Pap Test

	Test Overview
	Why It Is Done
	How To Prepare
	How It Is Done
	How It Feels
	Risks
	Results
	What Affects the Test
	What To Think About
	References
	Credits
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A Pap test is done to look for changes in the cells of the cervix. During a Pap test, a small sample of cells from the surface of the cervix is collected by your health professional. The sample is then spread on a slide (Pap smear) or mixed in a liquid fixative (liquid-based cytology) and sent to a lab for examination under a microscope. The cells are examined for abnormalities that may indicate abnormal cell changes, such as dysplasia or cervical cancer.

It is important to have your first Pap test within 3 years of having sex for the first time or by age 21. You may be able to stop having regular Pap tests after you are 65 to 70 years of age, if you have had 3 normal Pap tests in a row, you do not have a high risk of cervical cancer, and you have not had any new sex partners over the last 3 years. If you do not have a uterus, you don’t need a Pap test as long as cervical dysplasia or cervical cancer was not the reason your uterus was removed. You may need more frequent Pap tests if you have had an abnormal Pap test in the past. Talk with your health professional about how often you should have Pap tests.

A high-risk type of the human papillomavirus (HPV) is the cause of most cases of cervical cancer. In women older than 30, an HPV test may be done at the same time as a Pap test. A vaccine (Gardasil) is available to prevent infection with the types of HPV that are most likely to cause cervical cancer.

If your Pap test shows an abnormal result, see the topic Abnormal Pap Test.

A Pap test is done to look for changes in the cells of the cervix. Finding these changes and treating them when needed will greatly lower your chance of getting cervical cancer.

A Pap test is usually done as part of a woman's regular pelvic exam. For more information, see the medical test Pelvic Examination.

Before a Pap test:

• Try to schedule the test when you are not having your period, since blood can interfere with the results of the test. If your bleeding is light, you may still be able to have a Pap test.
• Do not use douches, tampons, vaginal medicines, sprays, or powders for at least 24 hours before having a Pap test.

At the beginning of your visit, tell your health professional:

• If you are or might be pregnant.
• If you have any reproductive or urinary tract symptoms such as itching, redness, sores, swelling, or an unusual odor or increased vaginal discharge. If you have been performing regular vaginal self-exams, discuss any changes you have noticed with your health professional. For more information, see the medical test Vaginal Self-Examination (VSE).
• If you are using birth control.
• If this is your first Pap test.
• The first day of your last menstrual period and how long your period lasted.
• If you have had surgery or other procedures such as radiation therapy to the vagina, cervix, vulva, or uterus.

If you have had problems with pelvic exams in the past or have experienced rape or sexual abuse, talk to your health professional about your concerns or fears before the exam.

No other special preparations are needed before having a Pap test. For your own comfort, you may want to empty your bladder before the exam.

Tell your health professional whether you have had an abnormal Pap test in the past. Talk to your health professional about any concerns you have regarding the need for the test or how it will be done. To help you understand the importance of this test, fill out the medical test information form(What is a PDF document?).

You will need to take off your clothes below the waist and drape a paper or cloth covering around your waist. You will then lie on your back on an examination table with your feet raised and supported by footrests. This allows the health professional to examine your external genital area, vagina, and cervix. You may want to wear socks to keep your feet warm while they are in the footrests.

The health professional will insert a lubricated speculum into your vagina. The speculum gently spreads apart the vaginal walls, allowing the inside of the vagina and the cervix to be examined.

Your health professional will collect several samples of cells from your cervix using a cotton swab, brush (cytobrush or cervix brush), or a small spatula. Cells are collected from the visible part of the cervix as well as from its opening (endocervical canal). In women who do not have a cervix, cells from the vagina are collected if a Pap test is needed. The cells are smeared on a slide or mixed in a liquid fixative and sent to a lab for examination under a microscope.

You will feel more comfortable during your Pap test if you and the health professional are relaxed. Breathing deeply and having a light conversation with your health professional may help you relax. Holding your breath or tensing your muscles will increase your discomfort.

You may feel some discomfort when the speculum is inserted, especially if your vagina is irritated, tender, or narrow. You may also feel pulling or pressure when the sample of cervical cells is being collected.

There is very little chance of a problem from having a Pap test. You may have a small amount of vaginal bleeding after this test, and you may want to use a sanitary napkin or panty liner to protect your clothes from any spotting.

A Pap test is done to look for changes in the cells of the cervix. Results are usually available in 1 to 2 weeks. Ask your health professional when you can expect the results.

Classification systems

In the United States, the Bethesda system (TBS) is the most widely used system for reporting Pap test results. It provides information about the quality of the cell sample and the types of cell changes found. Other classification systems may still be used in other parts of the world.

Normal

The sample contained enough cells and no abnormal cells were found.

Abnormal

The sample did not contain enough cells, or abnormal cells were found. For more information about abnormal Pap test results, see the topic Abnormal Pap Test.

Pap test results may be affected by:

• Menstrual blood on the slide. This can make it harder to examine the cervical cells.
• A vaginal infection.
• The use of douches or vaginal creams or preparations within 24 hours of the exam.
• Not enough cells in the sample.

• It is important to have regular pelvic exams and Pap tests starting within 3 years after becoming sexually active or by age 21. For more information, see the medical test Pelvic Examination.
• Ask your health professional how often you should be tested. You should be tested every 1 to 3 years, depending on your risk factors.
• After you have had three or more consecutive, normal pelvic and Pap tests, these tests may be performed less frequently, depending on your risk factors for cervical problems and the advice of your health professional.
• A vaccine (Gardasil) is available to prevent infection with some of the kinds of the human papillomavirus (HPV) most likely to cause cervical cancer. But the vaccine does not prevent all types of cervical cancer, so sexually active women who get the vaccine should keep getting regular Pap tests.
• Normal Pap test results do not completely rule out the presence of abnormal cells (dysplasia) or cervical cancer. The test may fail to find abnormal cells when they are present (false-negative). Having 3 normal Pap tests in a row reduces the chance of false-negative results. Or the test may show abnormal cells when they are not present (false-positive). Talk with your health professional about the meaning of your Pap test results.
• If you have an abnormal Pap test, your health professional may recommend a test that looks at the cervix through a magnifying instrument (colposcopy). For more information, see the medical test Colposcopy and Cervical Biopsy.
• Some women with abnormal Pap tests or women older than age 30 may be tested for human papillomavirus (HPV), a sexually transmitted disease (STD) that causes genital warts. Some high-risk types of HPV can cause cervical cancer. The HPV test may or may not be done at the same time as the Pap test. The results of the HPV test can help doctors decide if further tests or treatments are needed. For more information, see the medical test Human Papillomavirus (HPV) Test.
• A liquid-based Pap test method also may be done. For this method, the tools used to collect the cells from the cervix are washed with a special liquid that is saved and sent to a lab for examination under a microscope. The cells collected in this way can also be tested for human papillomavirus (HPV). However, studies show that liquid-based Pap tests may produce more false-positive results.
• A Pap test alone is not used to diagnose dysplasia or cervical cancer. Other tests are needed, such colposcopy and cervical biopsy.
• A Pap test is not used to screen for sexually transmitted diseases (STDs) or cancer other than cervical cancer. If an STD is suspected, other specialized testing may be needed to confirm a diagnosis. For more information, see the medical tests Vaginal Wet Mount, Tests for Bacterial Vaginosis (BV), Herpes Tests, Syphilis Tests, Chlamydia Tests, and Gonorrhea Test.
• Vaginal self-exam (VSE) may help you better understand your body, know what is normal for you, and find early symptoms of infections or other abnormal conditions that might mean you need to see a health professional. VSE should be used along with (but not replace) a regular pelvic exam and Pap test done by a health professional. For more information, see the medical test Vaginal Self-Examination (VSE).

Other Works Consulted

• American Cancer Society (2003). Prevention and Early Detection: Pap Test. Available online: http://www.cancer.org/docroot/PED/content/PED_2_3X_Pap_Test.asp.

• Centers for Disease Control and Prevention (2005). Genital HPV Infection. Available online: http://www.cdc.gov/std/healthcomm/fact_sheets.htm.

• Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.

• Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.

• Runowicz CD (2007). Approach to the patient with an abnormal Pap smear. In DC Dale, DD Federman, eds., ACP Medicine, section 16, chap. 1. New York: WebMD.

• U.S. Preventive Services Task Force (2003). Screening for cervical cancer: Summary of recommendations. Available online: http://www.ahrq.gov/clinic/3rduspstf/cervcan/cervcanrr.pdf.