A Pap smear is one of the most effective ways to screen for cervical cancer and treat it early. Most women should get a Pap smear at regular intervals. This test uses a brush to collect cells from the surface of your cervix and vulva. It can also find cell changes that may lead to cervical cancer (called precancerous). The Pap smear is done in the doctor’s office.
Cervical Cells
Pap tests examine cells from the surface of your cervix to look for abnormalities. These could be precancerous changes or cancer. Worldwide, cervical cancer is the third most common type of cancer in women. But it’s less common in the United States because of regular screening and routine Pap smears. It takes years for the abnormal cells to develop into cervical cancer, so Pap tests can catch them before they become serious.
If the Pap test results are abnormal, your doctor will talk with you about what this means and may want to do more testing. There are many things that can cause an abnormal result, including sex and using a diaphragm shortly before having the Pap smear. Inflammation and minor cell changes also can happen. Your doctor may decide to repeat the Pap test in a few months or perform a colposcopy.
The most common abnormal Pap test result is ASCUS, which stands for atypical squamous cells of undetermined significance. This indicates that the squamous cells, which line the outer surface of the cervix, don’t look normal. These usually are caused by an infection, including HPV (human papillomavirus, or wart virus). These changes can go away on their own or need further treatment.
Less common are CIN 1 and CIN 2. These mean that the squamous cells appear more abnormal, but still don’t need further treatment. CIN 3 is more serious. It means that the squamous cells look more like cancer and need further treatment. Other abnormal results include glandular or adenocarcinoma cells. These cells form in the glandular tissue inside your uterus and cervix. Cancers of these types aren’t as common as squamous cell cancers, but they can be.
In rare cases, the cells in a Pap smear can be so abnormal that your doctor will want to look at them under a microscope right away (colposcopy). A colposcopy is more uncomfortable than a Pap test because your doctor will insert a thin metal tool, called a speculum, into your vagina and open it wide to see the cervix. The speculum can feel uncomfortable or painful, especially if it’s done during your menstrual period.
What You Can Expect
A Pap test involves taking a sample of cells from your cervix. The samples are then checked under a microscope for early cell changes that may lead to cervical cancer or other health problems. The test can also check for certain types of the human papillomavirus (HPV), a common sexually transmitted infection that increases the risk of cervical cancer.
Your cervix is the lower part of your uterus that connects to your vaginal canal. During pregnancy, your cervix closes to keep the fetus inside your uterus, and it opens during childbirth. The cervix makes mucus that helps to protect your body from infection-causing bacteria. The Pap test is one of the best ways to help prevent cervical cancer and other health problems.
Most Pap smears don’t hurt. If the speculum feels uncomfortable or painful, you can tell your health care provider and ask to have it removed. If you’re nervous about the Pap, it can help to bring a friend or loved one with you to support you. Dr. Kallen and Dr. Levy say it’s OK to be anxious about your first Pap, but it’s important to let your health care provider know if you aren’t comfortable with any aspect of the procedure.
You’ll likely be asked to undress from the waist down and put on a hospital gown for your exam. It’s best to wear loose, comfortable clothes. During the Pap smear, your healthcare provider will place a brush on your cervix and gently move it around to collect cells. It’s possible that you will feel some discomfort from the speculum, but most people don’t report this. You may have a little bleeding during this time, which is normal. If you start your period when you’re scheduled for a Pap, you should call your healthcare provider’s office and try to reschedule.
Most women should have a Pap smear alone or with an HPV test every three years from ages 21 to 65. Some doctors may recommend less frequent Pap testing if you’ve had a normal result in the past.
During the Test
A Pap smear is a quick, painless test. It is usually done by a health care provider in your doctor’s office or a clinic. The exam lasts only a few minutes. You will lie on an exam table and put your feet in stirrups at the end of the table. Your health care provider will insert a plastic or metal tool called a speculum into your vagina to open it and then collect a sample of cells from the inside of your cervix.
The swab is then placed in a liquid substance and sent to a lab for testing. A specialist called a pathologist will look at the cells under a microscope to see if they are normal or abnormal. A Pap test is one of the best ways to prevent cervical cancer, because it can detect changes in your cervix before they can cause cancer.
When the results come back, your health care provider will discuss them with you. The results are usually negative (normal), which means that your cervix looks healthy and there is no sign of precancerous or cancerous cells. If the Pap test shows abnormal cells, your health care provider may recommend further tests.
These additional tests may include a pelvic ultrasound or an HPV test. Having HPV, the most common sexually transmitted infection, increases your risk of having a Pap smear that is abnormal. Some women also have a colposcopy, a procedure that allows your doctor to view the surface of your cervix with a magnifying lens. The results from this exam can help your doctor decide if you need a biopsy.
You will probably be told that you need to have a Pap test again in 1 to 3 years, if your previous ones were normal. You should have another Pap test before you get pregnant. You should also have a Pap test if you think you might have cancer or have other symptoms that could lead to cervical cancer, like vaginal sores, spotting or bleeding, and a history of cervical cysts.
After the Test
Your health care provider will use a plastic or metal instrument called a speculum to open the walls of your vagina so they can see the back of your cervix. They may also remove a sample of cells from the bottom of your vagina or uterus for HPV testing. Then they will smear the cells on a glass microscope slide and place them in a vial of special liquid to send to the lab for analysis.
This part of the exam typically feels uncomfortable, but it should not be painful. It is important to schedule your Pap test when you are not on your period. It is also a good idea to avoid sexual intercourse and using vaginal douches or sprays or vaginal medicines for 24 hours before the test.
Once the Pap smear is in the lab, it will take several weeks to get the results. Your doctor will contact you if there is anything unusual found. A normal result means that no abnormal cells were detected.
Bleeding after a Pap test is not uncommon, but it does not usually indicate that you have cervical cancer. It is more likely to happen because the Pap smear irritated the sensitive lining of your cervix or because blood in the sample hid the abnormal cells from view. The bleeding is light and usually stops within a few days.
If your Pap smear shows some abnormal changes, your doctor may want to follow up with other tests to look for precancerous or cancerous cells. In some cases, the Pap smear may show low-grade lesions that are unlikely to become cancerous, and your doctor will want you to come back for another Pap smear in six months to keep an eye on those cells. In other cases, the Pap smear might show moderate- to severe-grade lesions that should be removed to prevent cervical cancer from developing. The most common procedure for this is a loop electrosurgical excision procedure (LEEP), which involves using a thin wire loop to essentially erase the abnormal cells in your cervix.
If you have insurance, the cost of a Pap smear is covered by most health plans. But if you have no insurance, you can check with your county or state health department or Planned Parenthood to see if they offer free or low-cost Pap tests.