•  
  •  

Pap Test

Test Overview

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 doctor. 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.

The recommended Pap test schedule is based on your age and on things that increase your risk. Talk to your doctor about how often to have this test.

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. If you are age 26 or younger, you can get the HPV shot 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.

Why It Is Done

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 topic Pelvic Examination.

How To Prepare

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 doctor:

  • 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 doctor. For more information, see the topic 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 doctor 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 doctor whether you have had an abnormal Pap test in the past. Talk to your doctor 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?).

How It Is Done

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 doctor 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 doctor 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 doctor 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.

How It Feels

You will feel more comfortable during your Pap test if you and the doctor are relaxed. Breathing deeply and having a light conversation with your doctor 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.

Risks

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 pad or panty liner to protect your clothes from any spotting.

Results

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 doctor 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.

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.

What Affects the 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.

What To Think About

  • 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 doctor about the meaning of your Pap test results.
  • Some women with abnormal Pap tests or women older than age 30 may be tested for human papillomavirus (HPV), a sexually transmitted infection (STI) 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 topic 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 HPV. But 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 as colposcopy and cervical biopsy.
  • A Pap test is not used to screen for sexually transmitted infections (STIs) or cancer other than cervical cancer. If an STI is suspected, other specialized testing may be needed to confirm a diagnosis. For more information, see the topics 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 doctor. VSE should be used along with (but not replace) a regular pelvic exam and Pap test done by a doctor. For more information, see the topic Vaginal Self-Examination (VSE).

References

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.
  • American College of Obstetricians and Gynecologists (2009). Cervical cytology screening. ACOG Practice Bulletin No. 109. Obstetrics and Gynecology, 114: 1409–1420.
  • 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 (2008). Approach to the patient with an abnormal Pap smear. In EG Nabel, ed., ACP Medicine, section 16, chap. 16. Hamilton, ON: BC Decker.
  • U.S. Preventive Services Task Force (2012). Screening for cervical cancer: Summary of recommendations. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspscerv.htm.

Credits

By Healthwise Staff
Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
Specialist Medical Reviewer Kirtly Jones, MD - Obstetrics and Gynecology
Last Revised May 4, 2012

Last Revised: May 4, 2012

Author: Healthwise Staff

Medical Review: Sarah Marshall, MD - Family Medicine & Kirtly Jones, MD - Obstetrics and Gynecology

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

To learn more visit Healthwise.org

© 1995-2012 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.