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 the routine procedure, cells from your cervix are gently scraped away and examined for abnormal growth. The procedure is done at your doctor’s office. It may be mildly uncomfortable, but doesn’t usually cause any long-term pain.
According to the American Cancer Society, screening should start at age 25. Some women may be at increased risk for cancer or infection. You may need more frequent tests if:
- you’re HIV-positive
- you have a weakened immune system from chemotherapy or an organ transplant
If you’re over 25 and have not had abnormal Pap tests, ask your doctor about having one every five years if the test is combined with a human papillomavirus (HPV) screening. Current guidelines recommend that people between the ages of 25 and 65 should have an HPV test every five years.
HPV is a virus that causes warts and increases the chance of cervical cancer. HPV types 16 and 18 are the primary causes of cervical cancer. If you have HPV, you may be at an increased risk of developing cervical cancer.
Women over the age of 65 with a history of normal Pap smear results may be able to stop having the test in the future.
You should still get regular Pap smears based on your age, regardless of your sexual activity status. That’s because the HPV virus can be dormant for years and then suddenly become active.
How often do you need a Pap smear?
How often you need a Pap smear is determined by various factors, including your age and risk.
| Age | Pap smear frequency |
| <21 years old, | none needed |
| 21-29 | every 3 years |
| 30-65 | every 3 years or an HPV test every 5 years or a Pap test and HPV test together every 5 years |
| 65 and older | you may no longer need Pap smear tests; talk to your doctor to determine your needs |
These recommendations only apply to women who have a cervix. Women who have had a hysterectomy with removal of the cervix and no history of cervical cancer do not need screening.
Recommendations vary and should be individualized for women with compromised immune systems or a history of precancerous, or cancerous lesions.
How To Prepare For A Pap Smear
To ensure that your Pap smear is most effective, follow these tips prior to your test:
- Avoid intercourse, douching, or using any vaginal medicines or spermicidal foams, creams or jellies for two days before having a Pap smear, as these may wash away or obscure abnormal cells.
- Try not to schedule a Pap smear during your menstrual period. It’s best to avoid this time of your cycle, if possible.
What you can expect
According to Mayo Clinic, a Pap smear is performed in your doctor’s office and takes only a few minutes. You may be asked to undress completely or only from the waist down.
You’ll lie down on your back on an exam table with your knees bent. Your heels rest in supports called stirrups.
Your doctor will gently insert an instrument called a speculum into your vagina. The speculum holds the walls of your vagina apart so that your doctor can easily see your cervix. Inserting the speculum may cause a sensation of pressure in your pelvic area.
Then your doctor will take samples of your cervical cells using a soft brush and a flat scraping device called a spatula. This usually doesn’t hurt.
After the Pap smear
After your Pap smear, you can go about your day without restrictions. Depending on the type of Pap testing you’re undergoing, your doctor transfers the cell sample collected from your cervix into a container holding a special liquid to preserve the sample (liquid-based Pap test) or onto a glass slide (conventional Pap smear).
The samples are transferred to a laboratory where they’re examined under a microscope to look for characteristics in the cells that indicate cancer or a precancerous condition. Ask your doctor about when you can expect the results of your test.
Results of Pap smear
A Pap smear can alert your doctor to the presence of suspicious cells that need further testing.
Normal results: If only normal cervical cells were discovered during your Pap smear, you’re said to have a negative result. You won’t need any further treatment or testing until you’re due for your next Pap smear and pelvic exam.
Abnormal results: If abnormal or unusual cells were discovered during your Pap smear, you’re said to have a positive result. A positive result doesn’t mean you have cervical cancer. What a positive result means depends on the type of cells discovered in your test.
Here are some terms your doctor might use and what your next course of action might be:
- Atypical squamous cells of undetermined significance (ASCUS). Squamous cells are thin and flat and grow on the surface of a healthy cervix. In the case of ASCUS, the Pap smear reveals slightly abnormal squamous cells, but the changes don’t clearly suggest that precancerous cells are present.
With the liquid-based test, your doctor can reanalyze the sample to check for the presence of viruses known to promote the development of cancer, such as some types of human papillomavirus (HPV).
If no high-risk viruses are present, the abnormal cells found as a result of the test aren’t of great concern. If worrisome viruses are present, you’ll need further testing.
- Squamous intraepithelial lesion. This term is used to indicate that the cells collected from the Pap smear may be precancerous.
If the changes are low grade, it means the size, shape and other characteristics of the cells suggest that if a precancerous lesion is present, it’s likely to be years away from becoming a cancer.
If the changes are high grade, there’s a greater chance that the lesion may develop into cancer much sooner. Additional diagnostic testing is necessary.
- Atypical glandular cells. Glandular cells produce mucus and grow in the opening of your cervix and within your uterus. Atypical glandular cells may appear to be slightly abnormal, but it’s unclear whether they’re cancerous.
Further testing is needed to determine the source of the abnormal cells and their significance.
- Squamous cell cancer or adenocarcinoma cells. This result means the cells collected for the Pap smear appear so abnormal that the pathologist is almost certain a cancer is present.
“Squamous cell cancer” refers to cancers arising in the flat surface cells of the vagina or cervix. “Adenocarcinoma” refers to cancers arising in glandular cells. If such cells are found, your doctor will recommend prompt evaluation.
If your Pap smear is abnormal, your doctor may perform a procedure called colposcopy using a special magnifying instrument (colposcope) to examine the tissues of the cervix, vagina and vulva.
Your doctor also may take a tissue sample (biopsy) from any areas that appear abnormal. The tissue sample is then sent to a laboratory for analysis and a definitive diagnosis.
