What is a Pap smear?
A Pap smear (also called a Pap test) screens for cervical cancer. The test checks for abnormal cells in the cervix that are cancerous or have the potential to become cancerous. During a Pap smear, your healthcare provider takes cells from the cervix to examine under a microscope for signs of cancer. The test is named for an American physician, Dr. George Papanicolaou, who developed the Pap smear.
What is the cervix?
The cervix is the lower part of the uterus that connects to the vaginal canal. Sperm travels through the vaginal canal and cervix to the uterus to fertilize eggs. During pregnancy, the cervix closes to keep the baby in the womb (uterus). The cervix opens during childbirth. When you aren’t pregnant, your cervix makes mucus to keep infection-causing bacteria out of the body.
Why do healthcare providers perform Pap smears?
Healthcare providers perform Pap smears as part of a pelvic exam. The test checks for:
- Cervical cancer.
- Potentially precancerous cells in the cervix (cervical intraepithelial neoplasia).
- Human papillomavirus (HPV), a common sexually transmitted disease (STD) that increases the risk of cervical cancer.
What’s the difference between a pelvic exam and a Pap test?
During a pelvic exam, your healthcare provider examines and feels (palpates) the uterus, ovaries and other parts of the female reproductive system. This examination helps your provider identify infections, problems and certain types of cancer (but not cervical cancer). Your provider may also perform STD tests during a pelvic exam. A pelvic exam doesn’t always include a Pap smear.
What’s the difference between a Pap smear and a HPV test?
A HPV test checks for certain types of the virus that increase your cervical cancer risk. HPV is a common STD that affects approximately 79 million Americans. There are many different types of HPV. Not all cause cancer.
Providers can do HPV tests and Pap tests at the same time, using the same steps (a gentle scrape of the cervix for cell samples). When sending these samples to a lab, your provider specifies whether the lab specialist (pathologist) should check for precancerous or cancerous cells (Pap smear), HPV or both (a co-test).
Can a Pap smear detect STDs?
A Pap smear can’t detect STDs. To test for diseases like chlamydia or gonorrhea, your healthcare provider takes a sample of fluid from the cervix. Fluid isn’t the same as cervical cells. Blood tests can also identify certain STDs.
How often do I need a Pap smear?
Women and anyone assigned female at birth should start getting Pap smears starting at age 21 and HPV tests at age 30. How often you’ll have the test depends on many factors, including your age, health history and results from your last Pap or HPV test. Most people don’t need Pap smears after age 65.
Generally, Pap smears occur:
- Every three years from ages 21 to 29.
- Every three years from ages 30 to 65 without an HPV test.
- Every five years from ages 30 to 65 with an HPV test.
- Every year for those who have human immunodeficiency virus (HIV) or are immunocompromised.
- Every year for those whose mothers took a medicine called diethylstilbestrol (DES) during pregnancy. Exposure to DES while in the womb increases cervical cancer risk.
Do I need a Pap smear if I’ve had a hysterectomy?
A hysterectomy is a surgical procedure to remove the uterus. A partial hysterectomy removes the uterus but not the cervix. You’re still at risk for cervical cancer and need Pap smears.
Some people have a complete hysterectomy (removal of the uterus and cervix) due to a cancer diagnosis. In that case, you’ll continue getting Pap smears to look for changes that might indicate a cancer recurrence. If you had a complete hysterectomy to treat a noncancerous problem, such as uterine fibroids, you probably won’t need Pap smears.
How should I prepare for a Pap smear?
Some things that you do in the days before a Pap smear can affect test results. For the most accurate results, you should:
- Not have vaginal sex for two days before your exam.
- Not use tampons, vaginal creams or medicines, birth control foams or jellies, lubricants or douches for at least two days before the test.
- Schedule the appointment at least five days after your period ends.
What should I expect during a Pap smear?
Pap smears take place at a healthcare provider’s office. The test takes a few minutes. It isn’t painful, but you may feel some discomfort. During the procedure, your healthcare provider:
- Inserts a speculum into the vagina. You may feel a bit of pressure. This metal or plastic device holds the vagina open so your provider can see the cervix.
- Uses a small brush or spatula to gently scrape cells from the cervix (a biopsy).
What should I expect after a Pap smear?
Your healthcare provider sends the samples to a lab. A specialist called a pathologist examines the samples under a microscope to look for abnormal cells that may indicate cancer or HPV.
Are there any risks to getting a Pap smear?
Pap smears are very safe. You may experience some light spotting (vaginal bleeding) after the test, but you shouldn’t have cramps or pain.
Results and Follow-Up
When should I get my test results?
It can take up to three weeks for your healthcare provider to receive the lab results.
What do Pap smear results mean?
When you receive your results, they may be:
- Normal: No sign of disease.
- Unclear: The lab couldn’t determine whether the cells are normal or abnormal. Your healthcare provider may have you come back immediately or in six months for another Pap smear.
- Abnormal: The cells look different than they should.
Does an abnormal Pap smear result mean that I have cervical cancer?
An abnormal finding means that some cells in your cervix look unusual. Many things besides cancer can cause an abnormal result, including:
What follow-up tests might I need after an abnormal Pap smear result?
If you have an abnormal Pap smear result, your healthcare provider may perform another Pap smear immediately or in a few months. A second Pap smear can be helpful if your healthcare provider thinks an infection or other problems affected the test results.
Pap smears only screen for cancer — they can’t diagnose it. To get more information to help diagnose or rule out cervical cancer, your provider does a colposcopy. During this procedure, your provider:
- Uses a microscope device (colposcope) to view the lining of the cervix and vagina.
- Removes tissue samples from areas that look abnormal.
- Sends the samples to a lab for testing.
Pap smears are a lifesaving screening tool. The test identifies abnormal cervical cells before they have a chance to become cancerous. More than 95% of the time, people treated for precancerous cells don’t develop cervical cancer. During a Pap smear, your healthcare provider may remove cells to test for HPV, a STD that increases your risk of cervical cancer. An unclear or abnormal Pap test result doesn’t mean you have cancer. Your provider can discuss test findings and next steps with you.