Diagnostics
Pap Smear
What is Pap Smear?
A Pap smear, or a Pap test, is a diagnostic test to detect cervical cancer. It involves examining cells from the cervix under a microscope to identify any abnormal cells that may be cancerous or have the potential to become cancerous. In addition to cervical cancer, a Pap smear can detect certain infections and inflammation. The test is named after Dr. George Papanicolaou, the American physician who developed it.
Who performs Pap smear?
A gynecologist specializing in diagnosing and treating diseases of the female reproductive system usually performs a Pap smear in the clinic or hospital, and it takes only a few minutes.
What is the cervix?
The cervix is the lower part of the uterus that connects to the vaginal canal. It allows sperm to travel from the vagina to the uterus for fertilization. During pregnancy, the cervix remains closed to keep the fetus inside the uterus. It opens during childbirth. When not pregnant, the cervix produces mucus to protect against infection-causing bacteria.
What can a Pap smear detect?
A Pap smear, performed as part of a pelvic exam, can detect several conditions, including:
- Cervical cancer: The primary purpose of a Pap smear is to screen for cervical cancer. It helps identify abnormal cells in the cervix that may be cancerous or potentially develop into cervical cancer.
- Precancerous changes: The test can also detect precancerous changes in the cells of the cervix, known as cervical intraepithelial neoplasia (CIN). These changes indicate an increased risk of developing cervical cancer if left untreated.
- Human papillomavirus (HPV) infection: A Pap smear can identify the presence of high-risk types of human papillomavirus (HPV), which is a common sexually transmitted infection (STI) known to increase the risk of cervical cancer.
How often does an individual need a Pap Smear?
How often the patient will have the test depends on many factors, including age, health history, and results from the last Pap or HPV test.
The American Cancer Society recommends that cervical cancer screening should begin at age 25.
Age | Pap Smear Frequency |
<21 years old | Not necessary |
21 to 29 years | Every three years |
30 to 65 years | Every three years or an HPV test every five years, or a Pap test and HPV test together every five years |
65 and older | Not necessary if there have been adequate prior screenings with normal results and the individual is not at high risk for cervical cancer. |
Pap smear procedure
Preparing for Pap smear
- Avoid vaginal intercourse for at least two days before the exam.
- Refrain from using tampons, vaginal creams or medicines, birth control foams or jellies, lubricants, or douches for at least two days before the test.
- Schedule an appointment at least five days after the end of menstrual period.
During the procedure
During the Pap smear procedure, the doctor will:
- Insert a speculum into the vagina: This metal or plastic tool gently opens the vagina, allowing visualization of the cervix. Some pressure may be experienced during this step.
- Collect cells from the cervix: Using a small brush or spatula, the doctor will carefully scrape or brush the surface of the cervix to obtain a sample of cells. While Pap smears are generally not painful, slight discomfort or sensitivity might be felt during cell collection. After the Pap smear, trained professionals examine the collected cells in a laboratory.
What do the Pap smear results indicate?
When Pap smear results are received, they can be categorized as follows:
- Normal: This means that no signs of disease or abnormalities were detected in the cells examined. It indicates that the cells appear healthy and typical.
- Inconclusive/Unclear: In some cases, the laboratory may find it challenging to determine whether the cells are normal or abnormal. This could be due to various factors, such as insufficient cell samples or other technical reasons. In such situations, the doctor may recommend a repeat Pap smear immediately or schedule another test in about six months to obtain a clearer result.
- Abnormal: If the Pap smear reveals that the cells appear different from what is considered normal, it is classified as abnormal. Abnormal results do not necessarily indicate cancer but suggest changes requiring further investigation and follow-up. Additional tests, such as colposcopy (it is a procedure in which a lighted, magnifying instrument called a colposcope is used to examine the cervix and vagina) or biopsy, may be recommended to evaluate the abnormal cells and determine the appropriate course of action.
References
- Cleveland Clinic. Pap Smear. Available from: https://my.clevelandclinic.org/health/diagnostics/4267-pap-smear
- Mayo Clinic. Pap smear. Available from: https://www.mayoclinic.org/tests-procedures/pap-smear/about/pac-20394841
