What Is a Pap Smear?
A Pap smear, also called a Pap test, is an exam a doctor uses to test for cervical cancer in women. It can also reveal changes in your cervical cells that may turn into cancer later.
Why Is a Pap Smear Done?
A Pap smear is done to look for changes in cervical cells before they turn into cancer. If you have cancer, finding it early on gives you the best chance of fighting it. If you don’t, finding cell changes early can help prevent you from getting cancer.
If you are between the ages of 21 and 65, you should have a Pap smear on a regular basis. How often you do depends on your overall health and whether or not you’ve had an abnormal Pap smear in the past.
How Often Should I Have a Pap Smear?
You should have the test every 3 years from ages 21 to 65. You may choose to combine your Pap testing with human papillomavirus (HPV) testing starting at age 30. If you do so, then you can be tested every 5 years instead. HPV is the most common sexually transmitted infection (STI), and it’s linked to cervical cancer.
If you have certain health concerns, your doctor may recommend you have a Pap more often. Some of these include:
- Cervical cancer or a Pap test that revealed precancerous cells
- HIV infection
- A weakened immune system due to an organ transplant, chemotherapy, or chronic corticosteroid use
- Having been exposed to diethylstilbestrol (DES) before birth
Talk to your doctor if you have questions or concerns. They’ll let you know for sure.
If you are a transgender man or nonbinary person, it is still important to get regular Pap smears. Shop around to find a doctor who makes you feel comfortable.
Pap Smear Preparation
You shouldn’t have a Pap smear during your period. Heavy bleeding can affect the accuracy of the test. If your test ends up being scheduled for that time of month, ask your doctor if you can reschedule.
For the most accurate Pap smear, doctors recommend taking the following steps, starting 48 hours before your test.
- Don’t have sex or use lubricants.
- Don’t use sprays or powders near your vagina.
- Don’t insert anything into your vagina, including tampons, medications, creams, and suppositories.
- Don’t rinse your vagina with water, vinegar, or other fluid (such as a douche).
Pap Smear Procedure
It takes about 10-20 minutes for the whole exam, but only a few minutes for the actual Pap smear. The test is done in your doctor’s office or clinic.
You’ll lie on a table with your feet placed firmly in stirrups. You’ll spread your legs, and your doctor will insert a metal or plastic tool called a speculum into your vagina. They’ll open it so that it widens the vaginal walls. This allows them to see your cervix. Your doctor will use a swab to take a sample of cells from your cervix. They’ll place them into a liquid substance in a small jar and send them to a lab for review.
The Pap test doesn’t hurt, but you may feel a little pinch or a bit of pressure.
Pap Smear Results
Your doctor will get them within a few days. They’ll come back either negative (normal) or positive (abnormal).
A negative result is a good thing. That means your doctor didn’t find any precancerous or cancerous cells on your cervix. You won’t need another Pap until you’re due for your next scheduled one.
If your results come back positive, it doesn’t automatically mean you have cancer. There are several reasons you could have an abnormal Pap smear.
- Mild inflammation or minor cell changes (dysplasia)
- HPV or other infection
- Cancer or precancer
- Lab test error
Most often, the abnormal test result means there have been cell changes caused by the human papillomavirus (HPV). That’s the most common sexually transmitted infection (STI), and can be linked to cervical cancer. Changes to your cervical cells caused by HPV can be mild, moderate, or severe.
Inflammation can happen if you’ve had sex or used a diaphragm shortly before having a Pap smear.
If you have inflammation or minor cell changes, your doctor may take a “wait and see” approach. They may suggest you have another Pap test in a few months.
Will I Need More Tests?
Your doctor will review your test results and let you know. Their answer will depend on what type of abnormal cells are found in your cervix. The most common ones are listed below.
Atypical squamous cells of undetermined significance (ASCUS). Thin, flat cells called squamous cells grow on the surface of a healthy cervix. ASCUS occurs when these cells are not typical. Your doctor will do a test with a special liquid to see if HPV is present. If it’s not, there’s probably no need for concern.
Squamous intraepithelial lesion. These cells may be precancerous. Doctors call changes to them “low-grade” or “high-grade.” If they’re low-grade, a precancerous cell may not turn to cancer for many years. If it’s high-grade, the cells could turn to cancer much sooner. Your doctor will likely order more tests, including a colposcopy, an instrument that shows changes in the cervix that may lead to a biopsy of cervical tissue to check for cancerous cells.
Atypical glandular cells. These cells make mucus. They grow in the opening of your cervix and inside your uterus. If they appear to be abnormal, your doctor will order more tests, including a colposcopy, to find out for sure if it’s cancer.
Squamous cell cancer or adenocarcinoma cells. This means the cells on your cervix are so abnormal, your doctor is almost certain it’s cancer.
To be sure, your doctor will likely order two other tests: a colposcopy and a biopsy.
During a colposcopy, your doctor will insert a speculum into your vagina, just like they did for the Pap test. This time, they’ll look at the cervix with a colposcope. This is a tool that has a lens and a bright light that allows your doctor to get a better look at your cervix. They will swab your cervix with vinegar or some other liquid solution. It’ll highlight any suspicious-looking areas. Your doctor will be able to see them through the lens on the colposcope.
If your doctor finds areas that don’t look right, they’ll take a sample, called a biopsy. They’ll send the tissue to a lab for further testing.
Pap Smear Risks
A Pap smear is considered a safe procedure. But it’s possible that the test may miss some abnormal cells or cervical cancers. This is called a false negative. Talk to your doctor about the benefits and risks of cervical cancer screening.