Pap Smear (Pap Test): What to Expect

Who needs a Pap smear?

The American Cancer Society recommend that screening should start at age 25. Some women may be at increased risk for cancer or infection. You may need more frequent tests if:

• you’re HIV-positive
• you have a weakened immune system from chemotherapy or an organ transplant

If you’re over 25 and have not had abnormal Pap tests, ask your doctor about having one every five years if the test is combined with a human papillomavirus (HPV) screening. Current guidelines recommend that people between the ages of 25 and 65 should have an HPV test every five years.

HPV is a virus that causes warts and increases the chance of cervical cancer. HPV types 16 and 18 are the primary causes of cervical cancer. If you have HPV, you may be at an increased risk of developing cervical cancer.

Women over the age of 65 with a history of normal Pap smear results may be able to stop having the test in the future.

You should still get regular Pap smears based on your age, regardless of your sexual activity status. That’s because the HPV virus can be dormant for years and then suddenly become active.

How often do you need a Pap smear?

How often you need a Pap smear is determined by various factors, including your age and risk.

These recommendations only apply to women who have a cervix. Women who have had a hysterectomy with removal of the cervix and no history of cervical cancer do not need screening.

Recommendations vary and should be individualized for women with compromised immune systems or a history of precancerous, or cancerous lesions.

How to prepare for a Pap smear

You can schedule a Pap smear with your annual gynecological examination or request a separate appointment with your gynecologist. Pap smears are covered by most insurance plans, though you may be required to pay a co-pay.

If you’ll be menstruating on the day of your Pap smear, your doctor may want to reschedule the test, since results could be less accurate.

Try to avoid having sexual intercourse, douching, or using spermicidal products the day before your test because these may interfere with your results.

In most cases, it’s safe to have a Pap smear in the first 24 weeks of a pregnancy. After that, the test may be more painful. You should also wait until 12 weeks after giving birth to increase the accuracy of your results.

Since Pap smears go more smoothly if your body is relaxed, it’s important to stay calm and take deep breaths during the procedure.

What happens during a Pap smear?

Pap smears can be a bit uncomfortable, but the test is very quick.

During the procedure, you’ll lie on your back on an examination table with your legs spread and your feet resting in supports called stirrups.

Your doctor will slowly insert a device called a speculum into your vagina. This device keeps the vaginal walls open and provides access to the cervix.

Your doctor will scrape a small sample of cells from your cervix. There are a few ways your doctor can take this sample:

• Some use a tool called a spatula.
• Some use a spatula and a brush.
• Others use a device called a cytobrush, which is a combination spatula and brush.

Most women feel a slight push and irritation during the brief scraping.

The sample of cells from your cervix will be preserved and sent to a lab to be tested for the presence of abnormal cells.

After the test, you might feel mild discomfort from the scraping or a bit of cramping. You could also experience very light vaginal bleeding immediately following the test. Tell your doctor if discomfort or bleeding continues after the day of the test.

What do the results of a Pap smear mean?

There are two possible results from a Pap smear: normal or abnormal.

Normal Pap smear

If your results are normal, that means that no abnormal cells were identified. Normal results are sometimes also referred to as negative. If your results are normal, you probably won’t need a Pap smear for another three years.

Abnormal Pap smear

If the test results are abnormal, this doesn’t mean you have cancer. It simply means that there are abnormal cells on your cervix, some of which could be precancerous. There are several levels of abnormal cells:

• atypia
• mild
• moderate
• severe dysplasia
• carcinoma in situ

Milder abnormal cells are more common than severe abnormalities.

Depending on what the test results show, your doctor may recommend:

• increasing the frequency of your Pap smears
• · getting a closer look at your cervical tissue with a procedure called colposcopy

During a colposcopy exam, your doctor will use light and magnification to see vaginal and cervical tissues more clearly. In some cases, they may also take a sample of your cervical tissue in a procedure called a biopsy.

How accurate are the results?

Pap tests are very accurate. Regular Pap screenings reduce cervical cancer rates and mortality by at least 80 percent. It can be uncomfortable, but the brief discomfort can help protect your health.

Does a Pap smear test for HPV?

The main purpose of a Pap smear test is to identify cellular changes in the cervix, which could be caused by HPV.

By detecting cervical cancer cells early with a Pap smear, treatment can start before it spreads and becomes a bigger concern. It’s also possible to test for HPV from the Pap smear specimen, too.

You can contract HPV from having sex with men or women. To lower your risk of contracting the virus, practice sex with a condom or other barrier method. All sexually active women are at risk for contracting HPV and should get a Pap smear at least every three years.

The test doesn’t detect other sexually transmitted infections (STIs). It can occasionally detect cell growth that indicates other cancers, but it shouldn’t be relied on for that purpose.