by Siegal B
(Pap Smear; Pap Screening; Papanicolaou Test; Cervical Cancer Screening)

Definition

A Pap test is a way to look for changes in cells of the cervix. It is often done as part of a pelvic exam.

The Cervix
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Reasons for Test

Health issues and infections can cause changes in the cells of the cervix. These changes are called cervical dysplasia. Some of these changes can lead to cancer. A pap test can find these changes early and stop cancer from developing. The test can also detect cancer cells that have already developed.

A pap test is a recommended part of regular cancer screening. There are many different guidelines on how often the test should be done. The doctor and patient will decide what schedule is best. Some general guidelines include:

  • Age 21 to 29 years—Pap test every 3 years.
  • Age 30 to 65 years—Pap test with or without the HPV test every 5 years.
  • Age 65 or older—may be able to stop Pap and HPV tests if test results have been normal.
  • Note: You will need to have Pap tests done more often if you have abnormal results. You may also need more frequent testing if you have certain conditions. A suppressed immune system or a history of cervical dysplasia or cervical cancer increases the risk of cancer.

Possible Complications

There are no major problems caused by this test.

What to Expect

Prior to Test

To improve accuracy of results:

  • Do not schedule the Pap test during your menstrual period. If possible, schedule it 2 weeks after the first day of your period.
  • Do not use vaginal creams, medicine, or douches for 72 hours before the test.
  • Do not use contraceptives for 72 hours before the test. This includes spermicidal foams, creams, or jellies.
  • Do not have sex for 24 hours before the test.

Tell your doctor if you:

  • Are having your period.
  • Are pregnant.
  • Have had a abnormal Pap test result.
  • Have had any cervical procedures, like LEEP.
  • Are sexually active.
  • Have been exposed to HPV or other sexually-transmitted diseases.
  • Have had abnormal vaginal discharge or vaginal infections.
  • Have had surgery, radiation therapy , or chemotherapy.
  • Are taking birth control pills , hormone pills, or using hormone cream.

Description of Test

You will lie on your back on an examination table. You will place your feet in foot rests. A speculum will be inserted into the vagina. It will gently open the vagina. A fine brush or spatula will be used to wipe the surface of the cervix and its canal. The speculum will be removed. The cervical cells that stuck to the tools will be placed in a fluid-filled bottle. The cells will then be sent to a lab for testing.

How Long Will It Take?

The pelvic exam takes less than 5 minutes.

Will It Hurt?

A Pap test is generally painless. You may feel some pressure or a small cramp when the cervix is wiped to gather cells.

Results

The results of your Pap test are sent to your doctor within 2 to 3 weeks. Your doctor will let you know about the results.

  • If cells are normal, no treatment is needed. You will continue your regular Pap test screens.
  • If an infection is found, treatment will be prescribed.
  • If abnormal tissue is found, more tests will be done.

Call Your Doctor

After the test, call your doctor if any of the following occurs:

  • Signs of infection, including fever and chills
  • Foul vaginal odor, pain, or unusual vaginal discharge
  • Severe abdominal pain or swelling

If you think you have an emergency, call for emergency medical services right away.

RESOURCES

American Congress of Obstetricians and Gynecologists  http://www.acog.org 

Women's Health—US Department of Health and Human Services  http://www.womenshealth.gov 

CANADIAN RESOURCES

The Society of Obstetricians and Gynaecologists of Canada  http://www.sogc.org 

Women's Health Matters  http://www.womenshealthmatters.ca 

References

American Cancer Society (ACS) review of guidelines and issues on cancer screening can be found in CA Cancer J Clin 2019 May;69(3):184

Cervical cancer screening. EBSCO DynaMed website. Available at:  https://www.dynamed.com/prevention/cervical-cancer-screening#GUID-AC126B85-8E36-449D-AC6D-B94B87EE310D  . Updated January 29, 2019. Accessed September 27, 2019.

United States Preventive Services Task Force (USPSTF) recommendations for cervical cancer screening can be found in JAMA 2018 Aug 21;320(7):674

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