Pap Screening

Pap Test Procedure

(Pap Smear, Pap Screening, Papanicolaou Test)

Procedure overview

What is a Pap test?

A Pap test, named after Dr. George Papanicolaou who designed the test, is a screening test to collect and microscopically examine cells taken from the cervix, the lower, narrow part of the uterus (womb) located between the bladder and the rectum. The cervix forms a canal that opens into the vagina, which leads to the outside of the body. With a Pap test, cells can be collected from the vagina as well as the cervix.

Who should have Pap tests?

Women should seek expert medical advice about when they should begin screening, how often they should be screened, and when they can discontinue cervical screenings, especially if they are at higher than average risk of cervical cancer due to factors such as HIV infection.

According to the American College of Obstetricians and Gynecologists (the College), general guidelines include:

• Cervical cancer screening should begin at age 21. In the past, women were advised to have their first test at age 21, or three years after having sexual intercourse for the first time, whichever happened first.

• Cervical cancer is very rare in women younger than 21. That’s because the immune system of adolescent women naturally fights the virus that causes cervical cell changes. The College found that early Pap testing can lead to unnecessary procedures to remove suspicious cells—before the woman’s body can heal itself. These procedures increase the risk of having premature babies.

• Most women younger than 30 can now be tested for cervical cancer every other year instead of annually. Women older than 30 can be tested once every three years if they have had three consecutive Pap tests with normal results. Research shows this testing schedule prevents cervical cancer just as well as annual Pap tests.

• Women at high risk for cervical cancer may need more frequent screenings than the new standard guidelines suggest. This includes those who have a weak immune system or who have been treated for abnormal cervical cells in the past. Ask your care provider how often you should be tested.

• Women 65 to 70 years of age who have had at least three normal Pap tests in a row, are sexually inactive, and have had no abnormal Pap tests in the past may decide, on consultation with their health care provider, to stop cervical cancer screening.

• Women who have had a total hysterectomy (removal of the uterus and cervix) do not need to undergo cervical cancer screening, unless the surgery was done as a treatment for cervical precancer or cancer.

Other related procedures that may be used to diagnose cervical conditions include colposcopy, cervical biopsy, and loop electrosurgical excision procedure (LEEP). Please see these procedures for additional information.

What are female pelvic organs?

The organs and structures of the female pelvis are:

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• Endometrium. The lining of the uterus

• Uterus (also called the womb). The uterus is a hollow, pear-shaped organ located in a woman's lower abdomen, between the bladder and the rectum. The uterus sheds its lining each month during menstruation, unless a fertilized egg (ovum) becomes implanted and pregnancy follows.

• Ovaries. Two female reproductive organs located in the pelvis in which egg cells (ova) develop and are stored, and where the female sex hormones estrogen and progesterone are produced

• Cervix. The lower, narrow part of the uterus located between the bladder and the rectum, forming a canal that opens into the vagina, which leads to the outside of the body

• Vagina (also called the birth canal). The passageway through which fluid passes out of the body during menstrual periods. The vagina connects the cervix and the vulva (the external genitalia).

• Vulva. The external portion of the female genital organs

Reasons for the procedure

A Pap test, along with a pelvic examination, is an important part of a woman's routine health care because it may detect abnormalities that can lead to invasive cancer. Most cancers of the cervix can be detected early if women have Pap tests and pelvic examinations regularly. As with many types of cancer, cancer of the cervix is more likely to be successfully treated if it is detected early.

The Pap test is useful for detecting not only cancerous cells, but also other cervical and vaginal abnormalities including dysplasia (precancerous cells) and inflammation.

A Pap test may be used to diagnose and assist in the treatment of the following conditions in the cervix or vagina:

• Inflammation

• Infection

• Abnormal cells

• Precancerous cells

• Cancer

The HPV test is often done at the same time and sometimes in combination with the Pap test. Infection with HPV is the most important risk factor for the development of cervical cancer in women over age 30. The types of HPV that are most likely to cause cervical cancer can be identified by the presence of their DNA in cervical cells. The HPV test may also be used for any woman with abnormal Pap test results to determine the need for additional testing or treatment.

There may be other reasons for your doctor to recommend a Pap test.

Risks of the procedure

Patients who are allergic to or sensitive to latex should notify their doctor.

If you are pregnant or suspect that you may be pregnant, you should notify your health care provider.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your health care provider prior to the procedure.

Certain factors or conditions may interfere with a Pap test. These factors include, but are not limited to, the following:

• Menstruation

• Use of substances, such as vaginal creams, jellies, medications, or spermicidal foams, for two to three days before the Pap test, as these substances may alter the pH of the cells or hide abnormal cells

• Douching for two to three days before a Pap test as douching can wash away surface cells

• Vaginal intercourse within 24 hours prior to the test may cause inflammation of the tissue

• Infections

• Certain medications, such as tetracycline

Before the procedure

• Your health care provider will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.

• Notify your health care provider if you are sensitive to or are allergic to any medications, latex, and tape.

• Generally, no prior preparation, such as fasting or sedation, is required.

• Notify your health care provider of all medications (prescription and over-the-counter) and herbal supplements that you are taking.

• Tell your health care provider when you had your last menstrual period, and what type of birth control or hormone therapy, if any, you are using.

• Notify your health care provider if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting.

• If you are pregnant or suspect that you are pregnant, you should notify your health care provider.

• You should not use vaginal medications, spermicidal foams, creams, or jellies, and do not douche for two to three days before the test or for the time specified by your health care provider. Avoiding sexual intercourse within 24 hours prior to the test may be recommended.

• You will be asked to empty your bladder prior to the procedure.

• Based on your medical condition, your health care provider may request other specific preparation.

During the procedure

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A Pap test may be performed in a care provider's office, on an outpatient basis, or as part of your stay in a hospital. Procedures may vary depending on your condition and your health care provider's practices.

Generally, a Pap test follows this process:

1. You will be asked to undress completely or from the waist down and put on a hospital gown.

2. You will lie on an examination table, with your feet and legs supported as for a pelvic examination.

3. Your health care provider will insert an instrument called a speculum into your vagina to spread the walls of the vagina apart to expose the cervix.

4. For the Pap test, cells will be gently removed from the cervical tissues and from the back of the vagina by using an endometrial brush, swab, or small wooden spatula. The cells will then be placed into a vial of liquid or smeared on a glass microscope slide.

5. If the HPV test is needed, a sample of cells will be collected for this test as well.

6. If you have symptoms of a vaginal infection, vaginal secretions may be collected for testing.

7. Usually, your health care provider will perform a pelvic examination after the Pap test.

8. The Pap test specimen will be sent to a lab for further study.

After the procedure

You may rest for a few minutes after the procedure before going home. Because scraping the cervix may cause a small amount of bleeding, you may want to wear a sanitary pad for any spotting that may occur.

Notify your health care provider if you have any of the following:

• Bleeding

• Foul-smelling drainage from your vagina

• Fever and/or chills

• Severe abdominal pain

Pap test results usually take a few days. Ask your health care provider how you will be notified of results.

Your health care provider may give you additional or alternate instructions after the procedure, depending on your particular situation.