The Pap Test (Pap smear)

The Pap test finds changes in the cells of the cervix (the mouth of the womb) that are not normal. When a female has a Pap test, she is positioned on an exam table and a device called a speculum is gently inserted to open the vagina. The speculum allows the healthcare provider to view the cervix and upper vagina. Once the provider can see the cervix, a "broom" device or a brush/spatula combination will be used to collect the cells. While the technique is a little different depending on the device chosen, in general, the provider will gently rotate the device in the endocervix (the cervical canal) and the ectocervix (the portion of the cervix extending into the vagina) to collect squamous and glandular cells. The cells are sent to a laboratory where they are prepared and evaluated under a microscope.

When a female gets Pap test, she is being screened for to make sure that there are no abnormal or precancerous changes in the cells on her cervix. If the Pap test results show these cell changes, this is usually called cervical dysplasia. Other common terms the healthcare provider may use include:

- Abnormal cell changes

- Precancerous cells changes

- CIN (cervical intraepithelial neoplasia)

- SIL (squamous intraepithelial lesions)

- "Warts" on the cervix

All of these terms mean similar things - it simply means that abnormalities were found. Most of the time, these cell changes are due to HPV. There are many types of HPV that can cause cervical dysplasia. Most of these types are considered "high-risk" types, which means that they have been linked with cervical cancer.

Just because a female has cervical dysplasia, it does not mean she will get cervical cancer. It means that her healthcare provider will want to closely monitor her cervix every so often - and possibly do treatment - to prevent further cell changes that could become cancerous over time if left unchecked.

How the Test is performed

You will lie on a table and place your feet in stirrups. The doctor or nurse will place an instrument (called a speculum) into the vagina and open it slightly. This allows the doctor or nurse to better see inside the vagina and cervix. Cells are gently scraped from the cervix area, and sent to a lab for examination.

How to prepare for the Test

Make sure your doctor or nurse knows about all the medicines you are taking. Some birth control pills that contain estrogen or progestin may interfere with test results.

Also tell your doctor or nurse if you:

- Have had an abnormal Pap smear

- Might be pregnant

Avoid the following for 24 hours before the test:

- Douching

- Having intercourse

- Taking a bath

- Using tampons

Avoid scheduling your Pap smear while you have your period (are menstruating), because it may affect the accuracy of the Pap smear. Empty your bladder just before the test.

How the test will feel

A Pap smear may cause some discomfort, similar to menstrual cramps. You may also feel some pressure during the exam. You may bleed a little bit after the test.

Why the Test is performed

The Pap smear is a screening test for cervical cancer. Most cervical cancers can be detected early if a woman has routine Pap smears. You may not need to have a Pap smear if you have had a total hysterectomy (uterus and cervix removed) and have not had an abnormal Pap smear, cervical cancer, or other pelvic cancer.

When will you know the results of the Pap Test?

It may take several weeks to get the test results. If you haven't heard from your doctor's office after three weeks, give them a call to see if your results have come back.

What do the results mean?

A normal Pap test means the cells from the cervix look normal. An abnormal Pap test means the cells do not look normal. Sometimes repeat Pap tests are needed. Different tests also may need to be done, such as a colposcopy (the use of a special microscope to examine the cervix and vagina). Pap tests can occasionally show signs of infection but cannot be relied on to screen for sexually transmitted diseases (STDs). Other tests are necessary to determine the presence of an STD.

What happens if the results are abnormal?

An abnormal Pap test does not necessarily mean that cancer cells were found during the examination. There are many causes for abnormal Pap test results, including infection, inflammation related to using a diaphragm or sex, and changes related to your menstrual cycle. Your doctor will evaluate the results to determine if further testing is necessary.

Why would you need to repeat the Pap Test?

A repeat Pap test may be necessary if there were not enough cells collected during the test. Since decreased levels of the female hormone estrogen also can influence Pap test results, menopausal women may need to take estrogen before they repeat the test. This is not an abnormal result but is called unsatisfactory for evaluation.

How often should you have a Pap smear

All women over 18 who have ever had sex are advised to have a Pap smear every two years, even if they no longer have sex.

Your general practitioner may recommend more frequent Pap smears if a previous smear showed significant cell changes or you experience problems, such as bleeding or pain after sex.

Personal note: I am having Pap Tests every year

Menopause - do you still need to have a Pap smear?

Yes, the risk of getting cervical cancer is the same even after menopause so it is important to keep having Pap smears every two years, even after menopause.

Women with hysterectomy. Do you still need to have Pap smears?

Following a hysterectomy, women should discuss their ongoing need for cervical screening with their doctor. Women who have had a hysterectomy usually do not require further Pap smears. However, in some cases, Pap smears may still be needed.

Women who have had a total hysterectomy, that is, the uterus and cervix removed, and have ever had treatment for severe changes on the cervix, are recommended to continue to have smears taken from the upper vagina (known as vault smears). Women who have had a hysterectomy but have never had a Pap smear should also have a vault smear. Women who have had a partial hysterectomy, where the cervix is not removed, should still have a Pap smear every two years.

Many women do not know exactly what type of hysterectomy they had. If you are not sure, it is important to find out. If your doctor has no records of the operation, an internal examination or a cell sample may be needed.

Considerations

The Pap smear test is not 100% accurate. Cervical cancer may be missed in a small number of cases. Most of the time, cervical cancer develops very slowly and follow-up Pap smears should identify worrisome changes in time for treatment.