Pap Smear: Overview, Indications, Preparation


Worldwide, statistics show that cervical cancer is the fourth-leading deadliest cancer among women. However, cervical cancer is preventable. Not only is there a human papillomavirus vaccine that prevents HPV (which often leads to cervical cancer), having regular Papanicolaou tests (also known as Pap smears), can help detect early signs of cervical cancer. Read on to learn more about Pap smears, what to expect during the procedure, and how often you should be tested. 

What Is a Pap Smear?

A Pap smear is a gynecological exam that tests specifically for cervical dysplasia, which are abnormal cervical cells that can directly lead to cervical cancer. Quite often, a Pap smear is part of a routine gynecological exam, during which the physician is also checking other areas of gynecological health. A Pap smear can also detect cervical cancer itself if it is present. 

During a Pap smear, the physician is likely to perform another examination for the human papillomavirus (HPV), which is also a direct cause of cervical cancer. Not all types of HPV can lead to cervical cancer, but many do. This test is accurate enough to read the DNA if HPV is present, letting the physician know what type the patient has. Make sure that you talk to your doctor before a routine gynecological screening to see if they are planning to perform the Pap or HPV testing. Depending upon a person’s age, Pap smears are not a yearly requirement unless the patient is at risk for the development of cervical cancer, or has had dysplasia or HPV in the past. Not all doctors perform Pap smears and HPV tests concurrently, so it’s a good idea to ask for the HPV test if it is not offered. 

What Happens During a Pap Smear?

If it is your first Pap smear or gynecological exam, it’s natural to be nervous. The test is slightly invasive, but it is performed very quickly and is not painful. Just like a regular gynecological or pelvic exam, you will lie on your back on the examination table with your feet in the stirrups. The gynecologist will need to open your vagina wide enough in order to swab the cervix and perform the test and will insert a speculum into the vagina. This is a small tool that opens the vaginal cavity. Speculums do come in certain sizes, so you may request a smaller one to be more comfortable. Once the speculum is inserted, the doctor will slowly open the vaginal cavity to provide access to the cervix. At this point, different gynecologists use different tools to examine the cervix to look for precancerous or abnormal cells. Some physicians use a small spatula, others use a brush, and some use a combination of the two known as a cytobrush. You will feel a slight scraping against the wall of the cervix, and then the test is complete. You may feel slight cramping or have light spotting after the test, but generally speaking, most patients do not feel discomfort or side effects afterward. 

When Should I Have a Pap Smear?

The frequency of Pap smears depends heavily upon age and gynecological history. It is important to have frank and honest discussions with your TWC physician. Many doctors prefer yearly pap smears. However, current recommendations are as follows: The first Pap smear is recommended when a woman turns 21. From the ages of 21 through 29, a patient should have a Pap every year. Women ages 30 through 65 should have a Pap smear every one to three years, or an HPV test every five years. Women who have never had dysplasia or abnormal cells in the cervix can have both the Pap and HPV screening tests every three to five years, performed concurrently. Needing a Pap smear or HPV test over the age of 65 is relatively uncommon. Women in this age group should speak to their gynecologist to see if cervical cancer screening is still a requirement. Women who have had a hysterectomy and who have had their cervix removed do not need either the Pap or HPV screening.

How Do I Prepare for a Pap Test?

When you call for your annual gynecological exam, ask if you should also have a Pap smear, depending on your age and medical history. The Pap test doesn’t require much preparation, but there are a few things to keep in mind. Try to schedule the test during a time of the month where you will not be menstruating. Many doctors will want to reschedule if a patient is menstruating because this can affect the results of the test and renders it less effective. The day before and immediately before the test, refrain from sexual activity or using spermicides, as this can also interfere with the results. 

If you are pregnant, it is okay to have a Pap smear up until the first 24 weeks of pregnancy. After 24 weeks, the test is not harmful to the fetus but could be painful for the patient. It is also important to not have a postpartum Pap for 12 weeks after giving birth. 

Pap Smear Results

The results of your Pap smear will either be normal or abnormal, but there’s much more behind that. If the test is normal or negative, that means that all of the cells in the cervix are normal and healthy, and it is not necessary to retest for three years in most cases. If the findings are positive or abnormal, this may mean several things. You will likely get a medical report in the mail outlining your results. Your gynecologist will also explain abnormal findings to you so you can proceed with the next steps. There are several types of abnormal results.

You may have an abnormal test from an infection unrelated to cervical cancer. Yeast infections, gonorrhea, chlamydia, or Trichomonas infections can cause an abnormal result. Your doctor should be able to identify the underlying cause of the abnormal result and treat you for the underlying problem. You should then have a new Pap smear in two to three months. Other types of abnormal results are related to the type of abnormal cells found, of which there are several:

  • ASC (atypical squamous cells). Squamous cells form on the surface of the cervix. However, atypical cells are divided into several subcategories:
  1. ASC-US (atypical squamous cells of undetermined significance). This is considered a mild abnormality and may not be related to HPV or cervical cancer.
  2. ASC-H (atypical squamous cells cannot exclude a high-grade squamous intraepithelial lesion). These cells are also undeterminable but have a higher risk of being precancerous cells. 
  • AIS (endocervical adenocarcinoma in situ). These are precancerous cells found in the glandular tissue of the cervix.
  • LSIL (low-grade squamous intraepithelial lesion). These types of cells are indicative of a low-grade HPV infection. The term lesion refers to an area of tissue that is abnormal.
  • HSIL (high-grade squamous intraepithelial lesion). This is indicative of a high-grade HPV infection and may likely lead to cervical cancer.
  • AGC (atypical glandular cells). These are abnormal glandular cells, but doctors are uncertain what the presence of atypical cells means. 
What is Cervical Cancer?

What If I Have an Abnormal Pap Smear?

A normal Pap smear requires no follow-up until it’s time for the next Pap test to be scheduled. However, an abnormal test result requires follow-up, depending on the type of cells found. Many times the gynecologist will schedule a test known as colposcopy. During this test, the doctor will use a lighted microscope known as a colposcope to look more intently at the cells in the cervix. This test is similar to a Pap smear, can be performed in the gynecological office, and can be performed during pregnancy. 

If the physician finds no new information, he or she will likely schedule a biopsy to take a small tissue sample from the cervix. This is the only accurate way to detect precancerous cells, cancer cells, or a healthy cervix. It is possible that the gynecologist can remove the abnormal tissue or precancerous cells during a biopsy. If cancer is discovered, the next course of treatment will be decided by a specialist. Cancer treatment often includes medication, chemotherapy, radiation, or a combination of treatments.  

If you need more information about Pap smear tests or need to schedule a yearly examination, schedule an appointment at The Woman’s Clinic. We have two office locations to better suit all of your gynecological and obstetric needs.

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