap smear)?
A Pap test, also known as a Pap smear, is a routine cervical cancer screening test. ‘Pap’ refers to its namesake inventor, Dr. Georgios Papanicolaou. A person may have a Pap test at a gynecological well-woman visit or at a visit to a primary care doctor. Its purpose is to screen for cervical cancer or any abnormal cells in the cervix, which could lead to cancer later on. The cervix is the lower part of the uterus, at the top of the vagina.
How often you need a Pap test depends mostly on your age. Females between the ages of 21 and 65 need regular Pap tests, though they may not need the test every year. Females in their 20s get a Pap test once every three years. People aged 30 or older may get a Pap test every three years or, instead, get a human papillomavirus (HPV) test every five years.
Some healthcare providers recommend getting both tests every five years. Younger people usually don’t need an HPV test because, if they have the virus, the infection will often clear up on its own. Certain kinds of HPV are known to cause cervical cancer, which is why an HPV test is helpful in screening for precancerous cells.
Females older than 65 typically no longer need Pap tests if their two most recent tests were negative and the last test was performed within the past five years. People who have had a total hysterectomy and no longer have a cervix also don’t need Pap tests.
If you get a Pap smear with an abnormal result, your doctor may recommend getting Pap or HPV tests more frequently. Other people who might need more frequent Pap tests include females with HIV or weakened immune systems.
If your mother took a medicine called diethylstilbestrol (DES) during pregnancy, you may have an increased risk of cervical cancer and should get more frequent Pap tests. Your doctor can discuss any risk factors that may indicate you need more frequent testing.
Why is a Pap test (Pap smear) performed?
Healthcare professionals perform Pap tests to check for abnormal cells on the cervix. Abnormal cells can be precancerous—not necessarily cancer yet, but could lead to cervical cancer in the future. A Pap test helps your doctor detect these precancers, before they have a chance to develop into cancer.
Most of the time, you can prevent cervical cancer when your doctor removes precancers early. If cervical cancer is already present, diagnosing the disease early could save your life because cervical cancer treatment is highly successful in the early stages.
Who performs a Pap test (Pap smear)?
A gynecologist or a primary care doctor can perform a Pap test. While a gynecologist has special training in female reproductive health, family medicine physicians can perform many routine gynecological examinations and tests, including Pap tests. If you receive an abnormal Pap test result, your doctor may refer you to a gynecologist for further testing and potential treatment.
Other medical professionals that perform Pap tests include nurse practitioners and physician assistants.
How is the Pap test (Pap smear) performed?
A Pap test is a very quick screening, taking only a few minutes. In your doctor’s office, you will undress from the waist down and lie on an examination table with your feet in footrests called stirrups. The doctor will gently open your vagina with a device called a speculum, which will hold back the walls of your vagina and help the doctor see the cervix.
Your doctor will gently collect some cells from the cervix with a soft brush or a tool called a spatula. While the cell collection procedure is not painful, it can sometimes be uncomfortable. The cells are colored using Dr. Papanicolaou’s stain before they are examined under a microscope in a lab for any abnormalities.
Oftentimes, you will have a Pap test along with a pelvic exam, but they are separate exams. During a pelvic exam, the doctor will feel, or palpate the reproductive organs to check for potential problems, such as an enlarged ovary. They cannot check for cervical cancer with a pelvic exam. You may not always have a Pap test when you have a pelvic exam.
What are the risks and potential complications of a Pap test (Pap smear)?
There is a small chance of risks and complications after a Pap test. If it is your first Pap test, you may want your doctor to discuss these risks and complications with you before performing the procedure.
Risks of a Pap test
The main risk of a Pap test is the chance of a false-negative result. This means that the test indicates a normal result, even though there are abnormal cervical cells. Several factors can cause a false-negative result, including:
Very few abnormal cells
Too few cells were collected
Blood, vaginal creams, or inflammatory cells concealing abnormal cells
- Abnormal cells were washed away or diluted by douching
While a false-negative result—not detecting the abnormal cells in a Pap test—would delay a diagnosis and any necessary treatment, your next Pap test will likely show accurate results. And because cervical cancer takes many years to develop, discovering the abnormal cells on the next screening will not necessarily affect a successful treatment.
You can reduce the risk of a false-negative result by not using any vaginal creams or having sex for a day or two before the test. Heavy menstruation can affect the test results, so if you are on your period, ask your doctor if you should reschedule the test.
There is also a chance for a false-positive result, meaning the test results indicate there are abnormal cells when there are not. If you get a positive test result, your doctor may recommend repeating the Pap test or performing another type of test, such as colposcopy, to ensure your Pap test result was not a false positive.
Rare complications of a Pap test
As for physical complications, a Pap test is a safe and routine procedure. You may have some spotting of blood afterward. This small amount of blood is not a cause for concern. In rare cases, some complications may occur after a Pap test, such as an infection. If you have heavy bleeding, severe pain, or a fever after a Pap test, call your doctor.
How do I prepare for a Pap test (Pap smear)?
Preparation for a Pap test is minimal, but it is important to explain your medical history to your doctor. Including medications you take and whether you could be pregnant. Also be sure to tell your doctor if you have a latex allergy. Your doctor will give you a chance to use the restroom before the test.
If you are nervous about the potential discomfort, you can take an over-the-counter pain reliever ahead of time.
Relaxing your pelvic muscles and vagina as the doctor guides the speculum into the vagina will improve your comfort level. The speculum is typically under a warm lamp before use, which helps relax the vaginal wall.
A Pap test can cause minor spotting, so you may want to bring a panty liner to place in your underwear after the procedure.
It is best to not douche, have intercourse, or use any vaginal creams or jelly for a day or two before your Pap test. as they could affect the accuracy of the test results.
Certain medications or an infection could also interfere with test results, so be sure your doctor knows all the medications you are taking and whether you could potentially have any kind of infection. Also, if you are menstruating, ask your doctor about rescheduling the test. In some cases, your doctor may want to delay the test until after your period to ensure the most accurate results.
What can I expect after a Pap test (Pap smear)?
A positive test result does not necessarily mean you have cervical cancer. It means you may need additional tests or more frequent Pap tests. There are different kinds of abnormal cells. Some differences are not cause for concern unless you also test positive for HPV. Your doctor will explain what your Pap test result means and whether additional testing or action is needed and when.
Even though Pap tests are routine and quick, you still may be nervous if you have never had one before. But, after it is over, usually there’s nothing more to do until your next Pap smear. Your doctor will discuss any reasons you might need a Pap test more often.
How long will it take to recover?
There is no recovery with a Pap test. The procedure takes only about five minutes. When it’s over, your doctor will complete any physical exam you need that day.
Will I feel pain?
Pap tests are not painful, but you may feel some discomfort. You will feel pressure from the speculum, but it should not hurt. Relaxing your vaginal muscles will make it easier for the speculum to go in, which will reduce discomfort.
When should I call my doctor?
After a Pap test, you may notice some spotting of blood, which is completely normal and not a cause for concern. However, contact your doctor right away if you have:
These symptoms could indicate an infection or other problem that needs medical attention.
When will I get results?
Your doctor will let you know your test results when they come back from the lab. It usually takes 1 to 3 weeks. Some doctors will let you know if the result is normal or abnormal, while other practices may only contact you if the lab detected abnormal cells in the sample. You can ask your doctor when you should expect results to come back. If you do not hear any news after three weeks, call your doctor about your results.