Pap smear

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A Pap smear, also called a Pap test or cervical smear, tests for abnormal cells in your cervix. Pap smears can also identify vaginal infections and inflammation. They’re mainly used to screen for cervical cancer.

For many decades, cervical cancer was the leading cause of cancer deaths for women in the United States. The incidence of cervical cancer has declined by 60 percent since Pap smears became available in the 1950s.

When cervical cancer is found early, there’s a far greater likelihood that it can be cured. Experts have established a schedule for when and how often you should have a Pap smear.

The U.S. Department of Health and Human Services, Office on Women’s Health has provided the following recommendations for women who have no known risks.

What if I’ve had a hysterectomy?

Ask your doctor if you need to continue having Pap smears. Usually, the tests can be stopped if your cervix was removed during your hysterectomy and you have no history of cervical cancer.

To increase the accuracy of your Pap smear, there are several things you should avoid doing for 48 hours before the test. They include:

  • having sex
  • douching
  • using tampons
  • using vaginal lubricants or medications
  • using vaginal sprays or powders

Also, you shouldn’t have a Pap smear when you’re on your period.

When you have a Pap smear, you’ll be asked to lie back on the examination table with your knees up. You’ll place your feet in stirrups located on each side of the table. You’ll need to scoot your bottom to the end of the table.

Your doctor will place a metal or plastic speculum in your vagina to hold it open. They’ll then use a swab to lightly scrape off some of the cells and mucus on your cervix.

Most women don’t experience pain during the test, but you may feel a slight pinching or pressure.

Your doctor will send your samples to a lab for evaluation under a microscope. Your doctor may also order a human papillomavirus (HPV) test. HPV tests are used for women ages 21 and older who’ve had abnormal Pap smear results and for women ages 30 and older.

The Pap smear is intended as a screening test that alerts the need for further examination. It’s considered a reliable test. A 2018 study showed that routine Pap smear screening detected 92 percent of the cervical cancer cases.

However, there are instances of false-negative and false-positive results, as outlined in a 2017 study.

Most Pap smear test results come back as normal. This means you’ve been given an all-clear and should continue to follow the recommended schedule for future tests. You may hear these results referred to as a “negative” test. That means that you’ve tested negative for abnormalities.

Unsatisfactory

Sometimes, Pap smear test results come back as unsatisfactory. This isn’t necessarily cause for alarm. It can mean several things, including:

  • not enough cervical cells were collected to perform an accurate test
  • cells couldn’t be evaluated because of blood or mucus
  • an error in administering the test

If your results are unsatisfactory, your doctor may want to repeat the test right away or have you return sooner than the normally scheduled retesting.

Abnormal

Getting results that your Pap smear is abnormal doesn’t necessarily mean you have cervical cancer. Instead, it means that some cells were different from other cells. Abnormal results usually fall into two categories:

  • Low-grade changes in your cervical cells often mean you have HPV.
  • High-grade changes can indicate that you’ve had an HPV infection for a longer period of time. They also can be precancerous or cancerous.

When changes occur in the structure of cells of your cervix, which is the lower part of the uterus that connects to your vagina, they’re considered precancerous. These precancers can usually be removed in your doctor’s office using liquid nitrogen, an electric current, or a laser beam.

In a small percentage of women, these precancers will begin to grow quickly or in large numbers, and form cancerous tumors. Untreated, the cancer can spread to other parts of the body.

Nearly all cervical cancer cases are caused by different types of HPV. HPV is transmitted through vaginal, oral, or anal sex.

HPV infection is very common.

It’s estimated that the likelihood of getting HPV at some point in life, if you have at least one sex partner, is more than 84 percent for women and 91 percent for men. You can be infected if you’ve only had one sex partner. You can have the infection for years without knowing it.

Although there’s no treatment for infections with the types of HPV that cause cervical cancer, they usually go away on their own, within one or two years.

We recommend that screening for cervical cancer should start at age 25 and people aged 25 to 65 should have a HPV test every 5 years.

Symptoms

Many women don’t have symptoms of cervical cancer, particularly pain, until it has progressed to a more advanced stage. Common symptoms include:

  • vaginal bleeding when you’re not on your period
  • heavy periods
  • unusual vaginal discharge, sometimes with a foul odor
  • painful sex
  • pelvic or back pain
  • pain when urinating

Certain factors put you at greater risk of getting cervical cancer. These include:

  • smoking
  • HIV
  • compromised immune system
  • having family members who were diagnosed with cervical cancer
  • your mother took the synthetic estrogen diethylstilbestrol (DES) while pregnant with you
  • being previously diagnosed with precancer or cancer of the cervix
  • having multiple sexual partners
  • being sexually active at an early age

In addition to Pap smears, there are other tests that are important for women to have.

Sources: Office of Women’s Health and Cleveland Clinic Health Guidelines for Women

Your doctor may recommend additional tests or other timelines, depending on your medical history. Always follow your doctor’s recommendations as they are the most familiar with your health needs.